Lower back issues are some of the most commonly reported physical ailments today. Why is so common?
There are many things that can cause this type of pain. One of the common ones is having a traumatic injury or chronic condition that leads to vertebral disc herniations, which can then put pressure on the nerves coming from the spine, causing discomfort and pain in the low back and even down into the hips/thighs.
Individuals who spend most of their day sedentary (sitting at desks or in cars for work or school) can end up with a slouched posture, causing poor seated ergonomics.
This can lead to weak abdominals and tight hamstrings, which can affect lumbo-pelvic (low back) posture and increase tension on the back muscles.
Not all people with poor posture get low back pain, but many can end up with extra stresses on the spinal alignment and a lengthening and weakening of the spinal muscles that support the spine. If someone has an injury or issue to the vertebral discs this posture could cause increased pressure and pain. Many individuals also have diffuse or general low back discomfort from inactivity or sitting too much in misaligned posture.
2) What exercises help with lower back pain? For each, explain why it helps and how to perform it (including safety cues).
This can vary depending on the cause of the low back pain. Regardless, the Pilates method is preferred by many Physical Therapists for rehabilitation and injury prevention due to its low impact approach and focus on core strength! Pilates apparatuses, such as the Reformer, (all which are used in Club Pilates classes) are designed to create resistance to strengthen the body in a gentle way and prevent and even heal injury!
Disclaimer - It is always a good idea to check in with their doctor to get the cause of the pain figured out before starting an exercise program.
Many people will get some relief from their discomfort by doing some stretches and simple moves, such as:
Tight hamstrings can pull the pelvis into a posterior tilt when in a shortened state which misaligns posture and can put some extra pressure on the low back.
Lying on the floor using a towel, dog leash, or luggage strap as a stretching strap, you can put the strap on the arch of one foot and keep the other leg down in contact with the floor (knee bent or straight depending on their mobility). Gently pull the strapped leg up towards the ceiling until you feel gentle discomfort in the back of the upper thigh where the hamstring is located. Hold for 15-30 seconds. To get a little deeper if available, you can then push into the strap activating the muscles for another 15 seconds, then release and relax back into the stretch again for another 15-30 seconds. . (( This is called PNF proprioceptive neuromuscular facilitation- contract/hold variation) If getting down on the floor is a challenge, you can also do a standing stretch with one leg extended straight out in front and hinge at the hip to push the pelvis back elongating the front leg— it is a good idea to be near a wall or chair to hold on for balance. You can still add the contract by a push of heel into the floor and relax into the stretch.
Prone press ups can also help alleviate some discomfort and pain in people with mild disc issues in the back.
Lying prone or face down on the floor or a mat, put your hands on the floor with elbows bent just in front and slightly wider than the shoulders, and start by pressing into the hands coming up on to the forearms in an extended spinal position—try to keep the pelvis still or slightly tilted back (more weight on pubic bone than the front hip points) and inhale into it to get more opening of front side of spine—this can relieve some pressure off of a disc that might be protruding into spinal column and putting pressure on nerves. If this decreases symptoms then you can press up to fully extended elbows and a bigger extension of spine.
Doing some basic abdominal work can help strengthen the abdominals which can also help support the spinal alignment and possibly take some pressure off the low back. If someone has disc injuries, they should start without flexing the spine into a full sit-up or crunch as this can put extra pressure on the nerves/discs. I would start with a quadruped/crawl position and just focus on drawing abdominals in deep or belly button to the spine while staying in as neutral of a back position (strategy as a board) to learn the deep ab engagement.
Another basic flexion-free move would be to progress this into a Pilates single leg stretch movement. Again, it can be good to start with head and shoulders down to keep some pressure off of the discs. The Single leg stretch is a move that starts with both legs in a table top (90 degree) position, then lengthening one leg out long towards the opposite wall on a 45 degree angle then alternating legs in a slow controlled manner keeping the back and pelvis stable. This can also be performed on the Reformer as well as the mat!
Bridges are another great exercise for people suffering from low back discomfort or pain. Bridges are an essential move in Club Pilates classes, both on the Reformer and on the mat!
Activating the gluteal muscles and hamstrings while opening up the front of the hips is a key component to a bridge. Based bridges are a hip lift while lying on their back on the floor. Keep knees bent and feet flat about hip width apart. While trying to keep abdominals engaged, press into the feet and lift the bottom off the mat into a shoulder bridge. The weight should end up on the shoulder blades and make a straight line from knees to shoulders while keeping the knees bent and feet flat on the mat or floor. Bridges have lots of variations and progressions, but again, someone with a known issue in the spine should probably keep in a smaller range of motion or avoid articulation of spine and do more of a hip press up.
Planks or modified Planks
These can be made easier by doing them against a wall or counter and progressing to being on the floor. A plank is basically holding the up part of a push-up. You want to stay strong and connected in the shoulders and shoulder blade area while pulling abs or ribs in tight and keeping the spine long. Common faults in a plank are sinking in the shoulders or sagging in the back and that is to be avoided. You can also start on the knees, like a modified push up. This exercise promotes stability in the entire length of the spine. If wrists are sensitive you can also do planks from forearms on the mat versus on the hands.
Don’t forget to use your Pilates breath! Breathing in and filling the lungs can relax the nervous system and take a bit of the brain away from feeling our pain/discomfort.
Exhaling naturally causes the diaphragm, pelvic floor muscles and deepest layer of abdominal and back muscles to engage in a spinal supporting way.
Always check your form and alignment of the spine while doing these exercises.
Working with a credible Pilates instructor can really be key, as well. Attending a Club Pilates studio is great - there are plenty of locations nationwide and the instructors go through extensive training to provide each individual case with the proper cues and help keep an eye on form. Club Pilates offers both private and small group style classes for an extra personal approach.
Additionally, being mindful of proper breathing and pulling abdominals in towards the spine is extremely crucial, and a Pilates instructor can help you with this. Start small range of motion then progress to full exercises. Go slow and find the control in all exercises versus fast and letting momentum do the work.when starting to add weight or resistance start lighter and progress as tolerated.
Checking in with your medical practitioner can be an important step in evaluating the root cause of your pain and getting on track to improve your amount of discomfort.
Pilates with a certified instructor can be a great form of exercise to strengthen and lengthen the body all while using your core. Trained Pilates practitioners should be educated in modifications for people with injuries and able to give you modifications of exercises to help you get stronger in a safe way decreasing your pain.
By Club Pilates Master Trainer, Cara Bonney.