The reasons and aims of doing routine lumbar spinal exercises have been explored in a previous article and now I explore the use of specific lumbar exercises and give an indication of how they should be performed. Performing the exercises carefully and smoothly with steady timing is the aim, holding at the end of joint range for a few seconds. An acceptable amount of pain is difficult to determine, but some pain during the performance should be accepted if it does not last for more than 15-20 minutes and is not too severe. Self management of low back pain involves repeated performance of lumbar exercises daily.
One leg to chest exercise Lying on the back, pull one of your knees up to your chest and hold it there for two seconds, letting the other leg remain flat on the bed. This will move and stretch tightness in the sacroiliac joint on the same side and in the hip and lumbar joints, ligaments and muscles.
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 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.
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.
This exercise puts a severe stretch on the lower back and should not be performed before trying the other, easier exercises or under advice.
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.
Lying Prone with Elbow Support In this exercise the person is lying on their front and gets up onto their forearms as if they are on a beach and looking out to sea. The lumbar joints are pushed further into extension in this exercise, which should not be kept up for longer than 30 seconds at a time to avoid overstressing the back at any one time.
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.
Being a strong passive movement into extension this movement can be aggravating to a back pain problem so needs careful testing to ensure the correct response before prescription.
Knee roll exercise for rotation Lying flat on the back with the knees bent and the feet on the surface, the knees are rolled side to side whilst being kept together. The movement is taken as far as the joints will comfortably go and a little further. The lumbar spine has very limited rotation but other spinal structures may be restricted and respond to movement.
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.
