Back pain: preventing and treating back injuries

Exercises to strengthen the back following injury

Phase 1- Muscle Balance

The aim of phase 1 is to restore normal muscle length, range of motion and introduce postural awareness.

Pelvic Tilts:
Lying supine, with knees bent, feet flat on floor and the spine in a natural curve (neutral alignment). Gently flatten the lower back and then arch, tilting the pelvis posteriorly and anteriorly. This movement is performed slowly and deliberately and the pelvis is tilted only within a pain free range of motion.

The movement is continued for up to 2 minutes or until the movement becomes fluid and controlled.

Curled forward bending:

Stand with feet positioned about hip width apart. Slowly reach towards the floor allowing neck, trunk and hips to flex until a comfortable range of motion is reached. Return to the upright position by contracting the glutes and extending the hips. The movement should not be initiated by extending the spine.

Side Bending

Standing with feet positioned about hip width apart. Place hands just above the iliac crests, at the lowest level of the ribs and slowly bends to one side by tilting the shoudlers rather than moving at the waist. Motion is repeated to the other side and continued until the movement becomes co-ordinated.

Phase 2- Static dynamic and reactive stabilization

1a. Floor Bridge

Lying supine, with knees bent and feet flat on the floor. Arms are held by the sides of the body. Begin by lifting the hips up towards the ceiling until there is a straight line between the knees and shoulders. Brace abdominals and contract gluteals. Return to start and perform about 6-10 times.

1b. Floor Bridge – arms across chest

1c. Floor Bridge – single leg

1d. Feet on stability ball

2a. Four point arm/leg reach

Begin in a 4 point kneeling position body weight should be central. Brace abdominals while reaching forward with one arm and backwards with the opposite leg. Neutral spine should be maintained throughout. Repeat on other side and do 6 repetitions.

3a. Pillar Bridge

Lie on stomach with fore arms on the ground under chest and knees on floor then move into a press up position with just your forearms and toes in contact with the floor. Push your chest as far away from the ground as possible. Brace abdominals head in line with spine. Hold for 20-30 seconds.

3b. Pillar Bridge alternate arms hold for 2 seconds

Phase 3- Functional Strength

3a. Stability ball back extension

Lie over the stability ball with knees slightly bent, hands by side of head and abdominals braced. Slightly flex and then move to extend spine, continue for 15 repititions. Movement should be performed slowly and deliberately to ensure that spine does not extend past neutral alignment.

3b. Stability ball back extension – ball moved further towards pelvis

3c. Stability ball back extension – Holding small weight in hand

4a. Forward ball roll

Start in a kneeling position in front of the ball and places clasped hands at the centre of the ball. Keep neutral spine and brace abdominals. Roll forward slowly, knee extension and shoulder flexion should be simultaneous. Do not arch back.

4b. Forward ball roll – increase holding time

4c. Forward ball roll – increase distance to roll

5a. Squat

Perform triple flexion of the hip, knee and ankle. Lightly brace abdominals and keep neutral spine. Ensure knees do not over shoot toes. Perform 10-12 repititions.

5b. Squat – slower tempo

5c. Squat – with bar bell

6a. Dead lift with dumb bells

Hold a light pair of dumbbells. Feet shoulder width apart. Lightly brace abdominals and keep neutral spine. Similar to a squat bend down to a position where the thighs are almost parallel with the floor, as if to place dumb bells by the side of body. Brace abdominals further and contract gluteals. Return to start position and perform 10-12 repetitions.

6b. Dead lift with bar bell

7. Kick outs on bench – one leg

Sit on the bench with hands behind you, gripping the edge of the bench so that you are well supported. Bend the knees and kick the legs through smoothly but quickly. Keep heels high and don’t point your toes.

7b. Kick outs on bench – both legs together

Phase 4- Functional Power and Agility

8a. Russian power twist – body on ball

Start in a bridge position on the ball holding medicine ball in both hands vertically above chest. Brace abdominals and aim to keep the spine in good alignment. Keep arms extended and roll over to right side – return to starting position and switch movement to left side. Perform 10-12 repetitions and increase speed as repetitions increase.

8b. Russian power twist – body on ball, weight increased.

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