Written by Robert Bonello
Saturday, March 14th, 2009
I have covered the rationale and aims of performing routine exercises for the spinal joints in a previous article, now I will move on to the performance of the spinal exercises themselves. Patients should follow the exercise instructions and perform the exercises smoothly with even timing through the range, holding for a short period at the end of the joint ranges. A moderate degree of pain may well be acceptable as long as it is not too severe and does not last long after the performance of the exercise. Doing the exercises daily is key to managing a back pain problem.
Leg flexion to the chest In supine hold on to your knee and pull your thigh up to your chest, keeping it at the full extent for a few seconds, with the other leg remaining flat down. The lumbar spinal joints, ligaments and muscles, hip and sacroiliac joints are mobilised during this manoeuvre.
Bilateral knees to chest stretch Lying flat on the back, bend your knees and pull on your shins, pulling your thighs up to the trunk. This is less stretching for the sacroiliac and hip but gives a stronger stretch to the low back structures including the ligaments, muscles and joints.
The Pose of a Child Kneel on the floor and allow the trunk to curl forward to lie on the fronts of the thighs with the back stretching out into flexion. This flexes the whole of the spine because the bodyweight increases the force of the stretch.
Squatting down This movement involves a greater degree of force than previous ones and can be useful to counteract the effects of sitting for too long. Extension movements are often recommended to restore the lumbar curve after sitting too long but flexion can be just as helpful in relieving discomfort.
Squat right down until your thighs are against your calves, using a block under your heels if you need to maintain balance. Staying down in that position for half a minute, allowing the lumbar spine to flex out, can be performed at times or three times in a row with rests between.
Stretching out at the bottom of the movement, the back is kept in this position for half a minute or so at a time.
Lying on the front Sometimes the ability to extend the lumbar spine is restricted and then prone lying, lying on the front, is a useful starting exercise as even this can stress the joints when they are stiff. The back is more extended in this position that it appears on the surface.
Elbow supported prone lying A progression from lying on the front is to get the patient to support themselves up on their forearms to increase the extension stretch on the lumbar spine. The lumbar spine is placed in greater extension than prone in this position, stressing the tight structures and forcing them to give.
McKenzie Repeated Prone Extensions McKenzie technique is a form of manipulative treatment at affecting disc dysfunction and derangement. Lying on the front with the hands placed near shoulder level, the patient pushes until their arms are straight whilst leaving the pelvis down on the bed, involving a significant lumbar extension.
This exercise is known to be aggravating in certain patients as it forces the facet joints together so needs to be tested by a physiotherapist to ensure effectiveness.
Lumbar Rotations ” Knee Rolling Lying on the back, the knees are bent and both knees are rolled to one side and then another, allowing the movement to go as far as it comfortably can. Although there is little rotation in the lumbar joints some of the spinal structures can be tight into rotation.
Lumbar Rotation Mobilisation The patient lies on their back and leaves their shoulders on the ground as they bend one leg up so the opposite hand can get hold of the knee and pull the leg over the body, stretching out the back. This stretches the facet joints and soft tissue structures strongly so other stretches might be more appropriate before progression is made to this exercise.
