exercises for low back pain

Level One Exercises | Level Two Exercises

Dynamic Lumbar Stabilization Exercises:

The above 'Levels of Rehabilitative exercises, with the exception of the Gym Ball hyper-extension exercises, are all classified as 'Dynamic Stabilization Exercises' (DSE).  The theory of this style of rehabilitative exercise is to achieve strengthening of the Core Muscle Stabilizers of the spine (transversus abdominus & multifidus) while keeping the patient in a ‘Neutral Spine’ position (1).   What does that mean? That means work and exercise but were not going to allow spine to bend too far forward, too far to the side, or too far backwards while were doing the exercises.

In other words, We are going to protect the injured disc, facets, and/or SI joints by exercising in a safe zone – i.e., the neutral spine position..

DSE exercises are geared toward the chronically disabled and post-surgical patients, whom could never tolerate the Extension exercises of McKenzie, nor the Flexion exercises of Williams, which puts unnecessary motion forces into an already danged and inflamed disc and/or facet joints.  

Why do you need to exercise if you've hurt your back? Because the muscles of the lumbar spine become very weak and even atrophied in a surprisingly short period of time after injury. In fact, you can even see this weakness and muscle atrophy after about three months by looking at an MRI scan. [12, 13] This is especially true after spine surgery, where trunk muscle strength loss has been calculated at 30% after simple discectomy! [2]

Why Keep the Muscle Strong?

The short answer is this: the stronger your lumbar core stabilizing muscles, theoretically speaking, the less axial load and less stress/strain is placed upon the disc and facets. In other words, the muscles start to take some of the axial load and other forces which helps the disc rest.

In technical speak, it is said that strengthening of the core lumbar stabilizers reduces mechanical irritation upon the disc, facets, and SI joint, which in turn decreases the magnitude of your pain [3] and increases your ability to be up against gravity.

WILL THESE EXERCISES REALLY HELP MY PAIN?

Yes! Exercise therapy for chronic lower back pain is recommended by several well respected guidelines (9 ,10,11).   In fact there are increasing numbers of high quality randomized controlled studies which demonstrate that 'Core Stabilizing exercise' have a profoundly positive and long-term effect on both decreasing lower back pain and improving over-all patient function (5,6,7,8).

FREQUENCY:

I have my patients perform these exercises three times per week. The exercises links towards the top of the pages are easier and should be done first. Once mastered, you may add new ones into your routine. Initially your secessions should only be about 10 minutes long. As you get stronger, your secessions should get longer and longer, up to about 60 minutes. Spend about half the exercise period doing the face-up exercises (which strengthen the transversus abdominus muscle) and the other half doing the face down exercises (which strengthens the multifidi muscles). I also have my patients walk for 10 to 45 minutes on the days (you should never walk so much that causes a flareup. If you have, you went too far) they are not exercising.

A final word of warning: disc injuries that involve nerve root damage (radiculopathy) are often very difficult to rehabilitate. These patients can't be pushed very hard, like physical therapists are used to doing. The "no pain no gain" analogy, which does work for some sorts of injuries, definitely does not apply to patients with true radiculopathy! You must take things very slow!   Believe me, I've tried so hard to 'speed-heal' myself and it ALWAYS ENDS IN SUFFERING! ( in fact I'm suffering as I type this very page (5-30-04) as the result of over-doing-it on my exercises...I never learn!) So please, do as I say and NOT as I do. Find a routine of exercise that works and stick with it. DON'T ADD TOO MANY NEW EXERCISES AT ONCE. If you do, you’ll never know which one hurt you and you’ll have to throw them all out!    So, have patients "grasshoppers" and only add one new exercise per week.

Level One Exercises | Level Two Exercises

References:

1) Yilmaz F, et al. "Efficacy of Dynamic Lumbar Stabilization Exercise in lumbar microdiscectomy." J Rehabil Med 2003; 35:163-167

2) kahanowitz N, et al. "Long-term strength assessment of postoperative discectomy patients." Spine 1989; 14; 402-403

3) Panjabi MM. "The stabilizing system of the spine: Part I. function , dysfunction, adaptation, and enhancement." J Spinal Disord 1992; 5(4):383-389

4) Hides JA, et al. "Evidence of lumbar multifidus muscle wasting inpsilateral to symptoms in patients with acute/subacute low back pain." Spine 1994; 19:165-77

5) O'Sullivan PB, et al. "Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis." Spine 1997; 22(24): 2959-67.

6) Hides JA, et al. "Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain." Spine 2001; 26:243-8.

7) Hides JA, et al. " Long term effects of specific stabilizing exercises for first episode low back pain." Spine 2001:26:243-8

8) Goldby L, et al. "An RCT investigating the efficasy of manual therapy, exercises to rehabilitate spinal stabilization and an education booklet in the conservative treatment of chronic low back pain. In: Proceedings of International Federation of manipulative Therapists. Perth, Australia: 2000

9) Albright J. “Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain.” Phys Ther. 2001 ;81:1641-1674

10) Bekkering G et al. “ KNGF-richtlijn Lage-rugpijn. Ned Tijdschr Fysiother, 2001 ;111( suppl):3

11) Spitzer W, et al. “Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians: Report of the Quebec Task Force on Spinal Disorders.” Spine 1987; 12( suppl):1-59

12) Parkkola R, et al. “Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects.” Spine 1993; 18:830-836

13) Reid S, et al. “Isokinetic trunk-strength deficits in people with and without low back pain: a comparative study with consideration of effort.” J Spinal disord. 1991 ;4:68-72

26) McGill S. "Low back disorders: evidence based prevention and rehabilitation." Champaign, IL: Human Kinetics Publishers, Inc, ;2002

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