People with low back pain show poor control and coordination of the spine muscles.¬†¬† Pain inhibits the function of muscles.¬† Inhibition often leads to atrophy (loss of muscle size) and abnormal movement. ¬†The lumbar multifidus plays an important role in restoring normal spine movement.¬† ¬†Those with low back pain exhibit atrophied multifidus muscles.¬† Lost muscle is replaced with deposits of fatty tissue.¬† Those with longstanding low back pain on only one side of the spine, show loss of multifidus muscle size and fatty infiltration on only the painful side of the back.
Rehabilitation exercises are prescribed to restore the control and coordination of the smaller low back muscles. ¬†Basic exercises are initially used to target the lumbar multifidus and other deep muscles of the back.¬† It is important that these exercises are performed in a slow and controlled fashion.¬† Normal breathing patterns should be maintained.¬† Generally, higher repetitions (10 to 20) are performed in order to promote muscle endurance.¬† This is consistent with how these muscles function in everyday life.¬†¬† Below are 5 exercises most people can get started with.
Lumbar Multifidus Activation
Begin on all fours with one knee placed on a small pillow, towel roll, or foam pad.¬† The shoulders are positioned over the hands and hips over the knees.¬† The spine is maintained in a neutral position.¬† Slowly lift the knee which is not supported on the foam pad.¬† The thigh and hip should move straight up.¬† This induces a small amount of rotation which is controlled by the multifidus.¬† Hold the up position for 2 to 3 seconds then slowly lower the knee back to the floor.¬† The foot stays in contact with the floor during the exercise.¬† To progress the exercise, elevate the foot with the knee or increase the hold time to 10 seconds.¬† Perform 10 to 20 repetitions on each side.
Begin by lying on your back with the hips flexed and the feet lined up with the shoulders.¬† Perform the bridge by lifting both hips from the floor.¬† A common mistake is to excessively arch the low back.¬† Hold the bridge position for 2 to 3 seconds then return to the starting position.¬† Lower the body back down in a slow and controlled manner.¬† Perform 10 to 20 repetitions for multiple sets.
Be sure to achieve the bridge position by extending through the hips.¬† If you lack mobility in your hip joints or hip flexor muscles this may lead to compensation through the low back.¬† This can be corrected with manual therapy and mobility exercises.¬† You can also try bringing your fleet slightly closer together and the knees slightly wider apart.¬† This will allow you to achieve greater hip extension range of motion.
Bridge + March
Perform a standard bridge and hold the top position.¬† With the hips elevated from the floor, lift one foot 2 to 3 inches from the floor.¬† Hold the foot off the floor for 2 to 3 seconds before lowering.¬† Without lowering the hips down to the floor, lift the other foot in the same fashion.¬† Lower the hips back down to the floor to complete the first repetition.¬† Maintain a level pelvis as one foot is lifted from the floor.¬† This requires activation of the glutes, hamstrings, and low back muscles. ¬† Perform 10 to 12 repetitions on each side for multiple sets.
Begin on the hands and knees with the back flat.¬†¬† The shoulders are directly over the hands and hips directly over the knees.¬† Slowly raise the left arm and right leg until horizontal with the trunk.¬† Maintain a straight line with the trunk, upper extremity, and lower extremity.¬† It is important to avoid trunk rotation and not allow the back to sag or arch.¬† Hold this position for 2 to 3 seconds.¬† Then repeat with the right arm & left leg, alternating sides with each repetition.¬† To increase the challenges of the exercise extend the hold time to 10 seconds. Perform 10 to 12 repetitions on each side for multiple sets.
Modified Side Plank
Lie on the side, with the knees comfortably bent.¬† Prop up on the elbow bearing weight through the forearm.¬†¬† Next, lift the pelvis up from the surface so the only contact remaining on the surface is through the forearm and lower leg.¬† Do not go beyond the neutral position (the body is in a straight line) and do not allow your body to rotate forward or backward.¬† Hold this position for 2 to 3 seconds, and then gently relax down to the starting position.¬† To increase the challenges of the exercise extend the hold time to 10 seconds.¬† Perform 10 to 12 repetitions on each side.
Low back exercises often target the lower abdominals, hips, and pelvic muscles.¬† Some refer to this as the ‚Äúcore‚ÄĚ.¬† However, it is important to realize that alleviating or preventing low back pain requires an exercise program beyond simply training the core.¬† Once basic low back and abdominal exercises can be performed correctly, progression is needed.¬† Exercises which integrate the smaller and larger muscles of the trunk with the extremities (advanced core exercises) are used to restore full function.¬† ¬†These exercises are developed on an individual basis with consideration for the goals, preferences, and activity levels of the individual.¬† A physical therapist can determine the best approach for you.