Enhancing Low Back Health through Stabilization Exercise

"Enhancing Low Back Health through stabilization exercise"Stuart M. McGill

Stuart McGill studies exercises with a low joint loading and high neuromuscular training effect for spinal rehabilitation.

Recent investigations into injury mechanisms have revealed that many back training practices actually replicate the loads and motions that cause the parts of the low back to become injured. For example, disc herniation's need not have excessive loading on the back to occur, rather repeated forward flexion motion of the spine is a more potent mechanism.

To relieve pain caused by sitting and other repeated forward flexion activities Robin McKenzie advocated laying prone try this for 3-5 minutes, then advance to up on your elbows for 10 deep breath cycles, repeat 5-8 sets.

Begin with the cat-camel motion exercise (spine flexion-extension cycles) to reduce spine viscosity (internal resistance and friction) and “floss” the nerve roots as they outlet at each lumbar level, perform 5-8 movements into each position holding each for 3 breaths

Next for an anterior abdominal exercises perform the abdominal the curl-up. The hands are placed under the lumbar spine to preserve a neutral spine posture. Do not flatten the back to the floor. Flattening the back flexes the lumbar spine, violates the neutral spine principle, and increases the loads on the disc and ligaments. One knee is flexed but the other leg is straight to lock the pelvis-lumbar spine and minimize the loss of a neutral lumbar posture. Alternate the bent leg (right to left) midway through the repetitions.

The exercise is made more challenging by raising the elbows off the floor. Even more challenging is first performing an abdominal brace (activating the abdominal muscles), and then curling up against the brace. Hold the posture for 7-8 seconds to the point of fatigue. Do not hold the breath but breath deeply.

Add a front plank starting on the wall, bracing the abdominals, not letting the spine or hips sag and working up to a 90 sec hold.

Then progress to the floor also working up to a 90 second hold. Perform 3 minutes of hold time and decrease reps and increase duration as you improve. All hold times should be pain fre

Next perform the Side Plank-Lateral and abdominal muscles (called quadratus lumborum, and the abdominal obliques) are important for optimal stability, and are targeted with the side bridge exercise. The beginners level of this exercise involves bridging the torso between the elbow and the knees. Once this is mastered, and tolerated, the challenge is increased by bridging using the elbow and the feet. Advanced variations involve placing the upper leg-foot in front of the lower leg-foot to facilitate longitudinal “rolling” of the torso (see figure) to challenge both anterior and posterior portions of the wall, and further groove stabilizing patterns which are transferable to upright tasks.

Stating on the wall and working up to a 90 sec hold.Then progress to the floor from knees and when strong enough from feet also working up to a 90 second hold. All hold times should be pain free. Be sure to keep the head, shoulders, hips and knnes in a straight line and the shoulders and hips stacked vertically. Perform 3 minutes of hold time and decrease reps and increase duration as you improve. All hold times should be pain free.

An advanced level side bridge involves holding the posture on one side for 7-8 seconds and the “rolling” over to the other, and repeating as endurance is increased. It is critical to lock the pelvis to the rib cage, via an abdominal brace, so that the spine remains rigid during the rolling. Finally, add deep breathing while in this posture. The rolling action with the breathing will prepare many people to meet any challenge with a stable spine

Next begin the Bird Dog on the hands and knees, hands are directly under the shoulders and knees under the hips, brace the abdominals and raise the opposite arm and leg, do not let the spine or hips sag, twist or curve and hold the posture for 10 seconds. Then lower the hand and knee, and “sweep” the floor with them and raise them again for the next repetition.. This motion will enhance the stabilizing patterns. Switch sides, the abdominal muscle are braced throughout. Perform repetitions to fatigue.

Stuart McGill has concluded this paper with some pearls of wisdom regarding spinal exercise strategies

1. While there is a common belief among some experts that exercise sessions should be performed at least 3 times per week, it appears low back exercises have the most beneficial effect when performed daily.

2. The pain-no gain axiom does not apply when exercising the low back in pained individuals particularly when applied to weight training, and scientific and clinical wisdom would suggest the opposite is true.

3. While specific low back exercises have been rationalized in this guide, general exercise programs that also combine cardiovascular components (like walking) have been shown to be more effective in both rehabilitation and for injury prevention. The exercises shown here only comprise a component of the total program.

4. Diurnal variation in the fluid level of the intervertebral discs (discs are more hydrated early in the morning after rising from bed), changes the stresses on the disc throughout the day. Specifically, they are highest following bed rest and diminish over the subsequent few hours. It would be very unwise to perform full range spine motion while under load, shortly after rising from bed.

5. Low back exercises performed for maintenance of health need not emphasize strength, with high-load low repetition tasks, rather more repetitions of less demanding exercises will assist in the enhancement of endurance and strength. There is no doubt that back injury can occur during seemingly low level demands (such as picking up a pencil) and that the risk of injury from motor control error can occur. While it appears that the chance of motor control errors, resulting in inappropriate muscle forces, increase with fatigue there is also evidence documenting the changes in passive tissue loading with fatiguing during lifting. Given that endurance has more protective value than strength, strength gains should not be overemphasized at the expense of endurance.

6. There is no such thing as an ideal set of exercises for all individuals. An individuals= training objectives must be identified, (be they rehabilitation, specifically to reduce the risk of injury, optimize general health and fitness, or maximize athletic performance), and the most appropriate exercises chosen. While science cannot evaluate the optimal exercises for each situation, the combination of science and clinical experiential wisdom must be utilized to enhance low back health.

7. Be patient and stick with the program. Increased function and reduction pain may not occur for 3 months.