maintenance & low back pain exercises & stretches

There aren’t many of us who haven’t suffered lower back pain at some point in our lives and it can be extremely debilitating and frustrating. The back is a complex and delicate structure and, if we are not mindful of our posture, the way we move or our lifestyle, it is easy to disrupt the wonderful mechanics of our bodies.

According to Health Executive figures (2005/2006) 3.7 million working days a year are lost through episodes of back pain. More than £1 billion of public money is spent by the health service each year on costs relating to back pain, with a further £565 million spent within the private sector (Maniadakis and Gray, 2000). Yet most cases of back pain are non-specific, which means there is no underlying cause such as an accident, sciatica, or a herniated disc etc. etc.

There are some simple back exercises and stretches you can do at home to help ease lower back pain and use as a back maintenance daily programme.  Your pain should ease within 2 weeks and will usually pass in about 4 – 6 weeks.  Please see your GP if your pain doesn’t improve within a few weeks or you experience severe pain whilst trying the exercises.

 Please go carefully into position for each one and SLOWLY work into and through the movement, slowing down where tightness or discomfort is felt.  As the muscles stretch you will be able to develop the range of movement.

Carefully go onto all fours for –

The Cat – opens up the spine, stretching the muscles that support it. Repeat 5 – 8 times.

With your wrists below your shoulders, your knees below your hips and your feet lined up with your knees, hip width apart, gently tighten your tummy muscles without pulling them in. SLOWLY push up through your arms, arching your back up to the ceiling, at the same time bring the head down to look at your knees so your spine is curved. Hold this position and count down slowly from 3, then slowly return to your start position and repeat. Staying on all fours do the following –

Hips to Heels Stretch – stretches the lower back, the hips and opens up the lumbar spine. Hold stretch for 30 – 60 seconds.

Drop back from all fours and bring your hips as close to your heels as you possibly can, leaving your hands on the floor in front of you. Just hold it here and let those muscles stretch. You can repeat this stretch again after the repeat of the Knees to Chest stretch at the end of these exercises. Now go on to your tummy for –

Gentle Neck and Back Extension – tightens neck and back muscles, stretches tummy muscles. Repeat 5 – 8 times.

Lying as shown, drop heels out to the side and put your forehead on your hands. Relax your back and your shoulders. With your tummy tightened, slowly lift your chest away from the floor without bringing your chin up. A very small movement to start with, then gradually increase range.

 Now turn onto your back, if you are in pain, roll onto your side, take one arm above your head and bend both knees up, then use your arms to help you roll onto your back for the –

Knees to Chest Stretch – stretches and flattens lower back, opens up lumbar spine, stretches the hips. Hold for 30 – 60 seconds.

Lying on your back, gently bring your knees into your chest and put your hands underneath the knees and your head on the floor, not as shown. You can repeat this stretch again after the Hip Rolls below. Go into position for the –

Pelvic Tilts – flattens and hollows the back, stretching and tightening. Repeat 5 – 8 times.

Lie with your arms down by your side and gently tighten your tummy muscles. Slowly and carefully flatten your back by pushing your pubic bone up to the ceiling and then slowly hollow your back by bringing the pubic bone right the way down and pushing the bottom of your sacrum (flat bit at bottom of spine) into the floor.

Hip Rolls – stretches and tightens stabilising muscles at the side of the body. Repeat 10 – 16 alternating sides.

Lying on your back with your knees bent and your arms out to the side of the body, not as shown, with the palms up. Tighten your tummy and slowly and gently take your knees to one side and your head to the other, not as shown. Hold here and count down from 3 slowly, then gently return to start and repeat to the other side.

Now repeat Knees to Chest stretch as above, then turn carefully onto all fours and repeat Hips to Heels stretch as above. Come up to standing using your legs and arms to help you.

Information from NHS, Health Executive and Future Fit Training

Pilates for Stress and Anxiety

 

Nearly a fifth of adults in the UK suffer from anxiety or depression.  Although a range of factors can contribute to the development of these, stress often has a significant impact when it comes to anxiety.  While doctors may prescribe medications to combat feelings of anxiety, these are not without their problems, so it is useful to explore the other treatment options available.

Managing Anxiety

Although clinical trials show that anti-anxiety medications are safe to take, they may cause a range of side-effects during the course of treatment.  For example, unwanted effects include drowsiness, dizziness, irritability, confusion, problems with movement, jaundice and reduced lung function.  In addition to this it is important to be aware that certain medications used to treat anxiety, such as Diazepam, are potentially addictive, so specialist help is sometimes required to withdraw from these drugs.  Thankfully though, talking therapies are also an effective treatment for anxiety,  but there are a range of strategies anyone can take to reduce stress levels that can help significantly.  For instance, eating a well-balanced diet and limiting alcohol and drinks containing caffeine can effectively reduce stress,  and, indeed regular exercise can also have a very beneficial effect.  There is evidence that exercise known for its ability to induce relaxation, such as Pilates, is particularly helpful for controlling stress and anxiety.

relaxationReducing Anxiety Among Cancer Survivors

One group of people known to experience high levels of anxiety are cancer patients and those who have survived cancer.  It is understandable that following diagnosis and during treatment it is an extremely anxious time, with many uncertainties about the future. However, for cancer survivors there is often a constant fear about recurrence of their illness.  Although there are not as many studies into the positive effects of Pilates on mental wellness among cancer survivors as there are for yoga,  there is promising evidence from  research conducted. For example, Pilates enhanced mood, quality of life and body image, all of which are related to anxiety, among breast cancer survivors.  Several physical benefits of Pilates were also seen for the participants, such as a greater ability and desire to exercise and improved range of movement, mobility and flexibility.

Managing Stress Among Students

Students are another group that often suffer from stress owing to the demands of balancing academic work with paid employment and a busy social life.  That’s before you even consider the added pressure of taking exams.  While students can access a range of support services to cope with life at university,  there is interest in whether taking part in movement-based sessions, including Pilates, may help to reduce stress.  One study among students found that after 15 weeks of Pilates stress levels were reduced together with with brighter mood and improved sleep patterns. This is not surprising, as suffering from stress can negatively affect mood and sleep quality.

Benefits For Pilates Practitioners

It isn’t just people taking part in a Pilates class who can benefit from improved mental health, as practitioners delivering sessions also gain.  A study investigating the influence of Pilates on the quality of life of practitioners, which looked at the benefits among those new to the discipline, established practitioners and ex-practitioners, found that benefits on mental well-being were greatest among experienced practitioners.

Why Pilates Is Effective

Although further research is necessary, Pilates may promote reduced stress levels and anxiety in a number of ways.  Firstly, all forms of exercise encourage your brain to release feel-good chemicals, such as endorphins and serotonin, which have a positive influence on your well-being.  At the same time your body reduces production of stress hormones like cortisol, which has obvious benefits. Beyond the chemical changes within your body, Pilates also helps to relax your muscles,  reducing the build up of tension, which can lead to physical problems, such as muscle pain and headaches, and can also worsen feelings of anxiety.  However, Pilates additionally promotes mindfulness, which is known to have a positive impact on stress and anxiety.  By focusing on just the movement and  breathing, the sights or sounds of the surroundings  distracts you from your worries, but it also helps you to become more aware of the connection between your thoughts, feelings and behaviour, allowing you to take positive steps to manage stress.

 

Research taken from an article in Pilates Union

Pilates for Beginners – A Brief Programme

Pilates for Beginners

Please check with your doctor first before you start – show them this programme. Please read all the information on Pilates on this site.

Programme Aim

Improve posture and mobility to the whole body.

Restore balance to the spine in the three planes of movement i.e. flexion, lateral flexion and rotation.

Stretch chest muscles, strengthen back muscles, stretch neck muscles, stretch muscles in between the ribs.

Stretch and strengthen muscles around the hip joint.

Strengthen the core.

Remember Pilates is slow and controlled and should flow – aim for that. Don’t overdo it.

Optimum posture is the best that you can do. Shoulders back and down, head in line with the spine, spine lengthened, pelvis* in neutral i.e. the two hip bones and the pubic bone should feel level. Just keep trying and you will get it. Get the exercise first before you start the breathing. Your breathing is probably inefficient at the moment as the majority of people breathe into the top of their lungs. Eventually your breathing will improve and that will mean your body will be getting more oxygen and nutrients and you will feel a whole load better. Engaging the core takes practice – you can practice this anywhere. Obviously this is slightly different for men!

It is a good idea to record your progress.

You will need a mat to lie on, a rolled up hand towel or small pillow and wear unrestricted clothing, I haven’t got photos for every exercise so just contact me if you are struggling.

Please do at least three times a week.  Once you have learned the exercises it won’t take long.

PROGRAMME

Warm Up (Spine flexion, rotation and lateral flexion) 3 – 5 repetitions

Standing in your optimum posture, feet straight and hip width apart, pelvis in neutral* with your shoulders back and down and relaxed, back of the neck long, chin parallel to the floor, lengthen through the spine lifting up out of your hips. With your arms down by your side and the palms facing back engage your core. Inhale to prepare, exhale and raise your arms up to the ceiling with your palms uppermost opening up the chest, inhale and bring your arms out to the side and lined up with your shoulders. Exhale and rotate to your right, keeping your hips facing forward, and inhale to return and repeat to the left. Exhale and take your right arm straight up to the ceiling, lifting out of the hips curve the arm over the head into a side bend. Slide your other hand down the thigh. Inhale back and repeat to the other side.

Exercises

Lying On Your Front

Deltoid Squeeze (Stretch the chest and neck, strengthen the back and shoulder) 3 – 5 repetitions

Lying on your front in your optimum posture with your arms down by your side with the palms up to the ceiling, lengthen through the back of neck. Take your feet to hip width apart and drop the heels out to the side and relax the muscles in the legs. You may find it helpful to put a rolled up hand towel under your hip bones to increase the lumbar curve at the back of your waist. Pull up the pelvic floor and pull in your abdominal muscles, inhale and lift your head and chest up as far as you can and at the same time rotate the arms bringing the elbows towards each other. Exhale and return to your start position. Do not tilt the head back as you lift; keep the back of the neck long and in line with the rest of the spine.

The Cat (Stretch the muscles each side of the spine) 3 -5 repetitions

Cat StretchOn all fours in your optimum posture, wrists below the shoulders, knees and feet hip width apart with the knees directly below the hips, pelvis in neutral. Engage the core lengthen through the neck so you are looking directly down at your mat, inhale to prepare, exhale lengthen through the arms arching the back right up to the ceiling drop the head down and bring the tail bone forward without moving the legs, inhale deep into the ribs and the back in that top position and then exhale back to neutral working through the spine bringing the pelvis back into neutral last.

Lying On Your Side

chest opener bestThe Chest Opener (Stretch chest muscles, strengthen the back, improve upper body rotation) 3 – 5 repetitions

Lying on the side, hips and shoulders stacked, head must be supported with small cushion or rolled up hand towel under the ear, knees bent to 45 degrees. Arms extended at shoulder height in front of you, hands together. Engage your core, inhale to prepare, exhale and take the top arm across the body and down towards the floor keeping the hips facing the front and following the movement of the arm with the eyes and head. Inhale to return.

Seated

Spine Twist (Stretch and strengthen the muscles at the sides of the body. Spinal rotation) 4 – 8 repetitions

spine twistSeated in your optimum posture with your legs straight out in front of you, feet hip width apart and the toes up towards the knees. Take your arms straight out to the sides so they are lined up with your shoulders, lift up out of your hips and get your back as straight as you can with the pelvis in neutral. Make sure your shoulders are back and down. Engage your core, inhale to prepare, exhale and rotate to one side as far as you can go keeping your hips firmly on the floor. Inhale and return to your start position. Check your posture again and then repeat to the other side.

Mermaid (Stretch the sides of the body and the hamstrings at the back of the legs. Lateral flexion of the spine) 4 – 8 repetitions

Seated in your optimum posture as above with both legs straight out in front of you with your feet hip width apart and the toes up. Place your left hand on the floor beside you for support. Inhale to prepare, exhale and lift your right hand up towards the ceiling lifting up out of the hips and curve the arm over your head. Taking care to keep the knees down and the hips on the floor. Inhale to return. Stay on one side for your reps and then repeat on the other side.

Lying On Your Side

The Chest Opener As above on your other side.

Lying On Your Back

Shoulder Bridge (Segmental control of the spine, stretching and strengthening spinal muscles, strengthening the legs and hips) 3 – 5 repetitions

Shoulder Bridge 1Lying on your back, knees bent, feet hip width apart and straight, pelvis in neutral, arms down by your side with the palms down, shoulders back and down. Lengthen through the back of your neck and bring your chin down. Engage your core, inhale to prepare, exhale and pushing your feet into the floor lift up your pelvis, without tucking it, and peel your spine off the mat bone by bone until you are at your highest position. Inhale here, exhale and start your return journey visualizing your spine as you return to your start position. Never support your head on this one.

Knee Circles (Stretch and strengthen the muscles around the hip joint, strengthen the core) 3 – 5 repetitions in each direction.

knee circlesThe picture is to show you the alignment of the working leg, the other foot must be on the floor with the knee bent. Lie on your back in optimum posture with your arms down by the side palms down, both knees bent. Engage your core and lift one foot bringing the knee directly above the hip socket and the foot lined up with the knee with the shin parallel to the floor. Inhale and circle the knee letting the movement come from the hip. In breath on the inside of the circle out breath on the outside (imagine a clock, in breath 12 – 12.30, out breath 12.30 – 1.00). Repeat in the other direction and then on the other leg taking care with the set up. Focus on keeping the pelvis and the non working leg stable. Breathing takes a while to get the hang of!

Hip Roll (Stretch and strengthen the sides of the body) 3 – 5 repetitions

hip roll low levelLying on your back with your knees bent and both feet flat on the floor. Take your arms out to the side so they are lined up with your shoulders. Bring your feet in together and then bring them in towards your hips taking care not to lose your neutral spine. Make sure your shoulders are back and down and the back of your neck is long with the chin down. Inhale to prepare, exhale and take your knees to the right at the same time turn your head to the left. Only take the knees over as far as you can keep the opposite shoulder blade on the floor. Inhale in this position. Exhale to return to your start position. Inhale here and repeat to the other side.

STRETCHES Hold for 20 seconds, the hamstrings for 30 seconds.

Hamstrings (back of thigh)

hamstring stretchLying on your back with both legs extended along the floor. If more comfortable this stretch can be done with the knee(s) bent. Relax the shoulders down and bring one leg in towards the chest keeping the hips on the floor where possible. Support the leg with both hands either below or above the knee and keep it straight if comfortable to do so. Flex the foot by bringing the big toe down towards the knee to take the stretch into the calf. Hold the stretch there for 30 seconds. Now breathe in, breathe out and ease the leg in a little further to encourage increased flexibility. You can use a towel or a resistance band to help you. Replace the leg on the floor and repeat on the other leg.

Quadriceps (front of thigh)

quad stretchLying on your front, take one arm above your head bend the elbow and place it on the floor. Take the other hand and reach down and pick up your foot and bring it in towards your hips until you feel a stretch at the front of the thigh. If you can’t reach the foot grab your sock or your trousers or you can use a towel or a resistance band to help you. Repeat on the other side. Can be done lying on your side with knees bent and bottom arm going straight up from the shoulder and your head on the arm.

Outer thigh

Seated in your optimum posture with both legs extended, take the right bent leg over the straight left leg and place the right foot on the floor. Hold the right shin with your hands and ease that leg over until you feel the stretch on the outside of the right thigh keeping both hips on the floor. Repeat on the other side.

Inner Thigh with Spine Stretch

Seated in your optimum posture with both legs extended, slide the legs apart until you can feel a stretch on the inside of the thighs. Keep both hips on the floor and put both hands on the floor in front of you and then walk them away taking your spine into a stretch and increasing the stretch in the inner thighs. Hold at your furthermost point and see if you can lower your elbows further down towards the floor.

Chest

Seated in your optimum posture with both legs extended, take both hands out to the sides of your body so that the elbows are lined up with your shoulders and the hands are directly above the elbows. Squeeze the elbows back together stretching out the muscles in the chest and bringing the shoulder blades in together.

Now say to yourself well done!

Pain and Exercise

Cat edit
When we are in pain our first instinct is to withdraw into ourselves and curl up as if to return to the womb. When we are hunched over in pain for long periods of time the muscles around the joints become unbalanced; too tight on one side of the joint and too long on the other. The tight muscle causes more pain and stiffness and the long muscle is weak and therefore makes the joint unstable. This in turn will exacerbate the condition that is causing the original pain and will delay or even prevent recovery. I can hear you thinking “but it hurts when I move!” Well, it will initially as the muscles are shortened and it is going to take time to stretch that muscle back to its original length so it is important to take things slowly.

Another reaction to pain is to stop breathing properly as the more pain we are in, the more stress we feel, our shoulders go up and we only use the top of our lungs to breathe. This gets worse as we are curled forward in our avoidance position and the muscles in the chest tighten making it difficult to breathe properly.

Back Pain

According to Health Executive figures (2005/2006) 3.7 million working days a year are lost through episodes of back pain. More than £1 billion of public money is spent by the health service each year on costs relating to back pain, with a further £565 million spent within the private sector (Maniadakis and Gray, 2000). Yet most cases of back pain are non specific.

Back pain can be split into categories; specific back pain and non specific back pain.

Specific Back Pain

This is associated with an underlying health condition or damage to the spine such as sciatica, a slipped/herniated disc and ankylosing spondilitis.

Sciatica – a condition caused by a nerve in the back (the sciatic nerve) being irritated or compressed

Slipped disc – where one of the discs of the spine splits and the gel inside leaks out

Ankylosing spondylitis – a condition where the joints at the base of the spine become inflamed

Non-Specific Back Pain

This condition is where the pain is not caused by serious damage or disease, but by minor injuries or a pinched or irritated nerve. It is thought that in some cases the cause may be a sprain (an over-stretch) of a ligament or muscle, a minor problem with a disc between two vertebrae, or a small ‘facet’ joint between two vertebrae. There may be other minor problems in the structures and tissues of the lower back that result in pain. However, these causes of the pain are impossible to prove by tests. Therefore, it is usually impossible for a doctor to say exactly where the pain is coming from, or exactly what is causing the pain. This article focuses on non-specific back pain.

What is the Pain?

Unspecific back pain is a very common condition and can affect adults of all ages. Your back is a complex and delicate structure that is made up of a combination of bones, muscles, tendons, ligaments, nerves and joints. Therefore, it does not take a significant injury or damage to disrupt the normal workings of the back and trigger an episode of back pain.

Back pain can be triggered by everyday activities at home and at work, or by poor posture. For example, back pain can occur as a result of bending awkwardly, lifting, carrying, pushing or pulling incorrectly, slouching in chairs, standing or bending down for long periods, twisting, coughing, sneezing, muscle tension, over-stretching, driving in a hunched position, driving for long periods without taking a break, being exposed to prolonged vibration and lack of exercise. You may also experience occasional episodes of back pain as a result of the normal ageing process of the spine, which can temporarily disrupt the normal function of your back. You may sometimes wake up with back pain and have no idea what has caused it.

To some people, not knowing the exact cause of the pain is unsettling. However, looked at another way, many people find it reassuring to know that the diagnosis is non-specific back pain which means there is no serious problem or disease of the back or spine.

What are the Symptoms of Non-Specific Low Back Pain?

Although non-specific back pain is sometimes called ‘simple’ back pain, simple does not mean that the pain is mild. The severity of the pain can range from mild to severe. Typically, the pain is in one area of the lower back, but sometimes it spreads to one or both buttocks or thighs. It is often made worse if you move your back, cough, or sneeze. So, non-specific low back pain is ‘mechanical’ in the sense that it varies with posture or activity. Most people with a bout of non-specific low back pain improve quickly, usually within a week or so, sometimes a bit longer. However, once the pain has eased or gone it is common to have further bouts of pain from time to time in the future. Also, it is common to have minor pains ‘on and off’ for quite some time after an initial bad bout of pain. In a small number of cases the pain persists for several months or longer. Back pain can also be classified according to how long the symptoms last i.e. acute back pain – the pain does not last longer than six weeks and chronic back pain – the pain lasts for more than six weeks.

Risk Factors

Risk factors for back pain include:

being 20 to 50 years of age – for reasons that are not fully understood, most cases of backache affect young and middle-aged adults
being overweight or obese – extra body weight places more strain on the bones, muscles and joints of your spine
smoking – it is uncertain as to whether this is a result of tobacco smoke damaging the tissue of the back or due to the fact that smokers tend to have unhealthier lifestyles than non-smokers (or it could possibly be a combination of both)
being pregnant – as with being overweight, the excess weight of carrying your baby can place additional strain on your back
the long-term use of medications that are known to weaken bones, such as corticosteroids
stress – it is thought that people who are under stress may unknowingly tense the muscles in their back, which could trigger an episode of back pain
depression (see below)

Depression does not directly cause back pain but it can be a major contributing factor. Many people with back pain and depression can fall into a vicious cycle. The pain makes them feel depressed, which means that they exercise less and do not take part in everyday activities. The lack of physical activity and exercise means that the symptoms of back pain persist, which in turn makes symptoms of depression worse.

Chronic back pain is less common than acute back pain, but it is still very widespread. In England, chronic back pain is the second most common cause of long-term disability (after arthritis). After stress, it is the leading cause of long-term work-related absence. A recent study found that one in every 10 people reported having some degree of chronic back pain.

The rates of reported cases of back pain in England have doubled over the past 40 years – a trend that is seen in almost all Western nations. There are a number of theories to explain the rise in the number of cases. One theory is that the rates of obesity, depression and stress are now higher than they were in the past. These conditions are all risk factors for chronic back pain. Another theory is that people are now more willing to report symptoms of pain to their GP than they were in the past. It is estimated that one in five people will visit their GP in any given year because of back pain. And 80% of adults will experience at least one episode of back pain at some point in their life.

Outlook

The outlook for back pain can vary considerably between individuals. Some people have minor episodes of acute back pain before making a full recovery. Other people have long periods of mild to moderate back pain that are interrupted by periods of severe pain, which makes them unable to do their normal daily activities.

An Australian study which looked at people who visited their GP because of back pain found that:

40% were completely free of pain within six weeks
58% were pain-free within 12 weeks
73% were pain-free within one year

Psychological and social factors play an important role in the expected outlook for back pain, particularly for chronic back pain. For example, people who have a positive frame of mind and report enjoying a good quality of life tend to make a faster recovery than those who report symptoms of depression and are unhappy with one or more aspects of their life.

Treatment options for back pain include painkillers, spinal manipulation, acupuncture and exercise classes. Some cases of chronic back pain may also benefit from additional psychological treatment for the reasons discussed above.

Information from NHS website and the Register of Exercise Professionals journal.