The ability to exercise while experiencing low back pain is very important to a successful outcome from your injury. Most conditions are comfortable in one of three positions, flexion, extension, or neutral, and holding that position for your daily activities and exercise training is the key to success. You may want to read the section of activity management for further explanation of this concept.

1. Flexion: You are most comfortable with your buttock tucked underneath you, with the curve in your back flattened. For example, you are more comfortable sitting for short periods of time than standing or walking, and when you do stand you prefer to lean forward onto something.

3. Neutral: You are most comfortable in the middle ranges, flexion and extension are both painful. Examples are you are most comfortable in the middle, not at either extreme.

Realize that you may be most comfortable in neutral, but biased towards flexion or extension. That is, a little bit of movement towards one direction feels good, but too much feels painful. If this is the case, you are either flexion or extension biased and should look at those exercises. You just need to modify the amount of movement to your comfort level.

Always combine Basic Stabilization Exercises with the Flexion or Extension Biased Exercises.

back to top

Basic Stabilization Exercises With Flexion, Extension, And Neutral Bias
Stabilization exercise is how you can safely exercise with a back injury. The principles of stabilization require that you find a comfortable starting position for your back (flexion, extension, or neutral as explained earlier) and maintain it throughout the exercise, thus your back is stable and not moving. Most exercises can be biased into flexion, extension, or neutral, and some are specific for flexion or extension. The key to your success is that the exercises be done with perfect form and NO spinal movement. This is very difficult, and you may want to seek the help of a qualified therapist to assist you.

How To Bias Basic Stabilization Exercises
1. Flexion bias — when on your back tuck your buttock up and put a towel roll under your buttock, in other positions flatten the curve of your low back.
2. Extension bias - when on your back arch your low back and put a towel roll under your low back, in other positions increase the curve in your low back.
3. Neutral bias — keep spine in the middle position in all postures.

Basic Stabilization Exercises

1. Lower Abdominals (transverse abdominal muscle)

• This muscle acts as the internal back support or corset for the spine.
• This is an isometric tightening of the lower abdominals (from the belly button to the pubic bone) Do this by pulling them in and up. You should feel a broadening across your lower abdomen.
• Isometric means that there is tightening of the muscle but no body movement (your spine, and chest do not move), so this exercise can and should be done in every position throughout your day, sitting, standing, waiting for the bus, in line at the grocery store, reaching up into the cabinet, reaching and bending over the table, etc. This is essentially how you stabilize.
• It will be demonstrated in the most common position of comfort.

Neutral - flat or normal lumbar curve

Flexion - towel roll under buttock

Extension - towel roll under low back

back to top

2. Dead Bug

• This is an exercise to strengthen the lower abdominals, as well as to teach you how to move your arms and legs separately from your spine.
• The goal is to hold the lower abdominals, spine, and pelvis stable while moving the arms, the legs, and then the arms and legs alternately.
  1. Begin on your back with your knees bent and feet on the floor.
  2. Bias your spine into your position of comfort with a towel roll.
  3. Tighten the lower abdominals, this is very important.
  4. Alternately lift one arm over your head and then the other. Do not let the low back arch up as you lift your arms over head.
  5. Alternately lift one knee up and then the other. Do not let the spine shift from side to side, arch, or let the abdominals go. This is much harder than the arms.
  6. Lift one arm and the opposite knee at the same time. Repeat with the other pair.
• There should be no movement or rock in the abdominal/pelvic region with this exercise.
• This is a difficult exercise to do correctly, go slowly and really pay attention to your spinal position and movement.
• A reasonable goal to work towards is 50 repetitions

Neutral — flat or normal lumbar curve

Flexion — towel roll under buttock

Extension — towel roll under low back

back to top

3. Bird Dog

• This is an exercise to strengthen the low back and abdominal muscles, and, again, teach you how to move your arms and legs separately from your spine.
• The goal of this exercise is to move your arms, legs, and then arms and legs on a diagonal without any spinal/abdominal/pelvic motion such as rocking or loss of your biased position.
  1. Start on your hands and knees (quadraped), and put your spine into your specific biased position. Having a friend rest a stick on your back often helps in finding your proper alignment, as well as in keeping your head in line with your spine.
  2. Lift one arm forward without sagging or changing your alignment. Put it back down and lift the opposite arm. Continue this alternately.
  3. Do the same with one leg at a time. You will find that the legs are much more difficult than the arms. Be very careful of your spinal position and movement.
  4. Do the opposite arm and leg at the same time. This is even more difficult and challenges your balance, which is excellent for spine strengthening.
• Hold each lift for 5 seconds.
• A reasonable goal is 20 of each

Neutral — flat or normal lumbar curve

Flexion — flattened or rounded curve

Extension — increased lumbar curve

back to top

Flexion Specific Exercises

1. Pelvic Tilt

• The goal is to strengthen the lower abdominals and stretch the lumbar spine.
• Begin on your back with your knees bent and feet flat on the ground.
• Tighten your lower abdominals (as learned in basic stabilization) and squeeze your buttock, resulting in your pelvis tilting upward.
• Your low back remains on the ground
• Hold approximately 5 seconds, repeat 10-20 times

back to top

2. Knee To Chest And Double Knee To Chest

• The goal is to stretch the low back and buttocks
• Begin on your back with your knees bent and feet flat on the ground
• Hug one knee to your chest, release and repeat with the opposite knee
• Alternate back and forth
• Now hug both knees to your chest, release and repeat
• Hold 5 seconds and repeat each 5-10 times

back to top

3. Childs Pose / Mosque Prayer Stretch

• The goal is to stretch the lumbar spine and extend the shoulders and upper spine.
• Begin on your hands and knees.
• Sit your buttock back over your heels, keeping your arms outstretched in front of you, and letting your head, chest, and armpits stretch down to the floor.
• You should feel a gentle stretch in your low back and possibly a stretch the chest and shoulder area.
• Hold 15-30 seconds and repeat 5 times

back to top