It has been estimated that approximately 80% of people in Western countries have experienced low back pain (LBP) at some point in their lives. Most cases resolve within 2-4 weeks without any medical intervention. However, within 1 year following the first episode of LBP, 60-80% of patients will have recurring pain.
Current research has reported that in most cases of LBP, certain muscles of the back that stabilize the spine are reflexively inhibited (shutdown) after injury. These muscles do not spontaneously recover even if patients are pain free with a return to normal activity levels. These specific muscles work together to support and stablize the spine to help prevent LBP.
These muscles include the lumbar multifidi and the transversus abdominus:
What Are the Lumbar Multifidi and Transversus Abdominus?
The lumbar multifidi are the deepest layer of muscles of the the back. They attach from the vertebral arches to the spinous processes. Each multifidi connects 1-3 vertebrae, (the vertebrae are the bones of the spine) controlling movement between the vertebrae.
The transversus abdominus is the deepest of the abdominal muscles and is also a stabilizer of the spine. Support by this muscle is considered to be the most important of the abdominal muscle and has also been found to be in a weakened state in those who have chronic back pain or problems. Its normal action along with the action of the the lumbar multifidus muscles function together to form a deep internal corset that acts to stabilize the spine during movement. This pattern of protection is disrupted in patients with low back pain.
It is uncertain why these muscles become dysfunctional after a low back injury, but specific exercises focusing on the contraction of these two muscles together will improve the protective stabilizing ability of the spinal muscles, reduce pain intensity, and improve activities of daily living as well as improve body awareness and posture.
How Is Low Back Pain Treated?
Physical therapy treatment for LBP often involves a wide range of techniques including heat therapy, ultrasound, massage, mobilization, exercise, and education about posture and body mechanics. Stabilizing and strengthening the lumbar spine (specifically lumbar multifidi and transverse abdominus) through a lumbar stabilization program is also an important part of a rehabilitation program for the patient with low back pain.
What Do Lumbar Stabilization Exercises Involve?
The lumbar stabilization program is a program of back exercises designed to teach patients strengthening and flexibility in a pain-free range. It not only improves the patient’s physical condition and symptoms but also helps the patient with efficient movement. It provides the patient with movement awareness, knowledge of safe postures, and functional strenghth and coordination that promotes management of LBP.
Prior to starting a lumbar stabilization program, the patient should first be evaluated by his/her primary care physician and physical therapist. Together the MD and PT will design a comprehensive rehabilitation program with the above mentioned techniques along with a lumbar stabilization program specified to the patient. Since every patient is an individual and presents with different conditions, a physical therapist is needed to design and monitor the rehabilitation program.
Lumbar Exercises for stability and alignment
(1) 90-90 WALL HIP LIFT
- Lie on your back with your feet flat on a wall and your knees and hips bent at a 90-degree angle.
- Place a 4-6 inch ball between your knees.
- Inhale through your nose and exhale through your mouth performing a pelvic tilt so that your tailbone is raised slightly off the mat. Keep your back flat on the mat. You should feel the muscles behind your left thigh engage.
- Hold this position while you take 4-5 deep breaths in through your nose and out through your mouth.
- Relax and repeat 4 more times.
(2) 90-90 HIP LIFT WITH HIP SHIFT
- Lie on your back with your feet flat on a wall and your larees and hips bent at a 90-degree angle.
- Place a 4-6 inch ball between your larees.
- Inhale through your nose and exhale through your mouth perfonuing a pelvic tilt so that your tailbone is raised slightly off the mat. Keep your back flat on the mat.
- As you maintain a hip lift, shift your left hip down and your right hip up so that your right knee is slightly above the left.
- Slowly take your bent right leg on and off the wall so that your right thigh comes toward your chest. You should feel the muscles behind your left thigh engage.
- Perfonrr 3 sets of 10 repetitions, 1-2 times a day.
(3) 90-90 HIP LIFT WITH MEDIAL HAMSTRING
- Lie on your back with your feet flat on a wall and your knees and hips bent at a 90-degree angle.
- Place a 4-6 inch ball between your knees
- Move your left foot and ankle slightly outward while gently squeezing the ball.
- Inhale through your nose and exhale through your mouth performing a pelvic tilt so that your tailbone is raised slightly off the mat. Keep your back flat on the mat.
- Slowly take your bent right leg on and off the wall so that your right thigh comes toward your chest. You should feel the muscles behind your left thigh and left outer hip engage.
- Perform 3 sets of 10 repetitions, 1-2 times a day.
(4) 90-90 HIP LIFT WITH HEMBRJDGE
1. Lie on your back with your feet flat on a wall and your knees and hips bent at a 90-degree angle.
2. Inhale through your nose and exhale through your mouth performing a pelvic tilt so that your tailbone is raised slightly off the mat. Keep your back flat on the mat.
3. Maintain your hip lift with your left leg on the wall and straighten your right leg.
4. Slowly take your straight right leg on and off the wall as you breathe in through your nose and out through your mouth. You should feel the muscles behind your left thigh engage. 5. Perform 3 sets of 10 repetitions, 1-2 times a day.
(5) 90-90 HIP LIFT WITH BALLOON
- Lie on your back with your feet flat on a wall and your knees and hips bent at a 90-degree angle.
- Place a 4-6 inch ball between your knees.
- Place your right arm above your head and a balloon in your left hand.
- Inhale through your nose and exhale through your mouth performing a pelvic tilt so that your tailbone is raised slightly off the mat. Keep your back flat on the mat. Do not press your feet flat into the wall instead dig down with your heels.
- Inhale through your nose and slowly blow out into the balloon.
- Pause three seconds with your tongue on the roof of your mouth to prevent airflow out of the balloon
- Without pinching the neck of the balloon and keeping your tongue on the roof of your mouth, take another breath in through your nose.
- Slowly blow out again as you stabilize the balloon with your hand.
- Do not strain your neck or cheeks as you blow.
- After the fourth breath in, pinch the balloon neck and remove it from your mouth. Let the air out of the balloon.
- Relax and repeat the sequence 4 more times.