Exercises for the Low Back
Exercises that stretch and strengthen the muscles of your spine can help prevent back problems. If your back and abdominal muscles are strong, you can maintain good posture and keep your spine in its correct position.
If your muscles are tight, take a warm shower or bath before performing the exercises. Exercise on a rug or mat. Wear loose clothing. Stop doing any exercise that causes pain until you have talked with your doctor.
EXERCISES
1. Pelvic tilt
(Purpose: strengthens gluteal (buttocks) and abdominal muscles. Flattens spine.)
Lie on back with knees raised. Squeeze the buttocks tightly together, then pull in your stomach muscles. You will feel your low back go flat against the floor. Hold for a count of 5. Relax and repeat 3 times, increasing gradually to 10 times. Do a pelvic tilt often during the day also in sitting and standing positions. The pelvic tilt is the most commonly recommended exercise for the low back.
2. Single-knee raise
(Purpose: stretches low back and hamstrings.)
Lie on your back, with both legs straight. Hold a pelvic tilt while you perform the exercise. Bend one knee and slowly bring it toward your chest. Use your hands to gently pull your knee close to your chest. Hold for 5 seconds, then lower your leg slowly. Repeat for a total of 3 times, increasing gradually to 10 times. Repeat the exercise with the other leg.
3. Double-knee raise
(Purpose: stretches low back and hamstrings.)
Begin with both knees bent. Hold a pelvic tilt while you perform the exercise. Pull your knees to your chest. Use your hands to pull your knees slowly toward your armpits. Hold for 3 to 5 seconds. Return to your starting position and repeat 3 times, slowly increasing to 10 times.
4. Single-leg raise
(Purpose: stretches low back and hamstrings. Strengthens stomach and hip-flexing muscles.)
Caution: If you have sciatica (pain down the leg), avoid this exercise.
Start on your back with one knee bent and your other leg straight. Hold a pelvic tilt while you perform the exercise. Slowly raise the straight leg, keeping it straight. Keep your low back flat. Raise your leg as far as possible without causing pain. Slowly lower your leg and flatten your low back as your leg nears the floor. Repeat with the same leg for a total of 3 times, increasing to 10 times. Repeat the exercise with your other leg.
5. Partial curl-ups
(Purpose: strengthens low back and abdominal muscles.)
Start on your back on a soft or carpeted floor, knees bent. Hold a pelvic tilt throughout the exercise. Slowly raise your head and neck, then shoulders, as you extend your hands to your knees. Keep your low and middle back on the floor. Hold for a count of 5. Return to starting position. Repeat for a total of 3 times, increasing gradually to 10 times.
(Purpose: stretches low back and buttocks.)
Start on your back, your legs bent. Keep both shoulders against the floor. Bring up your feet, with your knees somewhat together. Then lower your bent knees toward your left hip, then your right hip. Hold for 3 to 5 seconds. Repeat 5 times, increasing gradually to 10 times.
7. Sitting bend
(Purpose: strengthens and stretches the low back and hamstrings.)
Sit in a chair, feet flat on the floor, knees no more than a foot apart, hands at your sides. Perform a pelvic tilt so that your low back goes flat against chair. Bend over comfortably, hands reaching toward the floor. Hold for a count of 3. Return to starting position, with your back flat against the chair. Repeat for a total of 3 times, increasing gradually to 10 times.
Exercises to avoid
It is best to avoid the following exercises because they strain the low back:
• legs raised straight and together
• sit-ups with legs straight
• hip twists
• toe touches
• any backward arching
Sports and other activities
In addition to conditioning your back you need to condition your whole body. Physical activities such as walking or swimming can help to extend your life while also strengthening your back. It is always best to check with your doctor before you undertake any rigorous exercise program. Remember to begin slowly. The best physical activities include the following:
• walking
• bicycling
• swimming
EFFECTIVENESS of chiropractic for lower back pain
Chiropractors are no longer the only ones claiming that chiropractic works. Ph.D.s, M.D.s, even government agencies are agreeing that the care chiropractors provide is effective for many conditions.
In England, Dr. T. W. Meade compared the effectiveness of chiropractic treatment to hospital outpatient treatment of mechanical lowback pain. Dr. Meade found that "chiropractic was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. . . The benefit of chiropractic treatment became more evident throughout the followup period [two years]. Secondary outcome measures also showed that chiropractic was more beneficial. For patients with low back pain in whom manipulation is not contraindicated, chiropractic almost certainly confers worthwhile, longterm benefit in comparison with hospital outpatient management."2
A study, funded by the Ontario Ministry of Health and conducted by Pran Manga, Ph.D., was done to determine, among other things, the efficacy of chiropractic's management of lowback pain (LBP). Dr. Manga found that "on the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for LBP."3 Based on his findings, Dr. Manga recommended that the Ontario Ministry of Health fully integrate chiropractic into its health care system.
Dr. Manga also found that "there is no clinical or casecontrol study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of lowback pain....There is also some evidence in the literature to suggest that spinal manipulations are less safe and less effective when performed by non chiropractic professionals."3
The U.S. Government has also taken a giant step in support of spinal manipulation. In December 1994, the Agency for Health Care Policy and Research (AHCPR), an arm of the Department of Health and Human Services, published and announced its new clinical practice guideline for the treatment of acute low back problems in adults. The guideline was developed by a multidisciplinary team that reviewed relevant scientific research on LBP treatments. The AHCPR Guideline panel found that "for patients with acute low back symptoms without radiculopathy [disease of the spinal nerve roots], the scientific evidence suggests spinal manipulation is effective in reducing pain and perhaps speeding recovery within the first month of symptoms."4 The panel goes on to recommend spinal manipulation as a first line of treatment for low back problems.
Shortly after the launching of the U.S. Guideline, the British National Health Service announced its new guideline on back pain, developed by the Clinical Standards Advisory Group (CSAG). Like the U.S. panel, the British panel found "there is now evidence that manipulation is an effective method of providing symptomatic relief for some patients....''s The British panel recommends an early conservative intervention for back pain to prevent chronic pain conditions or other potential complications.
BEYOND THE BACK
Research has found that chiropractic treatment is effective for more than just back pain. For example, a study conducted to compare chiropractic treatment versus drug therapy (amitriptyline) for the treatment of chronic tensiontype headache, showed that though both offered relief during the treatment period, 82% of the drug therapy group suffered from adverse side effects, including dry mouth, drowsiness, and weight gain, while the chiropractic group had virtually no side effects. Additionally, the chiropractic group showed continued therapeutic benefit four weeks after therapy had ended; the patients in the drug group were back to the same headache frequency and severity as their baseline values. Patrick D. Boline, D.C., the principle investigator, concluded, "the results of this study show that spinal manipulative therapy is an effective treatment for tension headaches ',6
A randomized pilot study on chiropractic spinal manipulative treatment for primary dysmenorrhea (menstrual cramps) found that "immediately after treatment, the perception of pain and the level of menstrual distress were significantly reduced by SMT [spinal manipulative therapy]."7
A larger, randomized clinical trial by the same researchers is currently underway that will further evaluate these results.
Research is currently being done to investigate chiropractic's effectiveness for asthma, infantile colic, otitis media (ear infection), hypertension (high blood pressure), scoliosis (curvature of the spine), cerpal tunnel syndrome, and migraine headache, among others.
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