ADVANCED LOW

BACK EXERCISES
Muscles of the low back.
Back Extensors:
Longissimus
Iliocostalis
Side Flexors:
Transversus Abdominis
Quadratus Lumborum
Back Flexor:
Rectus abdominis

Principles of low back exercise.

There are 3 key principles to remember when performing the following stability exercises:
1. Maintain a neutral spine. This spares it from adverse compression.
2. Brace your abdominal muscles before and during exercise. This can be demonstrated by bending your
elbow and tensing all the muscles around it so that it feels stable and strong. This can be achieved at your
back as instructed by your therapist.
3. Aim for endurance rather than strength. This is emphasised by repeated static holds during exercise.

Warm-Up: Camel-Cat.
The camel cat exercise is designed as a warm-up to reduce the stiffness of the spine. This is a mobility
exercise not a stretch, so you should not push or hold at the end of each movement.

Starting Position: Kneel down on the floor in the "all-fours" position. Keep your head straight so that the
gaze of your eyes is towards the floor.
Action: Slowly lower your trunk as far as you can so that your back is arched. Do not pull it down but let it
relax as you lift your face towards the ceiling. Then round your back up at the waist as far as you can by
contracting your lower abdominal muscles as you lower the top of your head toward the floor. All motion
should be initiated from your lower back. Perform 10 cycles.

Birddog
This exercise has been scientifically proven to activate the back extensors (longissimus, iliocostalis and
multifidii) with minimal spinal loading (less than 2500N).

Starting position: On hands and knees with the hands under the shoulders and the knees directly under the hips.
This exercise should follow the cat/ camel exercise, in which a neutral/ mid position of the spine is found.
Action: Slowly raise one leg or one arm to shoulder or hip height. Hold for 10 seconds and repeat 10 seconds.
Progression: Raise the opposite arm and leg simultaneously. Avoid raising either arm or leg past horizontal.
Hold the limbs parallel to the floor for 10 seconds and repeat 10 times.
Note: Abdominal bracing needs to be performed with the spine in a neutral position. Avoid hip hiking or bad
form that twists the spine. It is useful to picture a tray of drinks on your back, which will spill if bad form is
adopted.

Side Bridging.
This exercise primarily activates the side/ lateral spine stabilisers, such as, quadratus lumborum, transverse
abdominal and abdominal oblique. Maintaining the bridge ensures constant muscle activation while the brace
introduces combinations of muscle recruitment to ensure stability.

Starting Position: Begin on your side, supported by your elbow and hip. Ensure that your head is in line with
your feet, and then bend your knees 90 degrees. Place your free arm along the body.
Action: Straighten your torso until the body is supported on the elbow and the knee.
Progression: Start as before, but with the knees/ legs straight. The torso is straightened so that the body is
supported by the feet and elbow.

Curl-Up.
This exercise mainly activates the rectus abdominis. It is important the technique is performed as described
below. Poor technique, as with a regular sit-up, or a twisting component, can place adverse compression and
stress through the lumbar spine.

Starting position: Lie on your back with both hands placed in the small of the back, supporting the lumbar
region. This maintains a neutral position of the spine. One knee should be bent to 90 degrees while the other leg
remains on the floor. Brace your head and neck. To do this, imagine that you have an orange tucked under your
chin, which you dont want to squash or release.
Action: Next, slowly bring your head and shoulders a short distance off the floor. You should not nod your head
forward, but instead try to tuck your rib cage into your waist, whilst resting your elbows no the floor. Hold for
6-8 seconds and repeat 10 times.
Progression: The first progression is to raise both elbows a couple of centimetres of the floor and repeat as
above. An advanced progression is to place the fingers lightly on the forehead and repeat as above.

Neural Glides and Stretches.

The spinal cord is like a thick band of string that runs from your head, down to the feet. If you have low back
pain then it may be worsened when your therapist straightens your leg and bends your foot in a slumped or flat
position. This is because as your leg and foot move and the cord glides or stretches up and down; it will irritate
the inflamed or tight structures centrally within your back.

Flossing: Over time nerves can dissolve and integrate with other tissues (muscle), which reproduces this
tightness on testing. As such flossing aims to move the tissue back and forth to gently untangle the nerve just
like flossing the teeth removes unwanted food.
Starting Position: Start in a seated position so that your legs are able to move freely, with your head bent
forwards.
Action: Extend your head backwards whilst simultaneously extending your knee on the side which produces
back or leg pain. Finally return to the starting position by simultaneously bending your head forwards and
bending your knee.

Exercises to correct posture and muscle imbalance.

Faulty posture can be a cause of low back pain, due to the adverse stresses that it places through the spine.
Exercise aims to correct this by strengthening and stretching specific muscles around the low back in order to
restore normal posture.

Lordotic Posture (Anterior pelvic tilt)

Here the lumbar spine is overly extended usually because the pelvis is rotated too far forwards.
This can lead to facet joint problems as they are constantly banging together.
STRETCHES
For short and strong (red shading):
Back extensors. Hip flexors.
1. Psoas stretch.

STRENGTHENING EXERCISES
For long and weak (orange shading):
Abdominal muscles. Hamstrings
1. Perform curl-Up as described.
2. Bridging.

Start in a lunging position, with your torso

upright. Slowly bend your back knee the floor,
feeling the front of your leg stretch. Hold for
30 seconds. Repeat 5 times

Perform as shown above. Hold for 10

seconds. Repeat 10 times.

Flat back posture (Posterior pelvic tilt)

Here the pelvis tilts backwards and the hip extends. This posture may increase the onset of disc
related problems.
STRETCHES
For short and strong (red shading):
Hamstrings.
1. Hamstring stretch.

STRENGTHENING EXERCISES
For long and weak (orange shading):
Hip flexors.
1. Straight Leg Raise.

Stretch as shown above. Hold for 30 seconds.

Repeat 5 times.

Hold as shown above for 10 seconds. Repeat

10 times.