Strengthening Exercise Program for Low Back Pain Relief

The next few exercises are examples of some basic stabilization exercises that aid in low back pain relief. Having strong midline support is critical to decreasing the stresses placed upon the lumbar spine (lower back) and pelvis. It should be noted, however, that often muscles that appear to be weak may actually be inhibited by an antagonist muscle (muscle on the opposite side of the joint) or by faulty lumbar facet joint mechanics.

Generally, an inhibited muscle will not respond to resistance training. Therefore, if low back pain or hip pain is being experienced, it is important to first see a spine therapist in order to screen for muscle inhibition. Attempting to strengthen an inhibited muscle may cause a substitution pattern that only reinforces a painful movement pattern. In general, it is advisable to see a spine specialist who specializes in back pain prior to beginning any exercise program.

In addition, unlike stretching exercises, it is important to take a few days off per week from strengthening exercises to allow the body to rest and build strong muscles. A licensed physical therapist can help design a strengthening exercise program to fit an individual's specific needs and help with pain relief. In general, a spinal stabilization exercise program usually includes strengthening the abdominal muscles in the front and the gluteal muscles in the back.

Transversus Abdominis Muscle Strengthening (Abdominal Exercise)

Many people think of performing abdominal crunches or situps to strengthen the abdominal muscles. While "six pack abs" look nice to some, it is more important to work the Transversus Abdominis (TVA) through abdominal exercise to achieve spinal stability. When retraining the TVA, it is important to maintain a neutral lumbar spine (don't try pushing the back all the way into the floor). The back is most often in a neutral spine position, so it makes less sense to strengthen the back in a flexed or extended position.

Lie on one's back with the knees bent. Knees and feet should be shoulder width apart. Draw the belly button toward the spine while maintaining a neutral spine. Upon exhalation, reach toward the ceiling as if trying to grab a trapeze overhead. Then raise the head and shoulders off the floor, just to the point where the shoulder blades are barely touching the floor, and hold 1-2 seconds. Inhale upon return and repeat at the end of the next exhalation. Continue until it is not possible to maintain a neutral spine or when fatigued.

• Hold 1-2 seconds
• Repeat until fatigued
• 1 time per day
• 4-5 days per week

Gluteus Maximus Muscle Strengthening (Buttock Exercise)

To strengthen this muscle, lie on the stomach with the hips and legs off the end of a table or bench. Tighten the buttock on one side and extend the leg up toward the ceiling while maintaining a neutral spine. Movements should be slow. Initially, it is common to only be able to perform a few repetitions at a time.

• Hold 5 seconds
• 4-10 repetitions per side
• 1 time per day
• 4-5 days per week

Gluteus Medius Muscle Strengthening (Hip Abductor Exercise)

This muscle (the hip abductor) is used to raise the leg laterally at the hip and also supports the pelvis when standing on one leg (single leg stance). If this muscle is weak or inhibited, the opposite pelvis will drop when single leg stance is performed. Functionally, single leg stance is performed whenever someone walks. A weak gluteus medius will result in the opposite hip dropping during the gait cycle and can cause an increase in low back pain and hip pain with walking.

To strengthen the gluteus medius, lie on one's side with the back against the wall. Draw the belly button in while maintaining a neutral spine. Raise the upper leg with the toes slightly pointed toward the ceiling and the heel maintaining contact with the wall. Perform slowly with a 2 second hold at the top.

• 10 repetitions per side
• 1 time per day
• 4-5 days per week

Optimizing Exercise Programs for Pain Relief

As with all exercise programs, these low back stretching and strengthening exercises should be preceded by warm-up and followed by cool-down activities, such as walking and gentle stretching. It is advisable to always consult a medical professional prior to beginning any exercise program, and if pain, such as low back pain or leg pain, is felt or aggravated, it is best to consult a spine specialist and/or physical therapist that specializes in these types of exercise programs.