When people are at a loss to understand their back problem, they frequently hold the rather bleary notion that 'a bit of exercise' will help, and to an extent this is probably true. As long as activities are not jerking or high-impact, the generalised tightening up of muscle tone, thus making the skeleton better held together, can often make a surprising difference; chronic back pain can seem to be on the wane.
Exercise binges usually coincide with arbitrary personal resolutions or season changes but often as not, the regime consists of wildly casting about; dredging up an arbitrary cache of ‘somebody said’ exercises but with no idea about what they are meant to be doing, nor any reason to be cautious. Understanding the value of specific exercises, what they are meant to achieve and the common pitfalls with each one is a valuable tool in helping manage your own back problem. Understanding is always half the cure.
The first set of exercises for back pain is appeasing exercises to get your spine out of acute crisis, then, when you are on surer ground, mobilising or loosening exercise to get the spinal segments better separated and the lower spine less compressed. The last set of exercises for back pain is spinal intrinsics strengthening, to give more power to the muscles that control the individual spinal segments, as well as more power to the retaining wall (the tummy) at the front.
If you are starting off in pain, you will always get better results by appeasing the lower back before you attempt to start mobilizing or strengthening. The most effective appeaser is ‘spinal rolling’. This is done by simply holding your knees while lying on your back on the floor (preferably on a doubled over towel on the carpet) and then rolling gently backwards and forwards along your painful spine.
What starts as a stiff, tentative low back, which clunks across the floor like a square wheel, will in a matter of minutes become fluent and painless. It is quite hard work for the tummy (not to mention the front of the neck) and you may need to stop after half a minute or so, relax with the legs crooked on the floor for a moment, then start up again. You should repeat this several times in one session before moving on to the other two.
Spinal rolling is a very important exercise. It seems so simple, yet really it's highly sophisticated. Apart from the pleasing pressure of your sore back against the floor, squeezing and squelching the lumbar segments past one another as your body rolls over them, it needs your tummy and back muscles to take turns switching on and off (towards your toes = tummy, towards your head = back muscles). Believe it or not, the 'spontaneous selective recruitment' in this partnership is one of the hardest co-ordination feats when your back is bad. Your back muscles stay over-active (muscle spasm) and it feels hard and sore, but you also can't switch your tummy on.
There's a lot to be said for seeing on video exactly how to do the exercises. You can see Sarah explain about the importance of getting out of pain quickly and demonstrating the three important exercises. You can read more about the contents of this video here.
As soon as your back is less painful you must start the mobilizing and by this I mainly mean ‘decompression’. There are many descriptions on this site on how to use the BackBlock to decompress the spine. It is one of the most important exercises for back pain.
Remember, in reality you will often alternate between appeasing and mobilizing phases with treating your spine. By this I mean that sometimes you have to pack-pedal or have a lay-off for a few days from using the BackBlock because you back is getting over-cooked. After a break of a few days you will resume the block when things are no longer stirred up. Remember, in the early stages of spinal rehabilitation, it is normal to go back and forth between active and more passive treatment phases. The passive appeasing may last several days to a couple of weeks before you go back to using the BackBlock on a daily basis.
Here you can see exactly how to do the BackBlock so as to be absolutely sure you are getting it right. Read more about this set of 4 important videos here.
And now we come to strengthening. It's no over-simplification to say that keeping a spine both well supported and well controlled (and these are two different things) is the most important way forward for lasting peace with your back. It is one thing to go to your physiotherapist or osteopath to have your spinal segments tinkered with (essential if you have some specific segmental jamming!) but you will never 'keep the cure' if you fail to follow up with exercises to keep the spine under control, front and back.
Strengthening the lower back are some of the most tricky exercises for back pain because if you overdo them you can make yourself worse. You can see Sarah on video here explain about the 5 different grades of spinal strengthening, including using the ultimate Roman Chair exercise. Read more about this important video here.
Lack of segmental control of the spine is a strange animal. On the face of it, it seems a non-event, yet lack of it has the most worrying consequences: it means your spine keeps suffering micro-trauma every time you move. This happens not only when you do unconscious movements, like turning over in bed at night, but also in more obvious ways, such as when you go to bend, or rise from a chair; you are pole-axed by a sickening jolt of pain through the back. What is happening here is that the weak segment is going to shear incrementally as you move. It is one of the major reasons why back problems keep on keeping on; in effect you keep hurting your back.
Which are the weak muscles?
The significantly weak muscles are those which exert control over the segments directly. These are transversus abdominis, the deepest tummy muscle (which circles your abdomen below your navel and vertically clenches the spinal segments to stop them sliding about) and multifidus, the small, deepest spinal muscles (which pass from vertebra to vertebra and hang onto the tail of each vertebrae, thus controlling it tipping when the spine bends). Weakness of both allows the spinal segments to slip and slide about as you are going about your business. I'm sure you can see how important it is to keep both groups strong - if you want to avoid pain, or better still, if you want to get out of pain.
The two exercises I am about to describe are significant because they are controversial. (See this page on the Myths of Core Stability Training). Both have been dogged by misunderstanding and mis-teaching, often fuelled by the health and fitness industry, as much as the orthopaedic world. The first is the strengthening of transversus abdominis. Although this muscle cannot be strengthened in isolation from the rest of the tummy muscles, it is possible to do the exercise in a way that pushes it to the fore.
Transverse abdominis is most effectively recruited doing reverse curl ups, which involve lying on the floor on your back with your hands clasped behind your head. With your knees bunched to your chest and lifting your bottom off the floor, make your back round so that your knees approach your chin. In any one session you should attempt to do 15-20 at a time, taking care as you lower your legs that your thighs never pass lower than 90 degrees before the return journey.
You will notice the effort is localised to your lower abdominal area, so essential for providing support to your lower spine. Never be tempted to strengthen your tummy by doing spinal 'crunches', a real favourite of the gym junkies. These do exactly what they say: crunch the spinal segments together, thereby increasing the compression of the base of the spine, at the same time making the lower tummy pouch out with the effort while over-working the upper abdominal muscles (instead of the lower). This is also a failing or poorly executed 'normal' sit-ups.
The final exercise in reclaiming segmental control of the spine is learning to touch your toes while standing up. You do this by reefing your tummy in like a greyhound, humping out your lower back and then curling downwards to the floor by bending in the middle. You can let your knees bend slightly, to take the tension off your hamstrings, and then let your head dangle. There is no rule against making tiny bounces to help tease out the length of bulky long back muscles but make sure to keep your back relaxed and your tummy firm. As you return to vertical, make it a cat-curling, unfurling action with your head coming up last. Two or three at a time, several times a day is ideal.
The strait-jacketing of the orthopaedic world made the decree several decades ago that spines should never do this - and I believe this directive alone has done more to hamper progress than any other single factor. Failing to encourage the spine to bend means that both the deep tummy and back muscles get weak. A weaker tummy fails to work effectively both as a competent retaining wall to steady the spinal segments from the front, plus (transversus abdominis specifically) fails to clench the individual segments and steady the segments gliding forward. Outlawing bending also results in atrophy and weakness of multifidus, so critical in steadying and controlling the gapping open of the vertebrae from behind as the spine goes over.
and yes, bending is good for you!
Treatment of any kind must incorporate these simple core issues, and then it is true to say that setting a back problem right can be as easy as this. You must have the automatic muscle power to control the minute movements of the vertebrae if you are to stop the lumbar segments insidiously self-damaging when you least know it is happening. Doing these three exercises for back pain (and you must admit they are simple) can do more than anything else to help you get spontaneity and strength back in your spine, and start getting rid of the pain. See how it works.