Back pain effects everyone, whether directly or indirectly. It is the product of our Sitting Culture. We sit at work, when we travel around, when we “relax” at home. Some of us sit more than we move in a day . . . and, get this: our bodies aren’t designed for prolonged sitting. The pelvis is not made to bear all that pressure and weight alone.
In an international study, it was found that the people with the healthiest backs in the world were Laotian rice farmers (whoda thought?) These farmers spent all day bending down, bending over and never did they sit. Time to eat? These farmer’s simply stood or squatted. They don’t own chairs . . . and they have the lowest incidence of back pain and back injury.
So, you can terrace the backyard and spend the remainder of your days tending your rice fields . . . and squatting during all meals . . . or, you can get a bit proactive and offset the Ways of the Sitting Culture.
Since throwing out all our chairs and standing during rush hour traffic just isn’t a possibility, the answer to keeping back pain at bay is to be found in some simple exercises and stretches. No need to go crazy and spend hours and hours on this, just 10-15 minutes a day will make massive improvements. Who knows, you may increase your exercises/stretches because you love them so much . . . it has been know to happen.
Exercises to Stretch the Back & the Legs:
These back exercises should be performed in a pain free manner. If pain is experienced, it is best to discontinue the exercises and consider being evaluated by a licensed physical therapist that specializes in treatment of the spine. If one already has low back pain or other health condition, it is advisable to first be evaluated by a physician and, as appropriate, receive guidance on how to do the following exercises by a spine specialist. Legalese out of the way . . . start with The Piriformis Stretch:
Piriformis Muscle Stretching Exercise
The piriformis muscle runs from the back of the femur (thigh bone) to the sacrum (base of the spine). Tightness in this muscle has
been linked to sacroiliac joint dysfunction and even sciatica-type pain along the sciatic nerve. To stretch the piriformis, lie on your back and cross the involved leg over the other. With both knees bent, place both hands together under the knee of the other leg (the lower leg), and gently pull the bottom leg toward your chest and hold both thighs closely until a stretch is felt in the buttock area. Breath into the tight area . . . there should be no pain.
- Hold 30 seconds
- Repeat
- 1-2 times per day
Psoas Major Muscle Stretching Exercise
The Psoas Major muscle attaches to the front portion of the lower spine and can greatly limit low back mobility when tight. It often is one of the sources of low back pain in patients who have difficulty standing for extended periods or kneeling on both knees. This
muscle can be stretched in a half kneeling position (kneeling on one knee). Rotate the leg outward and tighten the gluteal muscles on the side you’re stretching. Next, lean forward through the hip joint rather then bending through the lumbar spine. A stretch should be felt in the front of the hip that the patient is kneeling on.
- Hold 30 seconds
- Repeat
- 1-2 times per day
Hamstring Muscle Stretching Exercise
The hamstrings run from the back of the pelvic bone to just below the back of the knee. They are responsible for bending the knee
and assisting the gluteal muscles to extend the hip. These muscles are very important to stretch because, when tight, they make it nearly impossible to sit up straight. People who do not sit with an erect posture run the risk of early onset of degenerative disc disease and neck pain. Tight hamstring muscles are also associated with low back pain. One way to gently stretch hamstring muscles is to lie on the back and grasp the leg behind the knee with the hip flexed to 90 degrees and the knee bent. Attempt to straighten the knee with the toes pointed back toward you.
- Hold 30 seconds
- Repeat
- 1-2 times per day
Strengthening Exercises for Low Back Pain Relief
The next few exercises are examples of some basic stabilization exercises that aid in low back pain relief. Having strong midline support is critical to decreasing the stresses placed upon the lumbar spine (lower back) and pelvis. It should be noted, however, that often muscles that appear to be weak may actually be inhibited by an antagonist muscle (muscle on the opposite side of the joint) or by faulty lumbar facet joint mechanics.
Generally, an inhibited muscle will not respond to resistance training. Therefore, if low back pain or hip pain is being experienced, it is important to first see a spine therapist in order to screen for muscle inhibition. Attempting to strengthen an inhibited muscle may cause a substitution pattern that only reinforces a painful movement pattern. In general, it is advisable to see a spine specialist who specializes in back pain prior to beginning any exercise program.
In addition, unlike stretching exercises, it is important to take a few days off per week from strengthening exercises to allow the body to rest and build strong muscles. A licensed physical therapist can help design a strengthening exercise program to fit an individual’s specific needs and help with pain relief. In general, a spinal stabilization exercise program usually includes strengthening the abdominal muscles in the front and the gluteal muscles in the back.
Transversus Abdominis Muscle Strengthening (Abdominal Exercise)
Many people think of performing abdominal crunches or situps to strengthen the abdominal muscles. While “six pack abs” look nice to some, it is more important to work the Transversus Abdominis (TVA) through abdominal exercise to achieve spinal stability. When retraining the TVA, it is important to maintain a neutral lumbar spine (don’t try pushing the back all the way into the floor). The back is most often in a neutral spine position, so it makes less sense to strengthen the back in a flexed or extended position.
Lie on one’s back with the knees bent. Knees and feet should be shoulder width apart. Draw the belly button toward the spine while
maintaining a neutral spine. Upon exhalation, reach toward the ceiling as if trying to grab a trapeze overhead. Then raise the head and shoulders off the floor, just to the point where the shoulder blades are barely touching the floor, and hold 1-2 seconds. Inhale upon return and repeat at the end of the next exhalation. Continue until it is not possible to maintain a neutral spine or when fatigued.See Figure 4.
- Hold 1-2 seconds
- Repeat until fatigued
- 1 time per day
- 4-5 days per week
Gluteus Maximus Muscle Strengthening (Buttock Exercise)
To strengthen this muscle, lie on the stomach with the hips and legs off the end of a table or bench. Tighten the buttock on one side and extend the leg up toward the ceiling while maintaining a neutral spine. Movements should be slow. Initially, it is common to only be able to perform a few repetitions at a time.
- Hold 5 seconds
- 4-10 repetitions per side
- 1 time per day
- 4-5 days per week
Gluteus Medius Muscle Strengthening (Hip Abductor Exercise)
This muscle (the hip abductor) is used to raise the leg laterally at the hip and also supports the pelvis when standing on one leg (single leg stance). If this muscle is weak or inhibited, the opposite pelvis will drop when single leg stance is performed. Functionally, single leg stance is performed whenever someone walks. A weak gluteus medius will result in the opposite hip dropping during the gait cycle and can cause an increase in low back pain and hip pain with walking.
To strengthen the gluteus medius, lie on one’s side with the back against the wall. Draw the belly button in while maintaining a neutral spine. Raise the upper leg with the toes slightly pointed toward the ceiling and the heel maintaining contact with the wall. Perform slowly with a 2 second hold at the top.
- 10 repetitions per side
- 1 time per day
- 4-5 days per week
This bring up the million dollar question: where is that threshold? Well, it is completely different for each and every person. And it changes based on the time of day. It differs every day, every month, every season and every year. As you age it changes. As your mood changes this threshold re-calibrates. The food you eat and the thoughts you think will make that ever-moving target bandy about. Yes, I said “bandy about.”
