6
Chapter
The basic exercises- Basic exercises for the lumbar spine 1. Basic exercises for the lumbar spine
- Basic exercises for the lumbar spine 1. Basic exercises for the lumbar spine
- Basic exercises for the lumbar spine
With reference to the lumbar spine, low-back pain
should be mentioned as this is the most common
condition for which patients present to manual ther-
apists or start exercising.
As many different pathologies can cause low-back
pain, a thorough diagnosis is necessary. Particular
caution is necessary if the low-back pain is associ-
ated with neurological signs and symptoms, bowel
and bladder problems, or the patient has lost weight
or is feeling ill. If, after thorough medical investi-
gation, exercise therapy is appropriate, you need
to bear in mind the general function of the lumbar
spine as a weight-bearing structure that needs to be
able to lift against gravity and change direction, in
addition to being well balanced. Strengthening and
mobilizing exercises are required.
Mobilizing exercises may cause a problem if
they reach hypermobile areas instead of restricted
ones. We have seen patients’ conditions worsening,
particularly after intensive, ambitious practice. In
many cases we could see that the hypermobile segments
were vulnerable to being overstretched or overmobi-
lized. For these patients two things were helpful:- easing off slightly from the boundary, the limit
of movement - combining mobilization with muscle
strengthening.
Muscle strengthening is performed with only part,
about one-third, of full strength and repeated several
times. These exercises should be performed within
the painfree range.
Mobilization exercises should give a feeling of ease
and relaxation. This experience of easy, painfree exer-
cises can help eliminate conditioned pain reactions.
To integrate these abilities into more complex and
everyday actions we recommend the balance, coor-
dination, and synchronization exercises. For healthy
movement patterns of the lumbar spine a wider con-
text is important, particularly targeting the pelvis,
iliosacral joints, and the hips, as well as the feet and
knees. The functions in the middle and lower tho-
racic spine can also influence the lumbar spine. All
these connections contribute to a healthy balance of
stability and mobility of the lumbar spine. In this way
the cooperation between the muscles, the nutrition
of the discs, and the nerve roots can improve and be
kept at a healthy level. All the bony and soft tissues
and fluids can function in a healthy way.Exercise 1.1: Lumbopelvic stability
Aims: strengthening the lower abdomen, pelvic floor,
and lumbar area.- Lie on your back with your hips and knees bent,
the soles of the feet resting on the floor, the
heels one foot length away from the buttocks.
Use a pillow for your head if necessary. - Gently tilt your pelvis until you find the neutral
lumbopelvic position. Maintain this neutral
position throughout the following series of
exercises. - Put your fingertips on the central line of your
lower abdomen about 5 fingers below your
navel. Keeping your throat and your shoulders
relaxed, slightly pull this area of the lower
abdomen inwards and towards your lumbar
spine as you exhale; feel the slight contraction
of the lower abdomen beneath your fingertips.
Then inhale normally, keeping your abdomen
relaxed. - Perform point 3 3–5 times, with 1–2 normal
breaths in between if necessary. You may feel
the associated activity of the pelvic floor and the
lumbar area as well. - With an exhalation repeat the contraction,
hold it for up to 3 breaths, and release it while
exhaling. - Relax for a few breaths.
- Keeping your throat and shoulders relaxed,
practice the gentle contracting action of point 3
while inhaling; relax as you exhale; feel the slight
contraction with your fingertips on the central
line of the lower abdomen. - Perform point 7 3–5 times.
- Again hold the contraction for 3 breaths, and
release it while exhaling, hands comfortable. - Stay calm for a few breaths; feel the softness in
your abdomen and pelvic floor.