The Back – Additional Stretches, Exercise, and Advice

As important as treatment can be in resolving low back injuries and pain, the most vital part in reversing these conditions is the work that a patient does at home.  With that in mind, here are some more stretches and exercises that can be very helpful in stretching the muscles involved in chronic back discomfort.
Also, for patients who are suffering from these issues, one of the best things that a person can do is build their core strength.  Many people limit themselves to doing crunches as a way of building abdominal strength, but this exercise focuses predominately on the rectus abdominis muscle (the six-pack muscle).  While it is important to strengthen this muscle, it is also necessary to work the accessory abdominal muscles like the obliques and transversus abdominis.  These muscles form the sides of the torso and when they are exercised on a regular basis, they work like a column to support the upper body.  When these muscles are weak, the upper body is supported by only the muscles in the front and the back, which is the equivalent of only having a pair of planks providing support as opposed to the column provided by a strong core.  This arrangement leaves the back much more vulnerable to injury and insult, especially in situations where the torso is rotated (a common situation when people “wrench” their backs).
One of the best ways to work these other muscle groups is through Pilates.  Most community colleges offer low cost classes and most of the basic theory and mechanics can be learned in a mat class, which are often much less expensive and more available than the studio classes.  Once an individual has gotten a comfortable command of the basics, there are numerous DVD’s and internet-based Pilates programs which can be used for doing the exercises at home. T hese routines should be done 3-4 times a week, and after a few weeks, there should be a noticeable decrease in back discomfort.

For ALL exercises listed below, remember to breathe!  Holding your breath just increases pressure on the low back and if you can’t breathe, your muscles will tense up.  These are more advanced exercises than the ones presented in the previous article, so if there is significant pain or discomfort, stop the stretch and, if it is being done correctly, skip that movement and consult a health professional.  If the discomfort is mild to moderate, the pain may be due to muscle stiffness, so if that is the case, continue with caution and proceed slowly.

Pelvic Forward and Back Thrusts
Stand with your feet about hip to shoulder width apart and your hands on your hips.  Push your hips as far forward as you can.  Next, pull your hips back until your butt is sticking out behind you.  Now move your hips between these two positions by using a forward and back rocking motion with the hips.  It will probably feel a little silly, but it can really open up the hips and low back.  This exercise can also be done on an exercise ball.

Hip Circles
Stand with your feet about hip to shoulder width apart and your hands on your hips.  Now push the pelvis forward until it is jutting in front of you.  Slowly begin circling the hips to the left, pushing them as far as you comfortably can.  Continue the movement around the left until the hips are pushed back and the butt is sticking out.  Keep the movement going around to the right until the hip is jutting to the right as much as possible.  Continue moving until the pelvis is pushed to the front again.  Your hips should have moved in a complete circle.  Continue to do a few more circles to the left, stopping when your pelvis has returned to the front of the body.  Next, reverse the direction of the circles so that you start by moving to the right first.  Do an equal number of circles, stopping again with the pelvis in front of the body.  If you need an image in your head, picture using a hula-hoop or a belly or hula dancer.  This exercise can also be done while seated on an exercise ball.

Standing Lateral Flexion
Stand with your feet about hip to shoulder width apart and your arms by your sides.  Now slowly raise both arms until your hands are above your shoulders and your arms are completely extended.  Next, lower the left arm back to your side while keeping the right arm extended over your head.  Slowly start leaning to the left, moving the left hand down and slightly bending the right arm so that palm of the right hand stays over the top of your head.  You should feel this stretch through the right side of the torso. After 20 – 30 seconds, slowly return straighten up and bring the left arm back above the shoulder.  Now repeat the movement, but bring down the right arm and lean slowly to the right side of the body.  Again, hold the position for 20 – 30 seconds before returning to the starting position.

Front Bends
Stand with your feet about hip to shoulder width apart and your arms by your sides.  Place your hands on the front of your thighs (about level with the front pockets on a pair of pants). Now, while keeping the back as straight as possible, slowly walk your hands down your legs.  This stretch comes from bending at the hips as opposed to the back, so as you lower down, the back should not flex forward.  If it does, then walk the hands back up the legs until the back has returned to its original posture.  This is as much a hamstring stretch as a back stretch, so you may feel it mostly in the back of the legs as opposed to the back itself.  After finding a good position, hold the stretch for between 10 – 20 seconds and then, keeping the back straight, slowly walk the hands back up until you have returned to the starting position.  This stretch can be done throughout the day.

Back Bends
Stand with your feet about hip to shoulder width apart and your arms by your sides.  Now put your hands at the place where your low back meets the top of the glutes (for those with some anatomical knowledge, try to place your hands so that your thumbs are resting on your sacroiliac joints).  Slowly lean backward until you feel a stretch in both the low back and the abdomen.   Hold this position for just a few seconds and then carefully return to an upright position.  This exercise is considered a counter-stretch (a stretch which balances out another movement), so it’s often a good idea to use this stretch immediately after the front bend.  This stretch can also be done throughout the day.

Morning stretch
Stand with your feet about hip to shoulder width (this one can also be done in the seated position once you have it down).  Now raise your hands directly above your shoulders with the palms facing forward.  Once the arms are fully extended, pull the arms down so that your elbows are bent and are alongside the body.  You should feel the shoulder blades coming together as the arms come down.  As you bring the arms down, come down slowly like you are moving through molasses.  If you feel unsure about this stretch, perform it with your back against a wall so that your arms are in contact with the wall throughout the movement.  Repeat as often as you feel you need to.

Up Dog/Cobra
Start this stretch by laying face down on the ground.  Place your hands directly underneath your shoulders and slowly straighten your arms.  Allow your back to arch backwards as the arms straighten, but leave your hips and legs in contact with the ground.  When the arms are fully extended, the torso should be arched backwards, so that your torso is moving into a position perpendicular to the floor (if you aren’t yet flexible to reach full extension, just go as far as you comfortably can).  The advanced position of this stretch allows for the hips and knees to come off the ground, but for our purposes, the basic position is adequate to get the stretch.

Dead Bug
Start by lying face-up on the ground.  Next, raise your arms and legs so that the arms are extended with the hands positioned over the shoulders and the knees are over the hips (the knees should be bent ninety degrees so that the lower legs are parallel to the floor).  Now take the right arm and extend it back so that if you were standing upright, the arm would be above your head. Simultaneously, straighten the left leg so that it is parallel to the floor (it should be hovering a few inches off the ground).  The left arm and right leg should remain in the starting position during this movement.  Now, return the right arm and left leg to the starting the position. Repeat the motion with the left arm and right leg.  Alternate these movements until you have done 15 – 20 repetitions with each set of limbs.

Alternating Arm/Leg Lifts
This is the advanced version of the previous exercise that is more strenuous and also puts a greater stress on balance.  Start on all fours, with your hands and knees on the floor, with the hands underneath the shoulders and the knees under the hips.  Slowly raise the right arm until it is extended directly forward from the shoulder and parallel to the floor.  Simultaneously, straighten the left leg until it extends straight out from the hip and is also parallel to the floor.  Hold this extended position for a beat and then return to the starting pose.  Repeat the movement with the left arm and right leg, ending with a return to the original position.  Continue to alternate between the two opposing limb sets until you have done between 10 – 15 repetitions on each side.

Cat/Camel Stretch
Start on all fours, with your hands and knees on the floor, with the hands underneath the shoulders and the knees under the hips.  Take a deep inhalation and push your belly button towards the floor, arching the back downwards as far as you comfortably can.  Now exhale the air from your lungs as you pull your stomach upwards, arching your back upwards.  Repeat the movement with the breathing, inhaling as you push the belly downwards and exhaling as you arch the back upwards.   The name for this stretch comes from the visual image it creates, as the goal is to alternate feeling like you have a low, swinging belly like a cat to having a hump like a camel.

Lumbar Rotations
Lie flat on your back, facing the ceiling. Bring your right knee up to your chest and hug it with both arms.  Now extend your right arm out to your right and place the palm of your left hand on right side of your knee.  Gently draw the right knee to the left side of your body (keeping the knee bent), with the goal being to eventually bring the right knee to the ground on the left side of the body.  In the stretched position, your legs should look like the number 4 and you can move the knee closer to the head or feet in order to stretch different parts of the back.  After about 30 seconds, bring the right knee back to the right side of the chest and hug it to the chest again with both arms.  Straighten the right leg and bring the left leg up to be hugged to the chest.  Reverse the instructions so that the left arm in being extended and the right knee is being brought to the left side of the body.  After you have finished hugging the left knee to the chest at the end of the stretch, return to laying face up with both legs extended and the arms by your sides.

Rolly-Pollys/Potato Bugs
Lie flat on your back, facing the ceiling.  Bring both knees up to the chest and hug them with your arms.  Now gently rock forward and back along the length of the spine, making sure never to roll up onto the head.  Most of the contact should be between the upper back down to the top of the hips and the movement should be a steady rocking.  If you start to tip sideways or move in a more diagonal direction, stop rocking and start again.  You want to do about 10 – 20 repetitions of this exercise.  Once you have completed the repetitions, return to the starting position.  This is an excellent exercise to follow with a Up Dog stretch.

Bridges
Start by laying on your back, facing the ceiling.  Your knees should be bent and your feet should be flat on the floor, as close to your rear end as is comfortable. Now push your hips upward until only your shoulders, head, and feet are in contact with the floor.  If you find this position too tiring, you can use your arms to provide extra support by placing you hands under your hips and your elbows on the ground to provide extra structural support.  Hold this position for 15 – 30 seconds and then slowly lower yourself to the ground (if you had placed your arms under you for support, move them by your sides before you start to lower your hips).

Plow – This is an advanced stretch, proceed with caution
Start by laying on your back, facing the ceiling. Slowly raise your legs toward the ceiling as you bring your feet towards your head.  Allow your back to bend as you gradually bring your feet up and over your head.  At the end of the movement, your hips should be over your chest and your feet should be near your ears.  It is not unusual to have some difficulty breathing in this position as your chest and diaphragm are being constricted.  If you are able to maintain this pose comfortably and calmly, hold it for 10 – 20 seconds.  To get out of this position,  slowly allow the back to straighten, contacting the floor one vertebrae at a time.  The feet and legs should be the last body parts to return to the ground.  This is another stretch that can be followed by Up Dog for a nice counter stretch.

Hopefully you will find these additional stretches helpful in returning you to spinal health.  Remember to proceed with caution, and if you have any questions, feel free to contact me via email at cavemanmedicine @ gmail.com.  Thanks for reading!

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