Low back pain is a very common problem that affects most of us at some point in life. For some patients back pain is even a daily issue. Researchers have found low back-specific exercises can treat and prevent back pain. Like brushing our teeth, low back exercises are equally important in order to maintain, preserve, and optimize function. It can be difficult for patients to know which exercises are best for their back pain.
There are different methods for determining the right low back exercises for the patient. One of the most common is to try different exercises to determine individual tolerance. This is not very specific as it only determines if the patient is comfortable with an exercise. Another method is using physical performance tests (PPTs) that measure the strength and endurance of specific muscle groups, muscle shortness, balance, aerobic capacity, and spinal range of motion.
Physical Performance Tests
Physical performance tests are much more specific because they address each patient’s differences. Also, many PPTs include normative data to compare against the patient’s own performance, so repeat use of the abnormal PPTs on a monthly interval can gauge their progress (or the lack thereof), which is motivating to the patient and serves as a great outcome measure!
PPTs are performed once the condition is stable, usually two to four weeks after an initial presentation, so as not to irritate the condition. The initial exercise selection is based on “directional preference” or positional bias. This simply means if a patient feels best by bending over, we initially give “flexion-biased” exercises.
Flexion-biased exercises include (partial list): pulling the knees to the chest (single then double), posterior pelvic tilts (flattening the low back into the floor), sitting and/or standing bend overs, hamstring stretches, and more. If a person’s low back feels best bending backwards, their chiropractor may give extension-biased exercises, which include (partial list): standing back bends, saggy push-ups (prone press-ups), and/or laying on pillows or a gym ball on their back, arching over the ball.
Chiropractors generally add exercises to patient care gradually once a patient can tolerate them. Then they will recheck the patient periodically to make sure they are doing them correctly. Studies show that spinal manipulation achieves great short-term results. Long-term results for low back pain treatment are best when exercise is added to the treatment plan. Studies show that ONLY 4% of patients continue their exercises after pain is gone. If patients stop exercising and fall back into old habits back pain will likely return at some point.
