|At every party, sporting event or even in a supermarket queue, if it emerges that I am a Chartered Physiotherapist, I am almost invariably asked about back pain, or specifically, which are the best exercises for pain in the back?|
The answer always puts me on the spot, as no single exercise that has emerged from research to suit everyone. The fact is that different exercise strategies are required for different back pain presentations.
However for those with what is termed ‘simple’ or ‘non-specific’ back pain, defined as back pain and or stiffness confined to the lumbar region, not extending into the legs, the following exercises are safe and may be of help.
The first one is for morning time, before you ever get out of bed. It is great for mobilising backs that feel stiff or slow early in the morning. Just lying on your back, bend the knees so that the feet are flat on the bed. Then in a relaxed manner, start rolling the knees side to side starting with small movements, at an easy but not too slow pace. Continue for a full minute, gradually increasing the distance the knees travel until they arc fully from one side to the other. The movement should feel like a comfortable limbering or stretching sensation and should not bring on pain. This exercise appears to give best results after rest, so once done in the early morning is not generally necessary to repeat later in the day.
Spinal mobility is crucial in a healthy back. Many people spend much of the day with their lower spine bent or flexed, either through repeatedly bending forward or in sitting for prolonged periods during the working day. Though the human spine has great capacity to bend forward, in our modern mainly non-physical work environment, spinal flexion is rarely counteracted by bending backward. In my clinical experience, many more people are concerned about how much they can bend towards their toes in standing, ignoring how far back they can arch.
In fact, excessive forward bending gradually reduces the amount of spinal extension, or backward bending. This loss of extension often occurs insidiously. An old adage in orthopaedic medicine is ‘use it or lose it’. So if you rarely bend your lower spine backward, you may already have begun to limit the ability to bend backward. These two easy exercises are good for almost everyone.
Standing upright with feet hip distance apart, place your hands on the back of your pelvis, well below the waistline. Keeping knees straight, arch backwards, aiming to get your breastbone parallel to the ceiling. This is often surprisingly difficult. A common cheat is to unwittingly bend the knees to get further backwards (ask someone to watch you to see if this happens and if so, just lightly lock the knees). Hold this backward arched position for the count of 3-5 seconds. Return upright. Repeat 3 times and by the third time and you should notice that the position feels less strained and that you have gone back further with ease.
The second one is also performed in standing, but with arms at your sides this time. Now slide down along an imaginary line of a trouser seam to touch the outside of the knee. Don’t stop there, just immediately come up and then bend down to the other side. Do 3 quick side to side movements, making sure it is a pure sideways bend without any rotation.
These two quick and easy exercises only take 20 seconds in total and are ideally suited to any workplace. The suggestion is that they should be repeated 2-3 times spread out over the working day to prevent back stiffness in the evening.
A common complaint in commuters is aching having driven home from work. The two exercises above should help reduce this complaint. Another useful one is to lie on your stomach on the floor on arrival home. Put your hands flat on the floor, under the front of your shoulders and push your upper body off the floor, arching the lower back as you do so. This well researched exercise was devised many years ago by Robin MacKenzie, a New Zealander. His advise, based on research, is that you repeat the arch a number of times, every once in a while holing the arched position for several seconds or longer.
Another well researched exercise, this time for strengthening the back is part of a regime known as The Mayer Programme, a comprehensive set of strengthening exercises. The first step involves being on all fours on the floor, on your hands and knees. Keeping the elbows straight hold a slight arch in the lower back throughout. Draw in the stomach (without losing the arch) and lift one leg straight out behind you. This uses the actual weight of the limb as resistance, just like using resistance machines in a gym. Hold it out for 6-10 seconds before returning to the starting position. Repeat with each limb in turn. In the case of the arms, lift each one straight out parallel to the ear. One set is lifting each of the four limbs. Start with 4 sets, building to 10 sets as it gets easier.
These exercises will suit most people. If your symptoms worsen in any way doing these exercises, please stop immediately. Consult your G.P. or local Chartered Physiotherapist for a specific programme to suit your particular backpain presentation.