There are many exercises and stretches that you can perform to reverse the problems caused by prolonged sitting, but for simplicity, only those that you can easily practise at home or at work are being introduced in this article. There are numerous other beneficial exercises, but please be aware it is vital to use the correct technique whilst carrying out these exercises and stretches in order to avoid injury. There are many online videos that can help you with your technique. However, you are strongly advised to engage an exercise professional who can both motivate you and help you to implement the correct techniques. For example, many people perform the plank exercise incorrectly; instead of having a straight torso profile from head to toe, they have their bottoms up, thus creating a curved/concave back (excessive lumbar extension and hip flexion), with the abdominals in a lengthened position and shortened lumbar erectors (erector spinae in the lumbar region). This position compresses some of the spinal discs, thereby increasing the risk of injury. Stretches Before beginning, please be warned that muscles should only be stretched once they have been thoroughly warmed up. There are a number of different types of stretches: • Dynamic stretches (usually performed prior to exercises as part of the warm-up process) – for the purpose of improving flexibility, this type of stretch will not be considered in this article. • Proprioceptive neuromuscular facilitation (PNF) – a type of stretch carried out during cool-down after an exercise session, usually with an experienced practitioner. • Static stretches (can be categorised as developmental and maintenance) – these are the stretches that are advocated to improve flexibility. Developmental stretches – by holding a stretch for a period of time, the muscle spindles become desensitised which induces relaxation of the target muscle, allowing the stretch to be taken further. Stretch the muscle to a mild point of tension but without pain. If your muscle is tight, it may take a couple of minutes for the tension to be alleviated. When the tension subsides, take the stretch further; hold it until the tension goes and then take the stretch further once more. These stretches are especially important for the following muscle groups: • Calf • Hamstring • Adductor • Hip flexor • Pectoral Understanding back pain 2- exercises and stretches for back pain suffere Dr James Tang, MBA, BDS, LDS RCS General Dental Practitioner, Level 3 Personal Trainer (REP registration no R1045463), Sports Nutritionist & Level 3 Sports Massage Therapist, with special interest in postural dysfunction and lower back problems
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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.
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