Stabilizing Your Spine with Exercise Part I

Have you worked your “core” today?

Just say yes, because honestly, if you have been up walking, standing even sitting, you have worked your “core” muscles. But what muscles make up the core? The answer to that would vary depending on who I ask. When I go to the gym, I see people doing all kinds of exercise for their core, but which exercises are most beneficial for maintaining a strong back and prevent you from injury? As a PT, I consider the abdominal muscles and upper back muscles all part of the “core”, or what I call the trunk muscles. We will tackle the upper back and neck in next weeks posting, so if you are looking for ways to strengthen your upper back and neck, tune in. But today, we are discussing the low back and how to properly exercise the muscles that support your low back.

In the trunk, you have the abdominal muscles and back muscles; the muscles of the low back are the latissimus dorsi and the paraspinals. As a PT, I tend to focus more on isolation and strengthening of the abdominals and the multifidus (one of the paraspinal muscle). There are four layers of abdominal muscles; the most superficial layer of your abdominals is the external oblique, the next layer is the internal oblique. The next layer is the rectus abdominus, it gives us that “six pack” appearance. The deepest and most important of the abdominal muscle is the transverse abdominis (TrA). The TrA is the primary stabilizer of the lumbar spine(1), it is the deepest abdominal muscle, otherwise known as the “lower abdominal”. Strengthening this muscle is key to gaining stability and reducing pain in the low back. One study conducted over 6 weeks found that strengthening your TrA and multifidus reduced pain and improved functional mobility up to 90% (1). Strengthening these muscles requires specific exercises that require focus and subtle movements. While crunches, Russian twists and various gym machines are great for strengthening your rectus and obliques (2), they do little to isolate and strengthen the most important muscles that stabilize your spine. I have included some common exercises I prescribe as a PT at the of bottom of page.

Muscles of the Abdomen

Another aspect of a healthy low back is flexibility. The primary muscles that cause low back “tightness” and potentially injury are the hamstrings, piriformis and hip flexors. These are large muscles that attach to the pelvis and the lower lumbar vertebrae. When these muscles are “tight” they can actually inhibit other muscles from engaging. People who spend time sitting at a desk or in a classroom typically have muscle shortening. Flexibility is an important part of maintaining a healthy back and it should be done daily. I have included some stretches that I frequently prescribe here as well.

This is not an all inclusive list of exercises, nor is exercise the only answer to back pain. As a PT, I look at the whole body to see what needs to be addressed, strengthen what is weak, stretch what is tight, joint and soft tissue work, as indicated. However, what I have learned over the years is that education is key, what occurs during a visit must educate the client to care for themselves in the future.

Ready to feel better? If you try these exercises, or maybe you have already tried exercises like these, and need more guidance, please email or call me.

Transverse Abdominus:

>Lay on your back with your knees bent. Place your thumbs on your stomach just inside your hip bones to feel the muscle contract.

>Activate your abdominals by one of the following actions:

"Try to bring your naval to your spine" "Bring the two hip bones together" "Zip up your pants without using your hands"

Hold 3 seconds, repeat 10 times, 2 sets daily

Pelvic Tilt Marching:

>Lie on back with knees bent up and both feet on mat. Tighten your stomach muscles and flatten your back against the table. While holding this position, lift one leg up keeping a bend in the knee. Return leg down slowly.

>Alternate between lifting left and right legs, making sure to keep back flat on the table. Place your hands on your pelvis, do not let your pelvis rock.

Repeat 20 times, 2 sets daily

Bird Dog:

>Beginning on hands and knees, extended opposite leg and opposite arm away from body.

>Engage core muscles keeping pelvis flat- do not let your pelvis drop and do not arch your back.

Hold each position 3 seconds, repeat 10 times each side, 2 sets daily

Seated Hamstring Stretch:

>While seated, rest your heel on the floor with your knee straight and tip your pelvis forward until a stretch is felt behind your knee/thigh.

Hold 30 seconds; repeat 4 times daily

Seated Piriformis Stretch:

>While sitting in a chair, cross your affected leg on top of the other as shown; gently lean forward until a stretch is felt thru the buttocks of the crossed leg

>Lean forward from the hips keeping your back straight trying to place your belly on top of your thigh. DO NOT PUSH DOWN on your knee.

Hold 30 seconds; repeat 4 times daily

Exercise Photo Credit HEP2GO

Hip Flexor Stretch:

>While laying diagonally on a table, couch or bed, bring your opposite knee into your chest. Place the opposite leg on the floor.

>A stretch should be felt along the front of your thigh. Bend your knee slowly backwards to increase your stretch.

Hold for 30-60 seconds; repeat 4 times daily

(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2972594/ Segmental stabilization and muscular strengthening in chronic low back pain ‐ a comparative study pain Clinics 2010

(2)https://www.researchgate.net/publication/313375907_Electromyographic_Analysis_of_Traditional_and_Nontraditional_Abdominal_Exercises_Implications_for_Rehabilitation_and_Training