Another article has covered the goals and rationale behind setting and observing a lumbar exercise programme and in this article I go over the specifics of lumbar exercises and their performance. Exercise performance varies greatly between patients but the aim is smooth movement with steadily timed motions, moving through the full ranges and holding at the end of the movements for a short time. Pain is to be expected to some extent with exercising but this should not be more than moderate nor should it last for too long afterwards. Successful exercise programmes involve daily repetition over a long period.
Pulling one leg to the chest Lying down on the bed, get hold of one knee and pull it up towards the chest, holding it at the full bend for a short time. Keep the other leg flat down. This exercise mobilises and stretches the sacroiliac, hip and low back joints, muscles and ligaments.
Both knees to chest exercise Lying on the back, pull both your knees up to your chest, holding the top position for two seconds. This exercise stretches the hips and sacroiliac joints less than the previous one but increases the flexion stretch on the lumbar spinal structures.
The Child Pose Stretch Kneeling forward in a crouch so the knees are fully bent then lean your body forward so the abdomen lies forward on the thighs and stretches the back. The bodyweight increases the stretch on the spine.
Full Squats Because the bodyweight is used to stretch out the low back structures in this movement the effect is mechanically more severe and should be done only on advice from a professional therapist or after the easier exercises have already been performed. Advice is typically to perform extension movements after an prolonged time of sitting but end range flexion can also be useful to flex the lowest spinal segments.
Squatting down fully into the deep squat position is the aim of this movement, with a raise used under the heel if balance is difficult to maintain.
As this is a relatively severe exercise it would be useful to work at the earlier flexion exercises in lying first before tackling this.
Prone Lying Lying on the front puts the lumbar joints and discs into a significant level of extension, making it a suitable and simple exercise for starting off treating an extension dysfunction. Other movements may be too severe until this one has been achieved.
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 can be aggravating as it is a strong passive extension movement, so physiotherapists test the exercise carefully to make sure there is a positive response before recommending it.
Knee rolling for lumbar rotation In supine the knees are bent up with the feet flat on the bed and the knees kept together as they are rolled to each side, allowing as much range of movement as the joints are comfortable with. The lumbar joints have little rotation range but soft tissues structures may be tight and respond to stretching.
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. - 20761
Pulling one leg to the chest Lying down on the bed, get hold of one knee and pull it up towards the chest, holding it at the full bend for a short time. Keep the other leg flat down. This exercise mobilises and stretches the sacroiliac, hip and low back joints, muscles and ligaments.
Both knees to chest exercise Lying on the back, pull both your knees up to your chest, holding the top position for two seconds. This exercise stretches the hips and sacroiliac joints less than the previous one but increases the flexion stretch on the lumbar spinal structures.
The Child Pose Stretch Kneeling forward in a crouch so the knees are fully bent then lean your body forward so the abdomen lies forward on the thighs and stretches the back. The bodyweight increases the stretch on the spine.
Full Squats Because the bodyweight is used to stretch out the low back structures in this movement the effect is mechanically more severe and should be done only on advice from a professional therapist or after the easier exercises have already been performed. Advice is typically to perform extension movements after an prolonged time of sitting but end range flexion can also be useful to flex the lowest spinal segments.
Squatting down fully into the deep squat position is the aim of this movement, with a raise used under the heel if balance is difficult to maintain.
As this is a relatively severe exercise it would be useful to work at the earlier flexion exercises in lying first before tackling this.
Prone Lying Lying on the front puts the lumbar joints and discs into a significant level of extension, making it a suitable and simple exercise for starting off treating an extension dysfunction. Other movements may be too severe until this one has been achieved.
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 can be aggravating as it is a strong passive extension movement, so physiotherapists test the exercise carefully to make sure there is a positive response before recommending it.
Knee rolling for lumbar rotation In supine the knees are bent up with the feet flat on the bed and the knees kept together as they are rolled to each side, allowing as much range of movement as the joints are comfortable with. The lumbar joints have little rotation range but soft tissues structures may be tight and respond to stretching.
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. - 20761
About the Author:
Jonathan Blood Smyth is a Superintendent Physiotherapist at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in London.
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