Strength Training Eases Back Pain

Is avoiding strength training with weights best for your low back pain?  Many people believe they should not lift weights because of their chronic aching back.  This belief is unhelpful and can perpetuate your back pain. Strength training is a safe and effective way to decrease your persistent back pain.  This article addresses how you can structure your strength training program for the best results.

Strength Training Proven to Decrease Back Pain 

Multiple studies prove the benefits of strength training for people with persistent low back pain.  A 2014 study conducted at the University of Florida separated 49 individuals with back pain into 1 of 3 groups.  One group performed low back muscle exercises.  The second group performed a total body strength training program.  The third group performed no exercise.  After 4 months both exercise groups showed large improvements in back pain.  Disability in the total body strength training group decreased the most.

Lower back pain

Another study out of Sweden showed similar benefits.  In this study lumbar stabilization exercises were compared to heavy strength training.  The heavy strength training program consisted of only the dead lift exercise.  Pain, disability, and quality of life showed significant improvements in both groups.  These studies prove strength training with weights is at least as effective as traditional low back-specific exercises.

The 5 Basic Movement Patterns to Manage Back Pain

Designing your strength training program does not have to be complicated.  The best programs incorporate all major muscle groups of the body.  More importantly, the 5 basic patterns of movement are included.  These are the squat, hinge, push, pull, and carry.  We will discuss each of these movement patterns as they relate to low backpain in greater detail.  For recommendations about sets, reps, frequency, and the amount of weight to use, go here (Preventing Muscle Loss).

1. Squat

The squat wrongfully gets a bad rap.  Squatting is not harmful for your low back.  Squatting is a fundamental movement pattern that you repeatedly perform during each day.  There are many squat exercise variations available.  The leg press is a basic squat pattern performed with a machine.  This is a nice option for people with back pain because the spine is supported.  The barbell back squat is a more technically challenging exercise.  There are many variations in between.

The goblet squat is an excellent option because it helps reinforce proper squatting mechanics.  The basics of the squat include keeping the chest up, back straight, and knees out.  You also want to “sit back” into the squat as if you were sitting into a chair.  When performed properly, the squat is arguably the best total body exercise.

2. Hinge

The hinge pattern involves flexing your hips with your spine in a neutral position.  The dead lift and all its variations are the classic hinge exercises.  These exercises strengthen your backside.  This includes your hamstrings, glutes, and low back muscles.  Unfortunately, many people are unable to properly perform the hinge pattern.  Improper form combined with heavy loads often leads to injury.  Get help from your physical therapist if you are having difficulty.  The Romanian dead lift (RDL) is mastered before progressing to any type of conventional dead lift.

3. Push

Push exercises include the bench press and military press. It also includes the push-up and all its variations.  These exercises strengthen your shoulders, chest, and arms.  To get the best total body benefit, we recommend the landmine press.  The landmine press is performed in a standing position.  This activates your lower body, core, and upper body muscles.  It is also less stressful on your shoulder joints.

4. Pull

Pull exercises include the row, pull-up, and lat pull-down.  These exercises strengthen your upper back muscles, shoulders, and arms.  Similar to pressing movements, we recommend standing or weight bearing exercises with free weights in place of seated machine-based exercises.  This activates your lower body, core, and upper body muscles in a more functional way.  Rows can be performed in many different fashions.  Be sure to include at least one row exercise in your program.

5. Carry

Loaded carries are often neglected in strength training programs.  However, carrying heavy objects is a natural part of our lives.  Your body should be prepared for this; especially if you have a history of back pain.  There really is no better core exercise than the loaded carry.

When first starting out, incorporate the 2-arm farmers carry with kettlebells or dumbbells.  Begin with 20% of your body weight in each hand.  Over time, perform the farmer’s carry with at least 50% of your body weight in each hand.  The length of your carry should be at least 25 feet and back.  With heavier loads, walk shorter distances.  And if using lighter loads, walk a little further.

Total Body Strength Training for Your Back Pain

If you have been dealing with back pain for many months or even years, strength training can help.  It is important to start small.  Choose one exercise from each of the 5 fundamental movement patterns described here.  It is fine to start with 5 exercises performed 2 to 3 days per week.  Keep the weights light until you master the movement pattern and gain confidence.  If you need help, call your physical therapist.  We are here to help you move and exercise without pain.

Stabilization Exercises for Back Pain

Is your usual response to back pain to take it easy and rest? Using hot packs, ice, or any topical cream certainly helps the body relax.  This has its benefits.  However, excessive rest is not best for managing your back pain.  The key is balance.  Don’t overdo it while you are experiencing pain.  But equally important is to keep your body moving.  This gives your body the best chance of healing physically, mentally, and emotionally.  Lumbar stabilization exercises are one of your best options you have to overcome your back pain.

What are Lumbar Stabilization Exercises?

People with low back pain show weakness and poor coordination of their deep spinal muscles.  This is especially true in people with longstanding persistent pain.  In these instances, the small deep muscles that support your spine atrophy.  Poor function and weakness of these muscles are also present in people with a new onset of back pain.  This can begin within a few days of experiencing pain.

Bird Dog

Stabilization exercises retrain these key muscles.  More importantly, stabilization exercises retrain how you move.  This involves both your muscles and brain.  As confidence in your ability to move without harming yourself improves, your body returns to its normal physical, mental, and emotional state.  In essence, stabilization exercises have little to do with absolute strength.  Instead, these exercises retrain your brain to perform smooth and precise movement.  As movement improves, your pain decreases.

Research Proves Lumbar Stabilization Exercises Help

A 2016 review of the published research on stabilization exercise suggests these exercises are most beneficial for people with chronic or ongoing back pain.  This review looked at 29 different studies including more than 2,000 people with back pain for more than 12 weeks.

Compared to no or minimal treatment, these exercises are effective at reducing pain and disability in the short and long-term.  Stabilization exercises are also more effective than exercise combined with electrical stimulation or other modalities like hot or cold therapy.  When compared to other types of exercise programs and manual physical therapy, the benefits are similar.

Exercises for a New Onset of Back Pain

Stabilization exercise, also known as motor control exercise, begins within a day or two of the onset of your back pain.  They key is to begin with basic exercises that are comfortable for you to perform. The goal is to relax overactive muscles (muscle spasm) and begin to activate the smaller deeper muscles.

These exercises are typically performed lying on your back with your knees bent.  Exercises performed on your hands and knees are also encouraged early on.  However, they can begin in any position that is comfortable for you.  Quality and control of movement is emphasized over the quantity of repetitions.  Abdominal bracing and lumbar multifidus exercises are often the first progressions.  Go here and here for more examples.

Exercises for Persistent Back Pain

People with ongoing or recurrent back will require greater challenges to retrain the core muscles and their movement patterns.  The lower abdominal muscles and the small lumbar multifidus are important to target.  The key is to perform increasingly challenging movements without holding your breath or excessively tensing your body.

Stabilization exercises are progressed from supported positions lying down to functional weight bearing positions.  We start lying on the back then move to kneeling positions.  From kneeling we progress to standing. Progression is based on your ability to properly perform each movement.  Examples of a progression include the dead bug, kneeling chop, and standing Pallof press.  Go here for more examples.

The Best Lumbar Stabilization Exercises for You

The right lumbar stabilization exercises for you are based on your abilities and goals.  Your physical therapist performs an examination of your core muscle function and your movement patterns.  Exercises are then prescribed to appropriately challenge you.  Your exercise program must be progressed to achieve lasting results.  Performing the same exercises over and over again is insanity.  Give your physical therapist a call if you would like help setting up or progressing your exercise program.

Aerobic Exercise and Back Pain

Eight of every 10 people will experience low back pain at some point during their lifetime.  Most low back comes in waves.  Acute flare ups are interspersed with periods with of very little or no pain.  You can manage how often and how severe each episode is by performing regular exercise.  Many different types of exercise are beneficial for people with persistent back pain.  The overall health benefits of aerobic exercise are unquestionable.  However, you may be unsure how aerobic exercise can help your back pain.  This article discusses 3 types of aerobic exercise that can help you manage your back pain.

What is Aerobic Exercise?

By definition, aerobic exercise means “with oxygen.” It is typically performed at low to moderate intensities over an extended period of time.  Your breathing and heart rate will increase as you exercise. This helps keep your heart, lungs, and circulatory system healthy.  Aerobic exercise is any type of cardiovascular conditioning.  It can include activities like brisk walking, swimming, running, or cycling. You probably know it as “cardio.”

physical activity exercise guidelines

The American College of Sports Medicine (ACSM) and the Center for Disease Control (CDC) recommends adults engage in at least 150 minutes of moderate physical activity each week.  We usually recommend 30 minutes of aerobic exercise 5 days per week.  The 30 minutes each day can be broken up into 2 to 3 shorter sessions that total 30 minutes.  Not only will this improve your health and fitness, it will also help you manage your back pain.

Walking for Back Pain

The most commonly prescribed form of aerobic exercise for people with back pain is walking.  It is human nature to walk.  Yet, most of us spend an excessive amount of time sitting versus walking.  Sitting increases stress to the discs in our low back.  Walking helps nourish and strengthen the discs, joints, and muscles of the spine.

walking for low back pain

A 2015 study published in the journal Pain compared the benefits of 3 different exercise programs in adults with at least 12 weeks of back pain.  Participants performed a supervised walking program, group fitness classes, or supervised physical therapy.  After one year, all 3 groups showed large improvements in pain, disability, and their fear of movement.  The participants who performed the walking program showed the best adherence and this form of treatment was the least costly.

This study helps establish guidelines for starting your walking program.  You can begin your walking program with as little as three 10-minute walks per week.  Start small and slowly progress your walking distances.  It is helpful to use a step counter or tracker.  Keeping a diary or log will allow you to track your progress and stay motivated.   Your goal is to meet the 150 minutes per week recommended by the ACSM and CDC.  How you structure the program is ultimately up to you.

Cycling for Back Pain

Walking is not the most enjoyable form of exercise for everyone.  You may prefer cycling on the road, in doors, or in nature.  Just like walking, cycling is a proven form of exercise that helps people with persistent low back pain.  Older adults often prefer cycling but this form of exercise can be beneficial for people of all ages.

cycling for low back pain

A 2003 study published in the Archives of Physical Medicine and Rehabilitation showed benefits to cycling in older adults with persistent back pain.  Participants performed 12 weeks of cycling 3 times per week.  After 12 weeks, physical functioning, mental health, and pain levels improved by 8% to 14%.

Another larger study published in Spine compared stationary cycling to Pilates in adults of all ages with persistent back pain.  Pilates is another proven form of exercise for people with low back pain.  Stationary cycling included slower steady state intervals mixed with hills and sprints.  Both groups showed clinically meaningful improvements in pain and disability after 8 weeks.  Participants performing the Pilates exercise did slightly better.  However, these results show that cycling 150 minutes per week is a viable strategy for people with persistent low back pain.

Running and Back Pain

Running gets a bad rap in many regards.  Yes, running increases some stress to the structures of your spine.  However, this does not imply that running is harmful to your back.  In fact, some studies show running is associated with a reduced incidence of low back pain.

aerobic exercise back pain

A 2020 review of back pain in runners showed very low prevalence and incidence compared to the general population.  This suggests running may be protective against back pain.  Further research is needed to prove this claim.  However, this study does show heavier runners, taller runners, and runners with poor flexibility are at greater risk for developing low back pain.

If you have never run before and you are bothered by back pain, we do not suggest you start.  Instead, start with a walking, swimming, or cycling program,.  However, if you are an experienced runner with back pain, keep running.  The benefits far outweigh the risks in most instances.  You just might need to supplement your running with other forms of exercise such as resistance training, stretching, and core exercise.

Start Your Aerobic Exercise Today

The physical and mental health benefits of aerobic exercise are unquestionable.  And many forms of aerobic exercise have also been proven to be effective at decreasing back pain.  The specific type of aerobic exercise is less important than the amount, frequency, and consistency.  Choose the form of exercise that resonates most with you.  Aim for the guideline recommended total of 150 minutes per week.  You can achieve this spread out over 3 to 5 days or more per week.  Call your physical therapist if you need help getting started.

Pilates Exercise for Back Pain

Are you looking for the right type of exercise to help your aching back?  There are many kinds of exercise that are helpful for people with ongoing back pain.  However, there is no one universal form of exercise that is best for everyone.  Pilates is one form of exercise that is very beneficial for many people with persistent back pain.  Pilates is a form of mind-body exercise that strengthens your core while also improving posture and flexibility. This low-impact approach may be a good option for you if your back pain has been aggravated by other forms of exercise.

Pilates Basics

Pilates is based on 6 basic principles: centering, concentration, control, precision, fluidity, and diaphragmatic breathing.   Each exercise is performed with isometric contraction of the transversus abdominis, perineal, gluteal, and multifidus muscles during diaphragmatic breathing.  This is known as the “Powerhouse”.  Pilates exercise is adapted to your abilities.  Exercises are gradually increased in difficulty as you become more comfortable and confident.  Pilates is now being prescribed for many people with back pain who have failed other forms of exercise.

Pilates for Back Pain: A Proven Approach

A 2014 study published in the Physical Therapy Journal looked at the effects of the Pilates Method in people with low back pain for more than 3 months.  Half the participants performed mat-based Pilates and the other half performed equipment-based Pilates using the reformer.   Sessions were lead by a physical therapist who was also a certified Pilates instructor.  After 6 weeks, all participants reported less pain, improved disability, and less fear of movement.  Participants performing the equipment-based exercise reported slightly less disability than those performing mat-based exercise.   In conclusion, both types of Pilates exercise can help people with back pain.

Your “Powerhouse”

Pilates begins with activating your “powerhouse” or core.  This is the foundational exercise for the Pilates Method.  To practice, begin on your back with your hips and knees bent.  Place your hands on your abdomen.  Concentrate on each breath.  Breathing occurs slowly through the rising and lowering of your abdomen.  Next, gently pull your belly button in and down towards your pelvis.  This activates your transverse abdominis and pelvic floor muscles. Be sure to maintain your diaphragmatic breathing as you activate your ‘”powerhouse”.

Modified One Hundreds

Lay on your back with your knees bent and arms to your side.  First activate your “powerhouse”.  Next, raise your arms from the mat.  Slowly raise your head and then shoulders slightly off the mat.  Hold this position and perform 5 arm movements for each breath in and each breath out.  Then, lower yourself back down to the starting position.  Perform 4 to 10 controlled repetitions.  Each repetition includes 10 arm movements up and down (5 on the breath in and 5 on the breath out).  The goal is to perform 10 repetitions for a total of 100 arm movements.

One Leg Circle

Lay on your back with one knee bent and the other straight.  First activate your “powerhouse”. Next, raise your straight leg up until you feel a stretch in the back of your thigh.  Slowly perform 5 clockwise circles with your leg.  Then perform 5 counterclockwise circles.  Lower your leg back down to the starting position.  Repeat another repetition on the opposite side.  Perform 4 to 10 controlled repetitions.

One Leg Kick

Lay on your stomach.  First activate your “powerhouse”.  Then prop yourself up onto your elbows.  Next, bend one knee until you feel a stretch in the front of your thigh.  You can perform 1 or 2 controlled kicks with each leg.  Alternate legs while you maintain activation of your “powerhouse”.  Perform 4 to 10 controlled repetitions on each side.

Side Kick

Lay on one side your both legs straight.  Begin with your feet slightly in front of your body.  Activate your “powerhouse”.  Raise your top leg slightly.  With your knee straight and toes pointed up, raise your leg in front of you.  You can perform 1 or 2 controlled kicks in this position.  Next, move your leg behind you as your point your toes down.  Perform 4 to 10 controlled repetitions on each side.

How to Get Started with Pilates

If you have been struggling with back pain for a while, Pilates may be right for you.  As with any new exercise program it is best to have your physical therapist examine you before starting.  You can also visit a local certified Pilates instructor at Pyour Core or Black Sheep Studios. This way you can avoid any unnecessary increase in pain.  If you would like our help, call to schedule an appointment.  We want to help you move pain free.

McKenzie Exercises for Back Pain

McKenzie exercises are effective for reducing your back pain especially if it has been traveling down your leg.  People with back pain lasting more than 3 months are good candidates for McKenzie exercises.  Based on the latest research, the McKenzie Method of treating back pain is equally effective to other approaches.  This includes manual therapy and stabilization or strengthening exercise.  The key is to identify the right exercises for you to perform.  There is no one-size-fits-all approach for managing back pain.

What are McKenzie Exercises?

Actually there are no specific exercises which are unique to the McKenzie Method.  Robin McKenzie was a physical therapist from New Zealand who popularized his approach to assessing people with back pain.  His approach is more about how to assess a person with back pain, not special exercises.  The McKenzie Method of assessment and treatment is based on several key principles.  These are the principles your physical therapist utilizes when evaluating you on your first day.  Here is a very brief explanation of 3 of those principles:

  1. End-range movements. Exercises are performed through a full range of motion.  This may include exercising with some back pain.  The key is that each movement is performed through an increasing range of motion provided the appropriate response is occurring (see principle #3 below).
  2. Repeated movements. Once the correct exercise is identified, it is repeated often.  Multiple sets of 10 or more repetitions are performed several times per day.  Sometimes we recommend the exercise be performed every hour during the day. Most exercises are performed in and out of the range of movement instead of holding each stretch.
  3. Centralization. This refers to the location of pain you experience during and after the exercise.  In simple terms, you want your pain to decrease in your leg even if it increases in your back.  Pain traveling down your leg is a sign of a longer recovery.  You want the pain out of your leg as soon as possible.  Identifying the right exercise to alleviate your leg pain first is the responsibility of your physical therapist.

McKenzie exercises

Which Exercises are Right for You?

The 3 principles described above, help your physical therapist identify the right exercise approach for you.  The most important principle is that of centralization.  It is very important that your leg pain does not worsen during or immediately after performing your exercises.  Sometimes, your back pain gets a little worse as your leg pain gets better.  This is a sign of improvement.  However, if your back feels better and your leg feels worse, you are not on the right track.  Below are several common exercises we prescribe to help alleviate leg and back pain.

Flexion Exercises

If sitting or bending forward alleviates your pain, flexion exercises might be best for you.  Your physical therapist will conduct an examination to confirm whether or not these are the right exercises.  For flexion in sitting, position yourself close to the edge of chair.  Spread your knees apart.  Relax your back and slowly bend forward towards the floor.  Do not bounce or force the movement.  With each repetition, try to move closer and closer to the floor.  If you can touch the floor easily, try to reach behind you.  Remember, you do not want pain to increase or spread down your leg.  Perform 10 repetitions several times per day.

Extension Exercises

If walking or leaning backwards alleviates your pain, extension exercise might be best for you.  Your physical therapist will conduct an examination to confirm whether or not these are the right exercises.  The most effective extension exercise is performed in the lying position.  Your arms do all the work.  Your back remains relaxed.  With each repetition, try to move further and further.  Remember, you do not want pain to increase or spread down your leg.  Pain in your back is okay. Perform 10 repetitions several times per day.

Shift Correction Exercises

Scoliosis

If you look or feel crooked, you may have a lateral shift.  Usually, people shift their shoulders away from the side of their back pain.  It is important to correct any shift before commencing with extension or flexion exercises.  This can be tricky.  It typically requires careful examination by your physical therapist.  The standing side glide is one exercise that is effective for correcting a shifted posture.  Start very gently and remember you do not want pain traveling down your leg.  Start with 10 repetitions several times per day.

Keys to Success with McKenzie Exercises

If you are struggling with back and leg pain, try these exercises.  Do any of these exercises feel good?  More importantly, do any alleviate or decrease your leg pain.  If so, continue with them.  Any movement or exercise which causes pain to spread down your leg is not right for you.  It is best to have your physical therapist examine you before starting.  This way you can avoid any unnecessary increase in pain.  If you would like some help, call your physical therapist to schedule an appointment.  We are here to help you move pain free.

5 Simple Low Back Stretches

Low back pain is one of the most common reasons people visit their doctor.  It is also a common reason to miss work.  More than 80% of people will experience back pain at some point in their lifetime.  A large majority will recover well in a few weeks.  Only about 10% will experience ongoing or persistent back pain.  Whether you experience ongoing or intermittent back pain, doing the right back stretches will help.

Frustrated with Your Back Pain

The truth is, your back pain most likely comes in waves.  You may experience low back pain for a few weeks, and then you fully recover.  This cycle repeats over time. However, with each new episode the severity of your back pain usually worsens. The duration of each episode becomes longer as well.  It becomes harder and harder to recover.  You become frustrated.  Some people seek the elusive magic treatment to make all their back pain go away forever.  Not finding it only adds to your frustration.

Your back pain does not have to be debilitating.  And instead of your back pain controlling you, you can control your back pain.  Exercise is a proven way to decrease your chances of having low back pain.  It is also a proven way to treat your already painful back.  There are many different forms of exercise that are helpful.  These include strengthening exercise, stretching, yoga, Pilates, and aerobics. This article focuses on simple low back stretches you can do to prevent and treat your back pain.

Feel Better with Low Back Stretches

knee to chest

Exercise has a powerful protective effect on low back pain.  Exercise performed consistently over time will reduce your chances of experiencing back pain.  It will not totally eliminate your risk.  However, when you do experience an episode of back pain, you will recover easier and quicker.  Large studies show strengthening exercises are the best for reducing your chances of back pain.  However, stretching exercises are also proven to be helpful.  The best approach is to include both strengthening and stretching exercises in a regular program.

Low Back Stretches: The Right Stretches for You

Low back stretches should be simple and easy to perform anywhere.  We recommend daily stretching exercises each morning.  Stretching takes no more than 10-15 minutes.  This is a great way to start your day.  You will feel more flexible, awake, clear-minded, and energetic.  The 5 stretches that follow are only a few examples.  There are many more stretches you can do.  The key is to find the vital few that work best for you.  Some trial and error is needed.  If you need some help, contact your physical therapist.

Pelvic Tilt

The pelvic tilt is one of the most basic range of motion exercises you can do.  It helps improve mobility of each individual joint in your lumbar spine and pelvis. You start on your back with your knees bent.  Place your hands on your pelvis.  Gently tilt your pelvis towards your head.  At the same time flatten your low back into the floor or bed.  You will feel your abdominal muscles gently tighten.  This is a good thing.  Next, tilt your pelvis in the opposite direction.  Now your back will arch away from the floor or bed.  Start with small and slow movements.  If you experience pain in either direction, minimize how far you move at first.  Perform 10 to 20 slow repetitions each day.

Double Knees to Chest

Knee to chest exercises lead to flexion of your spine.  This opens up your joints and vertebrae.  Many people with spinal stenosis benefit from flexion exercises.   You start on your back with your knees bent.  Raise your feet off the floor and hug your knees to your chest.  Hold this position for 5 seconds.  Perform 10 to 20 repetitions each day.  Avoid holding your breath.  Do not continue this exercise if you experience pain running down your leg.  If this is the case, try the press up exercise below or contact your physical therapist for more guidance.

Lower Trunk Rotations

Most people really like this stretch.  It is relaxing and easy to perform.  You start on your back with your knees bent.  Keep your feet and knees together.  Gently rock your legs from one side to the other.  Your hips can come up but keep your shoulders flat on the floor.  Hold each stretch for 3 to 5 seconds.  Perform 10 to 20 repetitions to each side.   To increase the stretch, hold your feet up off the floor.  This also causes the stretch to move up a little higher into your thoracic spine.  It is also more challenging.

Press Ups

Press ups help many people with sciatica or pain from disc problems.  Start lying on your stomach with your hands in a push-up position.  Relax your hips and legs.  Push your upper body up from the floor.  Keep your low back relaxed.  Your arms should be doing all the work.  Hold this position for 2 to 3 seconds.  Exhale fully, and then return to the starting position.  Perform 10 stretches each day. Do not continue this exercise if you experience pain running down your leg.  If this is the case, try the knee to chest exercise above or contact your physical therapist for more guidance.

Child’s Pose

There are many different modifications and variations to this exercise.  Start on your hands and knees.  Sit back onto your heels with your hands out in front.  Relax your back and exhale.  Hold the stretch for at least 5 seconds. You can emphasize stretching one side of your  back by moving your hands to the opposite side.  Do whatever feels best.  Perform 10 stretches each day.

Begin Your Low Back Stretches Today

Feel good

Low back stretches are best if they become part of your daily routine.  The 5 stretches included here can be modified to meet your needs.  There are also many other stretches that have helped many thousands of people with back pain.  The keys are to find what works for you and be consistent with performing them.  Don’t wait for your back pain to get out of control.  Start stretching while you are feeling good.  Don’t you want to feel great, all the time?  If you need help getting started, contact your physical therapist.  We want to help you move without pain.

5 Yoga Poses for Persistent Back Pain

At least 80% of Americans will experience low back pain during their lifetime.  Most of these people will recover well in a few weeks.  However, approximately 1 in 10 people with back pain will develop persistent ongoing problems.  Exercise is one of the few proven treatments for people with persistent low back pain.  And no specific form of exercise has been shown to be clearly better than another.  Aerobic training, strengthening exercise, Pilates, and stretching exercises have all been proven to be effective.

Yoga is becoming an increasingly popular form of exercise across the world.  In a previous article, we discussed the benefits of Yoga for people with shoulder pain.  This article provides some background and 5 Yoga poses which we recommend for people with persistent low back pain.

Yoga is Proven Treatment for Back Pain

Research from a 2005 clinical trial shows yoga improves function and reduces low back pain.  Researchers from Washington State compared the effects of yoga, a generalized low back exercise program, and an educational booklet in 101 adults with longstanding back pain.  Both the general exercise group and those performing yoga experienced significant improvements in pain and function 3 and 6 months later.  Of note, 69% of those in the yoga group improved by at least 50% compared with 50% of those in the exercise group The Yoga program consisted of 12 group sessions lead by an instructor who incorporated 5 to 12 different poses.  Several of these poses are included in this article.

Some Background about Yoga

Yoga is a form of mind–body exercise which incorporates physical exercise with mental focus through breathing and meditation. The poses are designed to increase flexibility and strengthen your body in a controlled fashion as well as improve balance. These poses are performed standing, sitting, reclining, or inverted and may involve forward bends, backward bends, or twists. Breathing exercises link the postures together and help your mind focus.

Yoga for back pain

By combining the benefits of physical exercise with relaxation techniques, people with low back are able to exert themselves without flaring up their pain.  This can be challenging when starting any new exercise program so be sure to start slow and easy.  Select 1 or 2 of the poses below which you can perform comfortably before trying the others.

Tree Pose

This pose is much harder than it looks.  Start with your feet together and weight evenly distributed.  Bend your right knee, then reach down and grasp your right inner ankle. Use your hand to draw your right foot alongside your inner left thigh.  Stand tall with a long spine.  Press your palms together in prayer position at your chest, with your thumbs resting on your sternum.  Fix your gaze straight ahead.  Inhale as you extend your arms overhead, reaching your fingertips to the sky.  Return your palms together then lower back to the prayer position at your chest.

Perform the movement 3 times each with a slow deep breath.  Repeat the same sequence of movements standing on your right leg.  Tree pose helps improve balance and control of your core.  It achieves these goals while placing very little stress on your spine.

Warrior 1

Start with your feet together.  Step with your left foot forward bending your knee into a lunge. Keep your right leg straight behind you. Raise your arms straight above your head.  Squeeze your shoulder blades together and downward.  Lift your chin to gaze at your hands overhead. Hold your pose for 3 to 5 slow breaths and then repeat on the left side.  Warrior 1 helps improve balance, leg strength, and hip mobility.

Warrior 2

Stand in a wide position with your feet parallel and approximately 3 feet apart. Extend your arms straight out to your sides. Relax your shoulders.  Turn your left foot out 90 degrees.  Bend your knee into a lunge.  Be sure to keep your knee above your ankle and pointing over your toes. Turn your head to the left and look over your fingers.  Hold your pose for 3 to 5 slow breaths and then repeat to the other side.

Airplane

Start in a balanced tall standing position.  Lean forward slightly and lift your right leg off the floor.  Press your right leg into an imaginary wall behind you.  Lengthen your spine as you assume a horizontal position with your hips level.  Relax your shoulders down and away from your ears.  Squeeze your shoulder blades together.  Maintain your gaze down and slightly forward.  With your palms down reach your arms out to the side.  Hold this pose for 3 to 5 breaths.  Repeat the same sequence supported on your right leg.  Airplane pose helps improve balance, hip strength, core control, and hamstring mobility.

High Lunge Twist

This is one of my favorites to improve flexibility of your spine.  Like most yoga postures, there are several variations to the high lunge twist.  Each has a different “twist” to the twist.  We will cover the prayer version here.  Start from a high lunge with your left foot forward and arms overhead.  Move your hands together in a prayer at the center of your chest.  Take a deep inhale, and slightly lift your chest.  Use your exhale to engage your navel to your spine and twist your torso to the left.  Hook your left elbow outside of your left thigh. Breathe here for 3 to 5 deep breaths, and then repeat on the other side.  This is a great exercise to improve balance, core control, and spine mobility.

Your Back Pain: Get Started with Yoga

There is no better time than today to get started with yoga.  Get started in your own home then consider taking classes when the time is right.  Several expert yoga instructors are available in our area (Hot or Not Yoga, The Yoga Hive). These instructors will be able to modify any pose to meet your individual needs. Some mild discomfort is expected when starting any new type of exercise.  However, with practice and mental focus you will begin to experience the benefits of improved flexibility, balance, strength, and less pain.

These 5 yoga poses are great to incorporate into your workouts.  I recommend performing them two days per week. You can cycle through each pose several times.  They will probably take you no more than 30 minutes each day. If you experience any difficulty give us a call.  We would love to help you out.

Low Back Pain in Athletes

Low back pain in athletes occurs at an alarmingly high rate.  Various studies suggest one- to two-thirds of athletes will experience low back pain during a competitive season.  Athletes are required to perform high-speed movements often with excessive loads.  Sports such as golf, baseball, gymnastics, hockey, and tennis require repetitive rotational movements that stress the bones, joints, and discs of the spine.   Repetitive rotation and extension (arching backward) with high forces at fast speeds contributes to injuries of the spine discs and bony structures.  Injured athletes must learn to control and dissipate these forces.  Thankfully, rehabilitation exercises can help the injured athlete get safely back to their sport.

Low Back Stress Injuries in Athletes

Stress reactions and stress fractures of the spine are common in young athletes.  The spine of children and adolescents are susceptible because the bones are still developing.  Spondylolysis is a crack or stress fracture in one of the vertebrae of the low back.  Most commonly, the stress fracture occurs in the fifth vertebra of the lumbar spine (L5).  In some cases, the stress fracture weakens the bone and the vertebra starts to shift or slip forward out of place. This condition is called spondylolisthesis.

Spondylolysis

In children and adolescents, this slippage most often occurs during a growth spurt.  The severity of the slippage is graded from 1 to 4.  Most athletes with grades 1 and 2 respond very well to a period of rest and rehabilitation.  The injured bone heals with rest from any repetitive rotation and extension movements involved in their sport.  Rehabilitation targets strength of the trunk muscles to help relieve stress on the healing bone.  Some higher-grade injuries may require surgery to stabilize the spine.

Research Support for a Safe Return to Sport

Athletes with stress injuries of the spine require a minimum of 3 months rest from their sport.  The severity of the injury and the nature of the sport may require longer periods of rest.  One study found excellent return to sport rates after 4.6 months of rest and rehabilitation across a number of sports.  A recent study showed baseball (54%), soccer (48%), and hockey (44%) to have the highest prevalence of stress injuries in boys.  Gymnastics (34%), marching band (31%), and softball (30%) were found to have the highest injury rates in girls.  Athletes in these sports may benefit from longer rest and rehabilitation periods.

A 2017 study from the Children’s Hospital in Columbus, OH investigated the timing of referral to physical therapy in athletes with stress injuries of the spine.  Athletes who began physical therapy sooner were able to make a return to sport 25 days earlier than those who delayed treatment.  The early physical therapy group returned to sport at approximately 3 months.  The delayed physical therapy group returned after 4.5 months of rest and rehabilitation.   These studies suggest appropriate rest and early rehabilitation foster a safe and timely return to sport.

Common Rehabilitation Exercises for Athletes with Low Back Pain

Early rehabilitation for stress injuries of the spine begins with controlling pain and normalizing mobility.  Most athletes experience a significant reduction in pain once they are removed from sports activities.  Trunk and hip strengthening exercises begin in non-weight bearing positions such as on the back, side, or all-fours position.  Athletes are instructed on how to maintain a neutral spine position to minimize stress to the healing bone.  The curl-up and heel hover are two exercises that are initiated once the athlete can control this neutral spine position.

After the athlete can maintain a neutral spine in non-weight bearing positions exercises are progressed to kneeling and standing.  The athlete is taught to control rotation and extension of the spine through exercises such as the chop and Pallof press.

Anti-extension and anti-rotation exercises are emphasized during the later stages of rehabilitation.  The strength and endurance of the trunk muscles are progressively challenged with these exercises.  All exercises should be performed with a neutral spine and in a pain free manner.

Closing Thoughts on Low Back Pain in Athletes

Low back injuries can be frustrating for the young athlete.  Appropriate rest and rehabilitation can expedite a safe return to sport.  These 6 exercises are only a sample of the types of treatments that can help.  Meet with your physical therapist and get started on the road to recovery.  Your physical therapist will continually assess your injury and progress your exercise program based on your goals.  The objective is to get you back to your sport as quickly and safely as possible.  Contact us today if you have questions about which treatments are right for you.

Herniated Disc: Non-Surgical Solutions and Physical Therapy

Eight out of every 10 people will have back pain at some point in their life. This suggest you are probably one of them. Back pain with or without leg pain is commonly due to a herniated disc in the low back. Discs are the cushions between each individual bone, or vertebrae, of the spine. They are strong structures that allow your spines to move and handle loads during your everyday lives. The outer part of your disc is durable with multiple layers. The inner aspect of your  disc resembles a thick fluid. A herniated disc occurs when a small tear in the outer part of your disc results in the inner material leaking out.  Thankfully, your herniated disc is best managed with exercise and other physical therapy treatments.

Low back disc injuries

Herniated Disc, Sciatica, and Pain

Disc herniation is the most common cause of of sciatica. Put simply, sciatica is pain that originates in your low back and travels down your leg. However, not all herniations cause pain in your back or down your leg. Many people older than 30 have a disc herniation on MRI but never experience pain. I am one of them. You might be too.  One study showed 30% of people in their 30’s and 60% of people in their 60’s have a disc injury but experience no pain. There are many factors that determine whether or not a person will experience pain. Possible contributors include the location of the herniation, the person’s physical health, and psychological factors.  Download our free report to learn more about pain here.

Pain

Recovery from Disc Herniation without Treatment

A disc herniation can spontaneously heal without treatment. In these instances, resorption of the displaced inner material occurs over time. This occurs within a few weeks of injury or it may not be seen for several years. One recent study showed spontaneous recovery occurs in approximately 2 out of every 3 lumbar disc herniations.  Because many disc herniations spontaneously resolve, conservative treatments are recommended before considering surgery. Conservative treatments include those offered by your acupuncturist, massage therapist, and physical therapist.

Evidence for Conservative Treatments

Half of the people who access the services of a physical therapist do so for low back pain. More than half of these people have conditions related to the disc. Your physical therapist will first conduct a comprehensive examination to rule out the presence of any serious problems such as an injury to the nerves or spinal cord. Whenever pain is present in your legs, the first objective of treatment is to decrease these symptoms. Disc problems are easier to manage once your pain is localized to only your low back.  This is called centralization.

McKenzie exercises

Exercise for Disc Herniations

Research shows that exercise is one of the most beneficial treatments for people with lumbar disc herniations. Exercises are designed to improve the strength, endurance, and coordination of the muscles that support your spine. Also, exercises can be extremely effective at reducing pain in your legs. Very often, exercises that promote extension of the spine, also known as “McKenzie exercises” are effective at resolving pain in your legs. However, an individualized examination must always be performed in order to determine the exercise approach which is best for you.

Manual Physical Therapy for Your Herniated Disc

Manual therapy performed by your physical therapist is also an evidence-based and effective treatment for people with a disc herniation. Joint mobilization techniques are useful to improve mobility, promote extension of your spine, and resolve symptoms in your legs. Joint manipulation alleviates stubborn pain and stiffness from a herniated disc. Doctors of Physical Therapy with advanced residency and fellowship training have expertise and skill with these techniques.

What Steps Can You Take

I recently rehabilitated a 40-year old landscaper with an L4-L5 disc herniation and pain radiating from his low back to his calf.  His doctors were considering injections and even surgery. However, after 5 weeks of physical therapy he was back to work and nearly pain free. Today he feels like a new person! Physical therapy takes patience and a commitment. There is no magic pill for resolving your back pain.  However, excellent results often occur. Your physical therapist will guide you through the recovery process. Contact us today if you are suffering or simply have questions about which treatments are right for you.

Spinal Stenosis: Causes and Treatment

Spinal stenosis refers to narrowing of the space surrounding the nerves or spinal cord in the back.  Many people with signs of spinal stenosis on an MRI experience no symptoms.  Others experience pain or a deep aching sensation in the buttocks, thighs, or lower legs.  Symptoms are worse when standing or walking.  Other symptoms may include numbness or tingling in the legs and weakness of the foot or legs.  Many people have no pain when sitting or lying down.  Symptoms may be eased or completely relieved when walking leaning over a shopping cart.

Causes of Spinal Stenosis

spinal stenosis

Most people with spinal stenosis are over the age of 50.  Spinal stenosis is usually caused by normal age-related changes in the spine.  Arthritis of the joints in the spine is the most common cause.  This can be associated with degenerative changes to the intervertebral disc.  These age-related changes are normal and no different than graying of the hair or wrinkles of the skin.  In some people these changes result in pain and in others symptoms are never experienced.  It is also important to understand that the extent of stenosis on an MRI does not always match up to the severity of symptoms experienced.

Treatments for Spinal Stenosis

Contrary to popular belief, spinal stenosis does not always worsen.  There are treatments which can reduce pain and improve function.  Common treatments include activity modification, aerobic exercise, stretching exercise, strengthening exercise, massage, manual physical therapy, acupuncture, and injections.  Surgery is reserved when conservative treatments are unsuccessful.  The remainder of this article will discuss the role of physical therapy, injections, and surgery.

Physical Therapy

In most cases, regular exercise should be the first step in managing symptoms from spinal stenosis.  Physical therapists develop individualized exercise programs for people with stenosis.  This often includes stretching exercises for the lower back, hips, and legs.  The benefits of stretching can be accelerated by also including manual therapy treatments delivered by the physical therapist.  Manual physical therapy to the hips and low back has been shown to reduce pain and disability associated with stenosis.

Strengthening exercises for the core muscles and legs is beneficial to improve walking ability.  It is also important for the exercise program to include aerobic training.  This is usually in the form of cycling or treadmill walking.  People with spinal stenosis are encouraged to continue to walk.  Some pain with a walking program is expected and acceptable.  Your physical therapist will help you determine how much pain is appropriate.

Injections

Epidural steroid injections are used to treat back and leg pain associated with spinal stenosis.  This involves injecting anti-inflammatory medication into the epidural space surrounding the spinal nerve.  Decreasing inflammation around the nerve may alleviate symptoms into the legs.  Some people experience immediate relief of symptoms with epidural injections.  This can result in improved walking ability in the short-term.  However, research suggests the long-term effectiveness of injections is limited.

Surgery

spinal stenosis

Surgery for spinal stenosis involves removing bone around the compressed nerve or spinal cord.  This is referred to as spinal decompression surgery or a laminectomy.  Some surgeons also fuse vertebrae to prevent movement within the spine.   Complications from surgery occur in 10% to 24% of cases.   These include fracture, failed fusion, cardiac events, stroke, respiratory distress, and in very rare cases death.   Surgery can be very effective for some people.  However, research suggests there is no long-term difference between those who are treated conservatively and those who undergo surgery.

Conclusion

Symptoms associated with spinal stenosis are common in those over 50 years old.  In the majority of cases, symptoms and function can be improved with exercise, lifestyle changes, and other non-surgical treatments.  Conservative treatments should be exhausted before considering surgery for spinal stenosis.  Research shows people who complete a course of physical therapy are less likely to undergo surgery for spinal stenosis.  Talk to your physical therapist about what you can do to get back to doing what you love.