by Jonathan Blood Smyth
The reasons and aims of doing routine lumbar spinal exercises have been explored in a previous article and now I explore the use of specific lumbar exercises and give an indication of how they should be performed. Performing the exercises carefully and smoothly with steady timing is the aim, holding at the end of joint range for a few seconds. An acceptable amount of pain is difficult to determine, but some pain during the performance should be accepted if it does not last for more than 15-20 minutes and is not too severe. Self management of low back pain involves repeated performance of lumbar exercises daily.
Pulling one leg to the chest Lying down on the bed, get hold of one knee and pull it up towards the chest, holding it at the full bend for a short time. Keep the other leg flat down. This exercise mobilises and stretches the sacroiliac, hip and low back joints, muscles and ligaments.
Pulling both knees to the chest Lying down, hold on to both knees and pull them up as far as you can or until the thighs hit the chest. Stretching the sacroiliac joints is less effective with this exercise but it places increased stretching force on the lumbar spine.
The Child Pose Stretch Kneeling forward in a crouch so the knees are fully bent then lean your body forward so the abdomen lies forward on the thighs and stretches the back. The bodyweight increases the stretch on the spine.
Full Squats Because the bodyweight is used to stretch out the low back structures in this movement the effect is mechanically more severe and should be done only on advice from a professional therapist or after the easier exercises have already been performed. Advice is typically to perform extension movements after an prolonged time of sitting but end range flexion can also be useful to flex the lowest spinal segments.
Squatting down fully into the deep squat position is the aim of this movement, with a raise used under the heel if balance is difficult to maintain.
Stretching out at the bottom of the movement, the back is kept in this position for half a minute or so at a time.
Lying Prone If lumbar extension, the ability to arch the spine, is restricted then the first movement might be to lie the person prone as an initial exercise. This places the lumbar discs and joints in a significant degree of extension and can be the first step if extension is very limited.
Lying Prone with Elbow Support In this exercise the person is lying on their front and gets up onto their forearms as if they are on a beach and looking out to sea. The lumbar joints are pushed further into extension in this exercise, which should not be kept up for longer than 30 seconds at a time to avoid overstressing the back at any one time.
Repeated Extension in Lying (REIL) This is part of the McKenzie technique of treatment and is mainly aimed at disc derangement or dysfunction. The patient lies on their front with their hands around shoulder level, pushing up to straighten the arms whilst allowing the hips to remain on the bed. This arches the lumbar spine significantly.
Being a strong passive movement into extension this movement can be aggravating to a back pain problem so needs careful testing to ensure the correct response before prescription.
Knee rolling for lumbar rotation In supine the knees are bent up with the feet flat on the bed and the knees kept together as they are rolled to each side, allowing as much range of movement as the joints are comfortable with. The lumbar joints have little rotation range but soft tissues structures may be tight and respond to stretching.
Lumbar Rotations ” Manipulation Stretch Lying on the back, the hip is bent up so the person can hold the knee with the opposite hand. Leaving the shoulders flat on the bed, the knee is pulled across the body by the opposite hand, stretching the low back. The knee can be pulled right over for a large lumbar stretch but preparatory work would be wise for most people.
About the Author:
Jonathan Blood Smyth is a Superintendent
Physiotherapist at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for
physiotherapists in Leeds.
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