Understanding back pain 2- exercises and stretches for ... · However, you are strongly advised to engage an exercise professional who can both motivate you and help you to implement

Therearemanyexercisesandstretchesthatyoucanperformtoreversetheproblemscausedbyprolongedsitting,butforsimplicity,onlythosethatyoucaneasilypractiseathomeoratworkarebeingintroducedinthisarticle.Therearenumerousotherbeneficialexercises,butpleasebeawareitisvitaltousethecorrecttechniquewhilstcarryingouttheseexercisesandstretchesinordertoavoidinjury.Therearemanyonlinevideosthatcanhelpyouwithyourtechnique.However,youarestronglyadvisedtoengageanexerciseprofessionalwhocanbothmotivateyouandhelpyoutoimplementthecorrecttechniques.Forexample,manypeopleperformtheplankexerciseincorrectly;insteadofhavingastraighttorsoprofilefromheadtotoe,theyhavetheirbottomsup,thuscreatingacurved/concaveback(excessivelumbarextensionandhipflexion),withtheabdominalsinalengthenedpositionandshortenedlumbarerectors(erectorspinaeinthelumbarregion).Thispositioncompressessomeofthespinaldiscs,therebyincreasingtheriskofinjury.StretchesBeforebeginning,pleasebewarnedthatmusclesshouldonlybestretchedoncetheyhavebeenthoroughlywarmedup.Thereareanumberofdifferenttypesofstretches:

• Dynamicstretches(usuallyperformedpriortoexercisesaspartofthewarm-upprocess)–forthepurposeofimprovingflexibility,thistypeofstretchwillnotbeconsideredinthisarticle.

• Proprioceptiveneuromuscularfacilitation(PNF)–atypeofstretchcarriedoutduring

cool-downafteranexercisesession,usuallywithanexperiencedpractitioner.

• Staticstretches(canbecategorisedasdevelopmentalandmaintenance)–thesearethestretchesthatareadvocatedtoimproveflexibility.

Developmentalstretches–byholdingastretchforaperiodoftime,themusclespindlesbecomedesensitisedwhichinducesrelaxationofthetargetmuscle,allowingthestretchtobetakenfurther.Stretchthemuscletoamildpointoftensionbutwithoutpain.Ifyourmuscleistight,itmaytakeacoupleofminutesforthetensiontobealleviated.Whenthetensionsubsides,takethestretchfurther;holdituntilthetensiongoesandthentakethestretchfurtheroncemore.Thesestretchesareespeciallyimportantforthefollowingmusclegroups:

• Calf• Hamstring• Adductor• Hipflexor• Pectoral

Understandingbackpain2-exercisesandstretchesforbackpainsufferers

DrJamesTang,MBA,BDS,LDSRCS

GeneralDentalPractitioner,Level3PersonalTrainer(REPregistrationnoR1045463),SportsNutritionist

&Level3SportsMassageTherapist,withspecialinterestinposturaldysfunctionandlowerbackproblems

MaintenancestretchesThetechniqueusedissimilartodevelopmentalstretchesbutyoudonotneedtotakethestretchfurtherafterthetensionsubsides.Theseareparticularlysuitableforthefollowingmusclegroups:

• Quadriceps• Glute• Trapezius• Latissimusdorsi• Deltoid• Triceps

Examplesofdevelopmentalstretches1)HamstringstretchesDevelopmentalstretchesareparticularlybeneficialforthehamstrings.Youcanstandfacingachairandputyourlegupontheseat,keepingitstraightwithyourbackupright.Bendyourtorsoslightlyforwarduntilyoufeelthetensioninthehamstring.Alternatively,lieonyourback,raiseonelegoffthefloorandbringittowardsyourchest.Keepingyourlegstraight,placebothhandsbehinditandpullitinslightlyclosertoyourchestuntilyoufeelalittletension.Holdthispositionuntilthetensionsubsidesandthentakethestretchfurtheronemoretime.Repeatthestretchwiththeoppositeleg.2)HipflexorstretchesKneelwithonekneeonthefloorandyourotherfootinfrontofyouwiththekneebentata90-degreeangle.Pushyourhipforwardandkeepyourbackupright.Holduntilthetensionalleviates;then,takethestretchfurtheroncemoreuntilthetensionsubsides.

3)PiriformisstretchesStretchingexercisesforthepiriformismuscleandotherabductorsofthehipshouldbeperformedinadditiontoadductormusclestretches.Lieonyourbackwithbothkneesbentat90degrees.Theankleofthelegtobestretchedshouldbeplacedonthefrontofyourotherknee.Usingyourhands,thethighofthislegisthenpulledintowardsyourchest.Holdthispositionfor20–30secondsoruntilthetensiongoes.Then,takethestretchfurtheruntilthetensionsubsidesonceagain.

ExercisestoactivateyourdeepercoremusclesForyoursafety,youshouldnotperformanyexercises,eithercardioorresistancetraining,untilyouareabletoconsciouslyactivateyourtransversusabdominis(TvA);wheneverpossible,youneedto‘tightenyourcore’andkeepyourbackupright(maintainaneutralspine)sothatyourspineisprotectedduringthese‘explosive’movements.1)Activationofthetransversusabdominis(TvA)WhentheTvAiscontracted,consciouslyorsubconsciously,theothermusclesoftheinnerunitcontractimmediatelyafterwards.Duetoyearsofmisuse,poorpostureorweakness,contractionofthestabilisingmusclesoftheinnercoreunitcanbeverydifficult.Thiscanresultinalackofsubconsciousactivationofthesemuscles.Sittingonastablesurface,suchasachair,foraprolongedperiodoftime‘switchesoff’thesestabilisationmusclesasthereisnoneedforthemtostabilisethebodywhilstsitting.Thereareexerciseswhicharedesignedtoimprovethesubconsciousactivationoftheinnerunitmuscles(seebelow).Researchhassuggestedthatonly30percentofthemaximumcontractioncapabilityoftheinnerunitmusclesisrequiredtocreatesufficientintra-abdominalpressuretostabilisethespine.

Forthecontractionofthestabilisingmusclestobecomeautonomous,itisessentialtoperformconsciouspracticeofmusclecontractiononaregularbasis.TheTvAisoneofthemusclesresponsiblefortheforcedexpirationofairwhenwecough.Itisalsooneofthefirstmusclesto‘fire’whenwemoveandchangedirectionwhilstwalkingorrunning.TheTvAprovidesastablebasewithinthecentreofthebodyforactivitiesthataremoredistal,suchasheavylifting.Withthisinmind,itwouldbeusefultobeabletopinpointtheTvAandconsciouslyactivateit.Toactivatethetransversusabdominislieonyourbackwithyourkneesbentat90degreesandyourfeetflatonthefloor.Relaxandtrynottoflattenyourspineagainstthefloor,butrathermaintainanormallumbarcurvature.Findapositiontwoinchesbelowthenavelandtwoinchestoeitherside.Presslightlyoneachsideusingthefirsttwofingersofyourhands(thisisthelocationofthetransversusabdominis)thencough.YoushouldbeabletofeelthecontractionunderyourfingersastheTvAfires.

Breatheoutcompletely,trytodrawyournavelinasfaraspossibleandtiltyourpelvisupveryslightly.YoushouldfeelthecontractionoftheTvA.StartbreathingnormallywhilstmaintainingthecontractionoftheTvA.Theaimoftheexerciseistrytoreplicatethecontractionfeltwhilstcoughingbutwithoutactuallycoughing.Onceyoucancontractthetransversusabdominis,performthesameactionwithoutholdingyourbreathorcontractingtherectusabdominis.2)GlutebridgeThisisprobablyoneofthemostusefulexercisesever,butalltoooftenitsbenefitisnegatedbypoortechnique;itisimportanttorememberthatyoushouldnotuseyourlowerbackoryourhamstringstoperformthisexercise.

Lieontheflooronyourback.Bendyourkneesata90-degreeangleandplaceyourfeetflatonthefloor.Contractorsqueezeyourglutes(youshouldbeabletofeelthemtightening)toliftyourhipsandthighsoffthefloortoformastraightlinebetweenyourkneesandshoulders.Keepyourbackstraightatalltimes;maintainaneutralspineandtightenyourcore.Oncethishasbecomeeasier,youcanbridgewithjustoneleg,keepingyourotherlegstraight–thisismuchmorechallengingasthisintroducesunilateral/asymmetricalactivationoftheglutes.3)BodyweightsquatThebodyweightsquatisanexcellentexercisetoworkthemajorityofthelegmuscles,especiallythequadricepsandtheglutes.Itisa‘primal’movementpatternwhichmeansthatitissomethinginnateandnecessaryforhumanmovement,asopposedtofixedexercisemachinesthatonecanseeinmanygyms.

Toperformabodyweightsquatstandwithyourfeetatshoulder-widthapartandtoespointingforward.Keepyourbackstraightasyouinitiatemovementatyourhips.Pushyourbuttocksoutbehindyouandbendyourknees(donotletyourkneesmoveinfrontofyourtoes).Startwithshallowsquatsandincreasegradually.4)BodyweightlungesToperformabodyweightlungestepforwardwithonefootinalongstride.Makesureyourfeetareinlineandpointingstraightforward.Keepyourbackuprightasyouslowlybendandloweryourbackkneetowardsthefloor,raisingyourheel.Atthesametime,bendyourfrontkneewhilstensuringthatitdoesnotgobeyondyourtoes.Donotletyourbackkneetouchthefloorbeforereturningtothestartingposition.

5)ActivationofyourGluteMedius

Ifyouhavepoorpelvicstability,therestofthebodyisdrasticallyaffected.Spinalalignment,leglength,posture,shouldermechanics,kneestability(thelistgoeson).Mosttrainingthesedaysfocusmerelyintheanteriorandposteriorsupportforthepelvis.Justasimportant,however,islateralstabilisationbecausealackoflateralstabilityisbeingfoundtobedirectlyrelatedtokneeandbackproblems.

Lateralstabilisationisrequiredwhenthepelvisistiltedtotheleftorrighthandside–lateralmovement.Thishappenswhenyoustandononelegandwheneverwewalkorrun.

Theprimarystabilisingmuscleforthisistheglutemedius,however,wecanalsorecruitthetensorfasciaelatae(TFL)muscle(bothoftheseareabductormuscles),whichisattachedtotheiliotibialtract/band(ITB)downtothelateralsideofthelegtotheknee.Iftheglutemediusisnotperformingitsjobproperly,theactionwillbecompensatedbyincreasedcontractionoftheTFL,throughtheITBcausingexcessivelateralpullonthepatella,resultinginmal-alignmentandfinallykneepain.

Thelargestofthethreemuscles,yourgluteusmaximus,hastheprimaryroleofhipextension(togetherwiththehamstrings).

Asyourhipisnotfixedagainstanythingsolid,theglutesneedsomethingtoworkagainstinordertocreatestability.Thisistheroleoftheabdominalmuscles,suchastheTvA.

Youshouldbeabletofeelyourglutesworkingduringlunges,squats,deadlifts,polymericandalmostanyotherlargebodymovementyouareperforming.Ifyouarenotfeelingthosemusclesworking,thereisagoodchancethattheyarenotactivatedproperly.Duringanymovement,itisnecessarytoenforcetheneuralconnectionbetweenyourbrainandthehipstabilisers.

Themosteffectivetechniqueforimprovementoflateralstabilisationisunilateraltraining.i.e.performingeachexerciseononesideofthebodyinsteadofbothsidesatthesametimee.g.onelegsquat.Duringunilateraltraining,itisimportantthattheybodyremainstraightintheverticaldirectionandthatthehipsshoulderandkneesallremainintheproperalignment,withTvAengagedandbackstraight.

HyperkyphosisExercisesKyphosisisacommonconditioncharacterisedbyanexcessivecurvatureoftheupperportionofthespine.Thelongtermeffectsofkyphosisonthebodyincludeimpingementoftheshoulderrotatorsandchronictensioninthebackandshouldermuscles.1)ProneextensionBeginbylyingfacedownonthefloorwithbotharmsdownbyyoursideandpalmsfacingup.Placebothfeettogether.Slowlyliftyourchestoffthefloorashighasyoucomfortablycanwithouthyperextendingyourback.Contractingyourscapularstogether,raisebotharmsoffthefloor.Ensurethatyourheadisinalignmentwiththerestofyourbody.Holdthispositionfor10to12seconds.

2)ReverseflyToperformthisexercise,youwillneedasetoflightweightdumbbells.Sitontheendofabenchwithyourbackstraightandyourabdominalmusclestight.Leanforward,bringingyourchestoveryourknees.Stretchyourarmsoutandliftthemuptoyourshoulderlevel,squeezingtheshoulderbladestogether.Loweryourarmsdownoneithersideofyourbody.Whenperformingthisexercise,makesurethatyourelbowsareslightlybentanddonotraiseyourarmshigherthanshoulderlevel.

3)DumbbellshrugForthisexercise,youwillneedasetofmoderatedumbbells.Standwithbothfeethip-widthapartandyourshouldersdownandback.Slowlyraiseandloweryourshouldersinashruggingmotion.

ConclusionAlthoughsettingthebodyinmotioncanhelptolessenbackpainovertime,manypeoplechoosetostayinactiveduringaperiodoflowerbackpainbecauseofthediscomfort.Thisisincontrasttosomeoftheepidemiologicalevidence.Itisrecommendedthatbedrestshouldbeavoidedandpatientsshouldbeasactiveaspossible,includinggoingtowork.Thisisbecauseinactivityallowsthejointsandmusclestostiffen,whichcanmakenormalactivitiesdifficult.Evenifbackpainhindersyourabilitytoperformmildexercises,itisimportanttomoveasmuchaspossible,evenifitisjustwalkingthedogorcleaningthehouse.Pleasenotethattheaboveisnotanexhaustivelistofstretchesandexercisesthatwillalleviateyourbackproblems,youarethereforestronglyadvisedtoconsultyourpersonaltrainertodevisethemostappropriatestretchesandexercisestosuityourownpersonalcircumstances.Preventionisbetterthancure.Itisadvisablethatyoustrengthenyourcoreandavoidsittingforaprolongedperiodoftime.Standingupperiodicallywillhelp.Whenyousitdown,dosowithanuprightpostureandneutralspinebecausesittingwithanexcessivelumbarextensioncancauseanteriorpelvictiltwhereassittingwithanexcessivelumbarflexioncancauseposteriorpelvictilt.Bothofthesepositionscancreatemuscularimbalancepredisposingtobackpain.

Althoughthefocusofthisarticleisoneducatingthereaderabouttheanatomyofthetorsoandthedeepermuscles,manyresearchersofbackpainrecommendexercisesthatarealittlewiderinscopethancoretraining.Theseincludefunctionalandflexibilitytraining,aerobicexercisestostrengthyourheartandlungs,aswellastocontrolanyweightgain,resistancetraining,asmentionedearlier,andsquatsandlungesetc.Theseactivitiesimprovegeneralflexibility,thusensuringthereisagoodrangeofmovementaroundthejoints.