07. Strength Training for People with Low Back Pain

My Back Recovery: Recovering from Chronic Low Back Pain

Training and activity is your no1 option when recovering from low back pain.

This episode introduces two of the most important exercises for building up strength within your lower back and practice movement control.

Strength Training for People with Low Back Pain

Always check with your medical professional if it is save for you to exercise! This exercises are not a substitute for individual medical treatment but aim to complement and support your recovery process.

Find all videos for this episode on:

http://mybackrecovery.com/resources.page

video episode 07

The exercises we are going to explore on this episode build up on your basic movement control skills and are both:

• challenging your movement control skills
• helping you building up strength and strength endurance within your back muscles

If you have listened to episode 06 you already have come to learn that clinical guidelines recomend therapeutic exercise and activity with strong supporting evidence for the management of chronic low back pain.

A recent review concluded that: "The hypothesis of specific lumbar extensor deconditioning as being a causal factor in LBP is presently well supported." meaning: weak back muscles could cause LBP.1

It further says: "It is by no means the only causative factor and further research should more rigorously test this hypothesis (...) however specific exercise may be a worthwhile preventative and rehabilitative approach."

In this episode i will share some of my most favorite exercises for building up strength within your back extensor muscles and practice movement control. These classis exercises will give you more options with your training, and will take your training to the next level.

Training introduced on 'my Back recovery' so far:

Episode 03:

Easy and back specific circle training with save loading profiles in terms of exercising. A first step in starting to work on strength and strength endurance as well as stability. Also a great way of improving blood flow in your muscles.

video

Episode 05:

Movement control exercises - basic skills for exercising - moving your pelvis/hip influences the posture of your lower back - being able of keeping a neutral position during certain exercises.

video

As you learned the basics for movement control (ep 5) and started to get familiar with a back specific circle training (ep 3) it´s time for you to take the next step!

'Good Morning' & Squat

Video

The good morning and the squat are static exercises for your back. This means no movement in the back while you are doing the exercises. They are more difficult to perform than the exercise-set from episode 03.

It really pays of focusing on doing the good morning and the squat with correct posture! Once you got this you can do most of other exercises in a correct way and will have more options to adjust exercises to your own needs. Remember to always adjust your exercises to your individual situation so that you are able to perform pain free and without aggravation of your symptoms.

Good Morning

The 'good morning' is great for building strength2 and movement control. Actually the 'good morning' is also used as a part of a validated test series used to detect impaired movement control within people with LBP.3

It works the gluteus, hamstrings and lower back.

Basically the 'good morning' is about bending forward with a straight (neutral) back.

Remember the last movement control exercise from episode 05: sitting and rocking forward and backward while keeping a moderate arch of your lower back with no movement in the back. The good morning exercise is the same in a standing position.

Stay upright, bend your knees slightly. This will help you doing the movement from your hips (because your hamstrings are not that much stretched when you are bending your knees).

Bend forward while you are keeping a straight back (remember straight means slightly curved, we wanna see a moderate arch (like a weightlifter) at the lower back, if your back seems to be flat, it is already flexed, we want to trigger those back extensor muscles and keep a neutral position thats why we need that arch!

This exercise should be pain free! So if you are doing it correctly and start to experience pain while leaning forward, remember the golden training principles. Adjust the exercise. Don´t go so far. Maybe you can do it leaning fwd 45 degrees out from the vertical position and will feel fine, and pain starts only if you go further. So respect your pain and adjust the exercise.

Most people who hadn´t done this kind of exercise will find it difficult to perform in the beginning.

Here is how i teach the 'good morning' to my clients:

First i start with all the exercises from episode 05. If you havent mastered these go back and work on them until you feel comfortable with them.

video - basic movement control skills episode 05

Most of the time the problem is that people don´t know how to keep good posture in their lower back. The movement you need to do is 'push your bum out while leaning forward'. This will result in hip flexion and back extension and result in a moderate arch in your lower back. Again some people could experience discomfort when arching to much. So experiment and find a position that is comfortable and pain free. The basic movement control skills from episode 05 will help you with that!

Than i let my clients sit on a high chair or at the edge of a table with their feet standing on the ground. Now it´s like a mix of the rocking forward and backward exercise we did at the end of episode 05, and the good morning. It´s a bit easier than in the standing position. If you feel fine proceed to the standing position.

It´s natural that when leaning forward to much, you will loose the arch in your lower back. So just go as far as it is pain free and you can keep correct posture.

Even when you are doing only a small movement like 10-20 degrees forward bending you still train your muscles and start to practice movement control.

One thing i experience quite often when people are doing the good morning is that they are squatting simultaneously. Although there is nothing harmful with this i suggest making two exercises out of it and not mixing the good morning and the squat. With this strategy you will gain better movement control and have more variability in you training options. So keep your knees slightly bent but try not to squat while leaning forward, and check this in a mirror from your side! You have to actively work for not bending your knees while leaning forward.

Squats

Absolut classics! Squats also work your back extensor muscles. Squatting is a typical everyday activity. Besides working all major muscle groups in your body and helping you stay fit, good form/posture with squatting will help you becoming more aware of your posture in everyday activities. The squat is almost the same as the good morning but with knee-movement and less dynamic leaning forward and backward.

Starting position: Standing upright, having your weight evenly distributed to both of your feet, leaning a bit forward and squatting down. Again keep that lower back arched when leaning forward.

If you can control your back already let´s check your knees. When squatting down look to your knees and feet: have your toes pointing straight forward and try to keep your medial border of your kneecap outside of your big toe. This will result in proper hip knee ankle alignment and less stress and strain on your knee. 4, 5

You can do the squat in a narrow stance or a wide stance. But keep your feet pointing forward and mind your knee position!

find more information at www.mybackrecovery.com

Literatur:

1. Steele J, Bruce-Low S, Smith D. A reappraisal of the deconditioning hypothesis in low back pain: review of evidence from a triumvirate of research methods on specific lumbar extensor deconditioning. Curr Med Res Opin. 2014;30(January):1-47. doi:10.1185/03007995.2013.875465.
2. Steele J, Bruce-Low S, Smith D. A Review of the Clinical Value of Isolated Lumbar Extension Resistance Training for Chronic Low Back Pain. PM R. 2014;(OCTOBER 2014):1-18. doi:10.1016/j.pmrj.2014.10.009.
3. Luomajoki H, Kool J, de Bruin ED, Airaksinen O. Movement control tests of the low back; evaluation of the difference between patients with low back pain and healthy controls. BMC Musculoskelet Disord. 2008;9(Mc):170. doi:10.1186/1471-2474-9-170.
4. Lee TQ, Morris G, Csintalan RP. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. J Orthop Sports Phys Ther. 2003;33(11):686-693. doi:10.2519/jospt.2003.33.11.686.
5. Koga H, Nakamae A, Shima Y, et al. Mechanisms for noncontact anterior cruciate ligament injuries: knee joint kinematics in 10 injury situations from female team handball and basketball. Am J Sports Med. 2010;38(11):2218-2225. doi:10.1177/0363546510373570.