The Big 3 for Low Back Pain
Spinal stability is achieved by “stiffening” the muscles around the low back and abdomen AND teaching your body to move in a spine-sparing way (spine-sparing means that the hips do most of the movement rather than the spine).
These “Big 3” exercises create a core strength that enhances stability in the low back. Each exercise targets different muscles involved in creating this strength.
That’s why we want to try to get you doing the whole set of exercises – even if only in a very gentle, modified form that your body is comfortable with.
The point of these exercises is that they don’t put strain the low back – so stop if you experience any pain.
Before You Start
The foundation to these exercises is learning to do abdominal breathing and bracing.
Abdominal breathing is when you use your tummy muscles to breath rather than your chest. You can practice this by putting one hand on your tummy and one on your chest and breathing. What you need to master is breathing from your tummy (abdominal muscles) and not your chest. The hand on your chest should not move at all. Practice this in all positions, sitting, standing, lying down as well as walking and during activity.
Some people struggle to co-ordinate this abdominal breathing – in which case more practice is needed. Once you’re familiar with it move on to leaning how to brace the abdomen as well.
To learn how to create an abdominal brace your back properly first lie down, relax your abdominal muscles and push fingers into the front/side of your tummy muscles about 5 to 10 cm lateral to the navel. Just push in gently with the tummy muscles relaxed.
Keeping your fingers gently pushing into your tummy, then gently contract your abs. You will feel your fingers being pushed out. This is a great demonstration of how this abdominal contraction creates a pressurised support that helps to brace your low back.
Many people know to use this brace technique (basically tightening your tummy muscles) when you lift or move awkwardly, to protect your back. However, it’s often important to use routinely to keep the low back supported. For example, with a heavy lift you would brace more, while for activities that require spine posture control (e.g., sit to stand) you should still brace, but less force is needed.
Now We Move on to the Main “Big 3” Exercises
For each exercise we have a beginner, intermediate and an advanced version. We will just include the Beginner versions here with links below the exercise to the whole set.
The three exercises are:
· Curl Up
· Side Plank
· Bird Dog
The Curl Up
Position yourself lying down on your back with your hands supporting your low back region.
You should not flatten your back against the floor keeping the natural curve.
Bend one leg to 90 degrees with the other remaining on the floor.
Picture your head and neck as a rigid block that moves as one.
Start by putting on your abdominal brace. Make sure you can breathe in and out while maintaining this brace.
Then your head and shoulders are raised a short distance from the floor and held for 10 seconds before slowly lowering back down.
Key Tips For Your Curl Up
This is a tricky movement to get right, so here’s a couple of specific extra tips.
Firstly, although it’s similar to a sit-up this movement is NOT a sit-up. So, don’t try to sit up, you must keep the low back stiff and not actually roll up into a sit-up any more than lifting your shoulders off the floor by a 2-3 inches.
When you “curl up” make sure you move your torso and neck as one fixed unit. Although it’s called a curl-up we don’t want you to curl your neck or back at all. The movement is initiated from the lower core muscles.
Most people mistakenly lead the movement with their chin (even some of the online videos they do this). Don’t get too stressed about it. You just need to keep reminding your body of the correct movement pattern. As you practice the exercise more, just remind yourself to keep the neck neutral, moving your neck and torso as one fixed unit.
The Side Plank
Beginner Version – Lay on your side and form a bridge between your knees and forearms by lifting your pelvis off the floor holding for 10 seconds.
As you lift be careful not to twist at your hips. Also keep your neck in line with your spine.
The free hand should be placed on opposite shoulder for support. The key is making sure your back and legs are straight and have no bend in them.
For the intermediate Version of this exercise Lay on your side to create a bridge between your feet and forearms (lifting your pelvis). As you lift be careful not to twist at your hips. Try to keep in a straight line from head to toe.
This exercise is held for 10 second repetitions.
The advanced version of this exercise is in the same position raising an arm out above your side.
This exercise starts in the kneeling position with arms under shoulders and hips under knees.
In this position start your abdominal brace.
While bracing your abdominals extended one hand forward using your other three limbs to maintain the same position. Hold the position with the arm out for 10 seconds before returning to starting position.
Now change between extending each individual arm and leg for 10 seconds.
The key is not to rotate your body by keeping shoulders and hips in line while extending individual limb.
The more advanced version of this exercise has you extending an arm and opposite leg at the same time, holding for 10 seconds.
The key with this exercise is not to rotate your pelvis keeping your hips straight. The below picture shows too much rotation in the pelvis.
To correct this, I find that putting a tennis ball or golf ball in the small of the back provides great feedback in the absence of a mirror. If the ball rolls off your back, your hips are rotating too much.
Repetitions for the Exercises
Stick to 10 second exercises. Do not be tempted to hold longer. These exercises need to be done repetitively for the 10seconds, with excellent technique.
When you start to compensate your technique, stop the exercise as otherwise you’re neurologically reinforcing those bad movement patterns.
Do, don’t be a hero. But do be consistent. I recommend doing these 3-4 times a week (basically it’s a good idea to have a rest day between them).
Start with a higher number of repetitions for the first set, then decrease the number of reps for each set after that. Take it slow and focus on technique. You’ll build up to doing the full set outlined below.
You should start off doing less first then build up once you find it easy to hold good form throughout.
Ultimately, you’re aiming for:
10 REPS of 10 secs on each side, then
8 REPS of 10 secs on each side, then
6 REPS of 10 secs on each side
But you can start by just doing a few each side such as –
6 REPS of 10 secs on each side, then
4 REPS of 10 secs on each side, then
2 REPS of 10 secs on each side
If you want to read more about exercises you can do at home try these other blogs:
By James Revell
4 responses to “The Big Three Rehab Exercises For Low Back Pain”
Call now 01323 722499