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.
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.
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.
Stretching in the Child Pose This pose stretches out the whole of the spine by using the bodyweight to stretch the back out over the bent thighs in a kneeling down position, ending up in a curled up position with the face near the ground.
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.
Use a block under your heels if you need it to maintain your balance and then deep knee bend until you are in a full squat. The lumbar spine will stretch at the bottom of the movement as you let it go, performing the movement for a half minute at a time.
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 Prone If lumbar extension, the ability to arch the spine, is restricted then the first movement might be to lie the person prone as an initial exercise. This places the lumbar discs and joints in a significant degree of extension and can be the first step if extension is very limited.
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.
Repeated Extension in Lying (REIL) This is part of the McKenzie technique of treatment and is mainly aimed at disc derangement or dysfunction. The patient lies on their front with their hands around shoulder level, pushing up to straighten the arms whilst allowing the hips to remain on the bed. This arches the lumbar spine significantly.
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 Rotations " Manipulation Stretch Lying on the back, the hip is bent up so the person can hold the knee with the opposite hand. Leaving the shoulders flat on the bed, the knee is pulled across the body by the opposite hand, stretching the low back. The knee can be pulled right over for a large lumbar stretch but preparatory work would be wise for most people. - 16650
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.
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.
Stretching in the Child Pose This pose stretches out the whole of the spine by using the bodyweight to stretch the back out over the bent thighs in a kneeling down position, ending up in a curled up position with the face near the ground.
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.
Use a block under your heels if you need it to maintain your balance and then deep knee bend until you are in a full squat. The lumbar spine will stretch at the bottom of the movement as you let it go, performing the movement for a half minute at a time.
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 Prone If lumbar extension, the ability to arch the spine, is restricted then the first movement might be to lie the person prone as an initial exercise. This places the lumbar discs and joints in a significant degree of extension and can be the first step if extension is very limited.
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.
Repeated Extension in Lying (REIL) This is part of the McKenzie technique of treatment and is mainly aimed at disc derangement or dysfunction. The patient lies on their front with their hands around shoulder level, pushing up to straighten the arms whilst allowing the hips to remain on the bed. This arches the lumbar spine significantly.
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 Rotations " Manipulation Stretch Lying on the back, the hip is bent up so the person can hold the knee with the opposite hand. Leaving the shoulders flat on the bed, the knee is pulled across the body by the opposite hand, stretching the low back. The knee can be pulled right over for a large lumbar stretch but preparatory work would be wise for most people. - 16650
About the Author:
Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. He specialises in musculo-skeletal conditions and looking after joint replacements as well as managing chronic pain. Visit the website he publishes if you are looking for Physiotherapists in Exeter or elsewhere in the UK.
