Lower back pain is extremely common in recent times, with a significant increase in remote desk based work in the last five years. A combination of a poor ergonomic set-up and increased frequency of sitting down create substantial weakness in the muscles supporting the spine. This consequently has an impact on the spinal vertebrae and intervertebral discs during daily activity. Simple tasks such as standing, sitting upright and bending can become increasingly painful and debilitating.
To combat this, the body’s trunk requires sufficient strengthening to compensate for the stresses it is required to undergo daily.
EARLY STAGE EXERCISES
Lumbar Extension
Level 1: Start by lying on your front, with your elbows under your shoulders. Push up through the forearms to lift the chest and extend the trunk. Hold this position for 10 seconds. Slowly lower your chest back to the floor. Repeat 5-10 times.
Level 2: Start by lying on your front, with your elbows under your shoulders. Flatten the palms of your hands to the floor. Push up through the hands, straightening the elbows and lifting the chest from the floor, extending the trunk. Hold for 10 seconds. Slowly lower your chest back to the floor. Repeat 5-10 times.
Level 3: Start by lying on your front, place your wrists under your shoulders. Push up through the hands, straightening the elbows and lifting the chest from the floor. Extend the trunk. Hold for 10 seconds. Slowly lower your chest back to the floor. Repeat 5-10 times.
Lumbar Flexion
Level 1: Start by lying on your back on a comfortable surface. Bring both knees to your chest, using your arms to hold the knees close to the chest. Hold for 15-30 seconds. Repeat 2-3 times.
Level 2: Start by standing in front of a waist height surface, e.g. kitchen counter or dining room table. Place both forearms on the surface and step backwards, leaning forward at the hips. Bend forward to a comfortable position and hold for 20-30 seconds. Walk back towards the surface and return to an upright position. Repeat 2-3 times.
Lumbar Rotation
Level 1: Start lying flat on a comfortable surface. Bend the knees and both feet flat on the surface. Allow both knees to slowly drop to one side, keeping the shoulders and upper back flat to the surface. Hold this position for 15 seconds. Bring both knees back to centre with the feet flat on the surface. Drop the knees to the opposite side and hold for 15 seconds. Repeat 5-10 times.
Level 2: Start lying flat on a comfortable surface with the legs out straight. Bend one knee with the foot flat against the surface. Bring the bent leg across the body to rotate the lower back. Keep the shoulders and upper back flat against the surface. Hold this position for 20-30 seconds. Repeat 5-10 times.
Pelvic Tilt with Abdominal Engagement
Start by lying flat on a comfortable surface. Find the bony point at the front of the hips with two fingers on either side of the pelvis. Use the two fingers to press into the abdomen approx. 1 inch above the bony prominences. When squeezing the abdomen, you should feel two small muscles engage under the fingers. Keep your fingers on these points and tilt the pelvis backwards to flatten the lower back to the surface. Engage the core, feeling the two small muscles under the fingers engage. Hold this squeeze for 10 seconds. Relax. Repeat 5-10 times.
MID STAGE EXERCISES
Birddog
Level 1: Start on all fours. The knees should be directly below the hips and the wrists directly below the shoulders. Squeeze the core and raise one arm out in front of you. Hold for 5 seconds and lower the hand back to the floor. Repeat on the other side. Repeat 10-15 times.
Level 2: Start on all fours. The knees should be directly below the hips and the wrists directly below the shoulders. Squeeze the core and raise one leg out behind you. Hold for 5 seconds and lower the knee back to the floor. Repeat on the other side. Repeat 10-15 times.
Level 3: Start on all fours. The knees should be directly below the hips and the wrists directly below the shoulders. Squeeze the core and raise one arm out in front of you and the opposite leg out behind you. Hold for 5 seconds, keeping the back flat and your core engaged. Lower the hand and opposite knee back to the starting position. Repeat with the opposite arm and leg. Repeat 10-15 times.
Gluteal Bridge
Start by lying flat on a comfortable surface. Bend the knees so the feet are flat on the surface, with the heels below the knees. Tilt the pelvis backwards so the back is flat against the surface and engage the core. Push through the heels to lift the hips from the floor. Hold for 10 seconds before lowering the hips back to the floor. Repeat 5-10 times.
Standing Rotation (With Light Weight):
Start in an upright position with the feet approximately hip width apart. Hold a small weight (1/2 – 1 kg) at chest level with both hands and the arms outstretched. Engage the core. Slowly rotate at the trunk from left to right, keeping the feet flat on the floor. Repeat 10-15 times.
Heel Touches in Lying
Start by lying on a comfortable surface with the knees bent and the feet flat on the surface. Tilt the pelvis backwards so the back is flat against the surface and engage the core. Keeping the back flat, reach down on one side to touch the fingertips to the heel of the respective side. Straighten back up and reach down to the opposite heel with the respective hand. Repeat 10-15 times.
LATE STAGE EXERCISES
Deadbug
Start by lying on a comfortable surface, tilt the pelvis backwards so the back is flat against the surface and engage the core. Lift the arms straight out in front of the face at shoulder level and the knees up above the hips. Slowly lower one arm and the opposite leg down towards the floor, stopping with them approximately one inch above the surface. Hold for 1-3 seconds before bringing them back to the starting position. Repeat with the opposite arm and leg. Repeat 10-15 times. Ensure the core stays engaged.
Boat Hold
Start by sitting on the floor with the legs out straight in front of you. Engage your core and rock back on your tailbone, lifting the legs approx. 45 degrees from the floor and holding this position. The arms can be crossed over the chest or straight at the sides of the elevated legs. Hold this position for 20-60 seconds. Repeat 2-3 times.
Single Leg Gluteal Bridge
Start by lying flat on a comfortable surface. Bend the knees so the feet are flat on the surface, with the heels below the knees. Tilt the pelvis backwards so the back is flat against the surface and engage the core. Straighten one leg and push through the heel of the other to lift the hips from the floor. The other leg should remain straight and outstretched. Hold for 2-3 seconds ensuring the hips do not tip to either side. Lower the hips back to the floor. Repeat 65-10 times on either side.
FURTHER PROGRESSION
Isometric Lumbar Extension
This exercise is to be completed using a hyperextension bench. Starting with the hip pad directly against the bony prominences on either side of the pelvis. From a bent forward position, push the hips against the pad to extend through the trunk and straighten the back. Maintain this hold when the back is completely straight. Hold for 30-60 seconds. Repeat 3-6 times. This exercise can be progressed using weight.
Good Mornings
This exercise is completed using a barbell – a Smith Machine is recommended if accessible. Start in standing with the bar rested comfortably across the shoulders. The feet should be hip width apart. Brace the core and push the hips back. The trunk and core should remain engaged with the back straight. Remember – the bend is coming from the backwards movement of the hips as opposed to a bend in the back. Push back as far as the hips allow and then straighten back up. Repeat 10-12 times. This can be progressed with weight.
Russian Twists
Start by sitting on the floor with the knees bent. Engage the core and rock back onto your tailbone, lifting the feet approx 3-4 inches from the ground. Maintain this position. Slowly rotate from one side to the other whilst keeping the core engaged. Repeat for 1 minute. This can be progressed with weight.
