LOWER BACK PAIN: EXERCISES AND STRETCHES

      ANATOMY

The lumbar spine is an area of ​​the back located between the dorsal vertebrae and the sacrum. It consists of 5 vertebrae that form a lordosis or anterior curvature in the back. They support the weight of the body and give mobility to the spine in flexion, extension, inclination and slight rotation. Between each vertebra is the articular disc formed by a fibrous ring and a nucleus pulposus, its function is to allow movement and acts as a shock absorber. The lumbar spinal discs are larger than the rest of the spine as they have to bear more load, their nucleus pulposus is slightly posterior, which generates a greater number of hernias in this area.

Lumbar Vertebrae

MUSCULATURE

·         Lumbar erector spinae: They are located in the posterior area of ​​the back and are responsible for extending the spine and staying upright. Their contracture is usually painful.

·         Abs: When they are strengthened, they reduce the load that the lumbar curve receives. They frequently atrophy with age and obesity, causing hyperlordosis (increased curvature of the spine).

·         Iliopsoas: the lumbar spine is inserted in the anterior area; its function is flexor and internal rotator and its contraction increases the lumbar curvature.

·         Gluteus and Pyramidal: Located in the posterior area they extend the lower limbs, perform external rotation and support the pelvis so that it does not fall with the only support of one foot.

·         Hamstrings: They range from the hamstrings of the pelvis to the femur and fibula through the back. Various lumbar problems are related to shortened hamstrings, due to the fact that they perform a positional change of the pelvis, leading to retroversion and affecting the curvature of the back.

Musculature lower back

 

  LOWER BACK PAIN

Low back pain is defined as pain or discomfort in the back of the body, located between the margin of the twelve ribs and the lower gluteal region, which may worsen until it limits habitual activities. It is a very common health problem and represents the main cause of activity limitation, disability, loss of productivity and absenteeism in the world, which generates enormous economic burdens for social security. Ten years ago, it was considered a problem limited to western countries. Since then, however, a large number of studies have shown that low back pain is a major problem in countries with lower and middle development levels.

Low back pain syndrome is one of the most common conditions in clinical practice, up to 84% of adults experience a low back pain episode at a certain period of their life. It can have a major negative impact on quality of life and function, and is often associated with depression and anxiety.

Analysis of the incidence of lower back pain showed that the majority of our sample population suffered from pain in the lower back. Nonspecific lower back pain is frequently encountered in primary care, with 25-50% of cases following a chronic course. Over recent decades, a large body of research has focused on the effectiveness of both pharmacological and non-pharmacological treatments.

The origin of low back pain can be classified as mechanical, neuropathic and secondary due to another disease. Mechanical back pain implies that the source of the pain originates from the spine or its associated structures. Neuropathic pain indicates that the presence of symptoms is due to irritation of the spinal nerve root. There are several ways to distinguish mechanical pain from neuropathic pain in the lower back when taking an anamnesis. Patients often describe neuropathic pain at the tip of the finger by pointing to the nerve path, while mechanical pain can often be transmitted to the buttocks and upper leg, while pain below the knee is more common in the root pain.

In this report I will speak about some exercises for to stretch and strengthen that zone and minimize possible pains. In accurate pain, I recommend you begin stretching and doing simple movements of pelvic, and after start strength your abdominal area.

 

  STRETCHES

1. LUMBAR ERECTOR SPINAE

On your back on a firm surface, extend one leg towards the ground and the other bring the knee to the chest with the help of the arms to stretch the posterior musculature of the back. Stay 30 seconds in this position and change legs.

Lumbar erector spinae stretch

2. GLUTEUS

Same position as in the previous exercise, but the knee that previously went towards the chest now goes towards the opposite shoulder until tension is felt in the buttock. Hold 30 seconds.

Gluteus stretch

3. QUADRATUS LUMBAR

Sitting on heels, hands fully forward and back stretched. Lean to both sides and stay in position for 30 seconds.

Gluteus stretch

4. ILIOPSOAS

On your knees take a big step forward with one leg, your trunk straight, carry the weight forward until you feel tension in your groin. Hold 30 seconds.

Iliopsoas stretch

5. HAMSTRINGS

On your back or standing, raise the leg to stretch raised to a height with the knee flexed, flex the hip forward but without bending the spine and stretch the knee until you feel tension in the back of the thigh. Hold the position for 30 seconds.

Hamstrings stretch

 

  STRENGTHENING

      6. PELVIS GIRDLE

Face up, you should begin with a good static position so lie on your back with a bent towel under your head. Do movements of your pelvic arching your lower back and then touching it with the floor, trying to be aware of your hip position and try to keep an intermediate position between these two, called the neutral pelvic position. Do it 10 times

Pelvic girdle

 7. TRANSVERSE ABDOMINIS

Face up with both legs flexed, put your hand on you between your belly button and your hip, inhale with your noise and exhale with your mouth trying to hid your belly button and you should feel abdominal area get stronger.

If we feel the palpation area harder, we have successfully activated the deep muscles of the abdomen. The pelvis must be in a neutral position. Perform 3 sets of 12 repetitions.

Transverse abdominis

 From here, we can perform different exercises that increase abdominal tension to help strengthen it:

·         Face up, raise one leg to 90 degrees and then stretch it to 45 degrees.
·         Face up, raise both arms towards the ceiling and bring them back 45 degrees.

Variations to increase abdominal tension

 8. GLUTEUS

Shoulder bridge. Face up, perform retroversion of the pelvis, squeeze the gluteus and raise it to a straight line with the shoulders, pelvis and knees. And go back down. Perform 3 sets of 12 repetitions.

Shoulder bridge

   Of course that exercises have a lot of variations and complications, be careful but don´t be scared in to follow your progression.

EXAMPLES OF VARIATIONS

Shoulder Bridge Variation

Two Legs Raise

Shoulder Bridge Variation 2

Exercises for lower back pain

Physiotherapy exercises for lower back pain