How to alleviate low back pain and

protect your low back from injury

– A client’s guide

© 2011 PTDirect.com
Preface

In 1789 the famous American Benjamin Franklin stated that “In this world nothing can be
said to be certain, except death and taxes”. It seems that in the ‘2000’s’ we could update
this statement to include ‘low back pain’. In New Zealand it is estimated that 75% of all
people will suffer low back pain at some stage in their life, in America this estimation
increases to up to 85% of the population. In the United Kingdom, low back pain is
highlighted as the largest single cause of absenteeism from work.

Those who suffer from low back pain are not restricted
to manual workers; evidence shows that people in
sedentary occupations are just as likely to suffer.

This guide is not a tool for diagnosing individual injuries.

It is a general guide to help you prevent injury and pain
at work and at play. In particular it looks at the following
fundamental areas, namely;

1. Forming and maintaining a healthy lumbar curve

2. Sitting well at work
3. Standing after long periods of sitting or leaning
forward
4. Lifting well at work and play
5. Relieving pain and rebuilding your lumbar curve
6. Preventing injury – building strength and endurance in your mid-section

We recommend that you use this guide at all times in conjunction with guidance from your
Personal Trainer.

© 2011 PTDirect.com 2
Forming and maintaining a healthy lumbar curve

Your spine is made up of a series of vertebrae (bones) that sit one on top of another and
run from the base of your skull down to your pelvis. The vertebrae get progressively
bigger the further down the spine they sit. This is to resist the downward pressure of
gravity and the incremental weight of the structures of your body that sit above each
vertebrae. So there is more load (or pressure) on your lower back (lumbar) region than in
your neck region. This is one of the reasons why lower back pain is more common than
mid or upper back pain – there is simply more pressure on your lower back than your
upper back.

If you haven’t noticed yet, your spine has curves in it, it certainly isn’t flat. In light of this
please be wary of anyone who advises you to keep a flat back whether sitting, standing or
lifting.

These curves enable forces to be evenly

transferred through each segment of the
spine without undue strain being placed on
any individual structure. When these curves
are ‘normal’ as shown here the spine is said
to be in ‘neutral’.

When your spine is ‘in neutral’ it is very

strong. However problems arise when your
spine moves out of neutral as undue stress
is placed on numerous structures that can
result in pain and injury.

A neutral spine has an outward facing curve in the middle of the back known as a kyphosis
curve and two inward facing curves known as lordosis curves, in the neck and lower back
regions. Forming and maintaining a healthy lumbar curve is critically important for
preventing and alleviating lower back pain.

© 2011 PTDirect.com 3
So how do you form and maintain a healthy
lumbar curve? Follow these steps…

1. Grab a chair with a firm seat. Ideally use

your work chair as this is where a lot of
your time may be spent. Allow a
complete slouch to occur for a few
seconds as shown here.

(Note that this position may feel comfortable,

especially if you spend a lot of time bending
forwards as is often the case when working with
computers or digging in the garden.

It feels comfortable because many of the

structures in your body have adapted to this position. You may notice that the inward
facing curve in the lumbar region of this person has disappeared. In fact it has flattened
completely. In this position there is undue stress being placed on the lumbar spine and
lower back pain and / or injury is highly likely to occur).

2. Now after slouching, draw up and sit as tall

as you can. Try to accentuate the inward
lumbar curve as much as you can, as
shown in this picture. Hold this position for
a few seconds.

3. Move slowly from these extremes of

slouching to an accentuated lumbar curve
5 times. Repeat this a few times
everyday. This helps to build your
awareness of what an accentuated lumbar
curve feels like when compared to the
flattened lumbar spine that so often
becomes ‘the norm’.

© 2011 PTDirect.com 4
(Don’t worry about doing this exercise; it won’t injure your back as the spine is actually
designed to allow movement and we haven’t added any extra load. The real danger of
developing back pain and injury eventuates from sustaining the slouched, forward bending
posture for long periods of time and not changing it).

4. After moving between slouching to an

accentuated lumbar curve, release just a
little (say 10%) of the accentuated curve,
as shown here. Be careful to ensure that
your lumbar doesn’t flatten.

In this position your spine will be more or

less ‘neutral’. Try to get used to what this
feels like as it’s the strongest and safest
position for the spine to be in whether
sitting, standing or lifting.

A little muscular effort is required to

maintain this position – so give a gentle
squeeze to your tummy muscles and
hold this gentle squeeze for a few
seconds.

If you repeat these 4 simple steps throughout the day then before too long this will become
involuntary, i.e. you’ll be maintaining a strong, safe, ‘neutral’ spine without noticing it.

© 2011 PTDirect.com 5
Sitting well at work

Like it or not you’ll probably spend a fair chunk of your time at work sitting down. Even if
you have a manual job there will always be bookwork to be done which will require you to
sit for prolonged periods.

When sitting for prolonged periods it is vital to avoid sitting in the slouched, forward leaning
position shown earlier. Now falling short of an ‘over-the-top’ analysis of your workstation
here are some key points to protect you from leaning forward and slouching;

1. Keep your keyboard close to your body.

2. Position the top of your computer screen at eye
level and the screen close enough to you so
that you don’t have to lean forward or squint to
read it.
3. If you need glasses to view your screen then
get them and wear them! Your back will thank
you for it.
4. When your feet are flat on the floor ensure that
your seat height is set so that your hips are
slightly higher than your knees.

Aside from avoiding leaning forward and slouching there is actually no one ideal position to
sit in for prolonged periods of time. (The ideal sitting position from the previous exercise is
‘ideal’ for short periods only). Variety as it turns out is the spice of sitting as well as life.
The worst thing for your back is
sitting in one position for a long
period of time – especially if that
position is forward leaning.

So leaning back in your chair can be

good for your back…

© 2011 PTDirect.com 6
 Having your feet up on the table can also be
good for your back. Just make sure your
shoes are clean!

In fact the best thing for your back when sitting

is changing your position regularly. Ideally
you should change your sitting position every
10-15 minutes.

Your body is designed to move, this movement doesn’t need to stop just because you’re
sitting down. Sitting is often thought of as being ‘easy’ on the back. This is incorrect.
There is still a lot of load (gravity and the
weight of the upper body) on the spine during
sitting, and these loads need to be moved
regularly from tissue to tissue to minimise the
load and injury risk being placed on any one
individual tissue in your back.

So if your job involves large periods of time at

a desk or driving a motor vehicle then get into
the habit of shifting your position regularly. As well as shifting your sitting position, get out
of your chair and stand regularly. You may choose to go for a little walk which is great
also, but the sheer act of standing up helps to redistribute loads around your spine.

In light of this it is important to use

an ergonomic chair, but select and
use your chair properly. A good
chair is simply one that is easily
adjustable to allow you to adopt a
variety of sitting positions.

© 2011 PTDirect.com 7
Standing after long periods of sitting or leaning forward

As previously mentioned, interrupting long periods

of sitting with standing is crucial as it helps
redistribute loads across the different tissues in your
back. This principle is exactly the same if you find
yourself spending a lot of time leaning forward, such
as when working in the garden. Try to get into the
habit of standing up every 30 minutes at least.
(Every 10-15 minutes would be ideal).

If you’ve been sitting or leaning forward for a while

you may notice that you’ve acquired a bit of a
forward leaning posture (as shown here). So be
mindful to ‘ease’ your way back into standing and
push up from sitting to standing with your legs.

Now raise your arms over your head and push your arms up towards the ceiling as in the
pictures below. Inhale deeply as you push your arms to the ceiling as this helps to gently
and progressively extend your lower back that may well have become flattened or ‘flexed’
during sitting.

© 2011 PTDirect.com 8
Lifting well at work and play

Low back injuries are commonly the result of lifting. Regardless of whether the object
being lifted is heavy, light or awkward to lift, the lumbar spine is extremely vulnerable to
injury when it flattens or ‘flexes’ out of neutral. So regardless of what you are lifting and
how heavy the object is, you’ll protect your lower back from injury by keeping it in neutral.

When lifting heavy, awkward objects

you can make it easier to keep your
spine in neutral by ‘rolling’ the object
onto an edge and thus enabling you to
grasp it higher up without having to
bend the entire way down to the
ground.

Note that the higher you can grab an

object and the closer it is to your body
the easier it will be to keep your lower
back in neutral when lifting.

During the lift keep your spine in neutral the

entire time; you can help this by consciously
squeezing your tummy muscles throughout
the lift.

The only movement during lifting should be in

the hips, knees and ankles as your big force
producing ‘lifting’ muscles work on these
joints.

© 2011 PTDirect.com 9
 Injuries are just as likely to occur
when lifting or picking up small,
light objects from the floor. This
is primarily due to poor lifting
techniques where the lumbar
spine flexes out of neutral.

Supporting yourself against a

bench as shown here (known as
the golfers lift) and using the
extended leg as a counterweight
helps to minimise any movement in your lower back and reduce potentially dangerous
loads on your lower back. This example is a much safer way to pick objects up from the
floor than the often prescribed ‘bend your knees and keep your back straight’!

Another way you can minimise movement

and loads in your lower back is by
diverting or moving forces away from your
lower back.

Whether you love or hate digging,

chances are you’ll have to dig at some
stage. By resting an arm on the knee as
shown here many of the forces of digging
can be transferred through the front leg
down to the ground, rather than going
through the arm and into your lower back.

This position also enables you to maintain

a neutral spine and use your knee to
support your body weight and transfer it
away from your lower back.

© 2011 PTDirect.com 10
Relieving pain and rebuilding your lumbar curve

It is estimated that up to 85% of people will suffer from lower back pain at some stage in
their life. Even if you try to sit, stand, bend and lift correctly chances are you will
experience low back pain sometime – there is simply so much load placed on this area of
the body and so many pain producing structures that it is unlikely you’ll escape! So here
are some simple exercises to help alleviate pain and rebuild your lumbar curve if it has
become flattened.

Exercise 1 – Relax, lying face down

Relax completely for 2-3minutes in this

position – pay conscious attention to removing
tension from your lower back muscles and
allowing them to relax. This is also a good
resting position for a snooze or ‘power nap’!

Exercise 2 – Relax, supported on forearms

After exercise 1 place your elbows under your

shoulders and lean up on your forearms. Take
a few deep breaths and allow the muscles in
your lower back to relax. Hold this position for
2-3minutes.

Exercise 3 – Push up from lying

After exercise 2 push the top part of your body

up as far as your pain level permits. Try to
relax your pelvis, hips & legs and allow your
lower back to sag. Hold this position for 1-
2seconds and then lower back to resting
position. Repeat 10 times trying to get
gradually higher.

© 2011 PTDirect.com 11
(Please note – if your lower back pain is severe and acute i.e. you’ve just done something
nasty and it hurts like heck, then just perform exercise 1. After which it would be prudent
to call your personal trainer for advice. If they advise you to see a medical professional
then please heed that advice)

If the pain is not acute and severe you may complete the following two exercises:

Exercise 4 – Back extension in standing

After exercise 3, stand upright with your feet slightly

apart. Place your hands in the small of your back
with your fingers pointing backwards as shown here.
Slowly bend your trunk backwards as far as
comfortably possible. Maintain this position for 1-2
seconds and then slowly return to your resting or
normal standing position. Repeat this 10 times.

Exercise 5 – Flexion in lying

It is important to balance extension with some flexion exercise – this helps to protect the
discs between each of your vertebrae from developing bulges due to uneven forces being
transferred through them (discs are firm, gel like structures that act like shock absorbers).

Lie flat on your back with your knees bent.

Gently pull your knees up as close to your
chest as comfortably possible. Hold for 1-
2 seconds and release. Repeat this 5
times ensuring your head remains on the
floor. Follow this exercise with another
repeat of exercise 1.

You can complete these exercises whenever you feel pain or tension in your lower back.
Also if you were trying to rebuild your lumbar curve repeating these exercises 3-4 times a
day would be ideal.

© 2011 PTDirect.com 12
Preventing injury – building strength and endurance in your mid-section

The best form of rehabilitation is preventing injury in the first place and then preventing an
injury from re-occurring. Building strength and endurance in the muscles that support your
spine is just as important as sitting, standing and lifting safely and effectively. The
following three exercises can be performed at home or work and require absolutely no
equipment. They require a minimal investment of your time and will protect you from
costly, debilitative injury and pain in your lower back.

Your personal trainer will be able to help you with these exercises, indeed they may be
incorporated into some of your personal training sessions. These exercises involve
holding positions for 5-10 seconds which may be different to many of the exercises you
currently do in the gym. The reason for this is quite simple – a key role of many of the
muscles in your mid-section is to restrict movement and by virtue of this, to protect your
spine, so movement needs to be restricted for longer than just the 2-3 seconds a typical
gym repetition takes.

Each exercise here has an ‘easy’ and ‘not so easy’ version. Start with the easy version of
each exercise and only progress to the not so easy version when you feel you are getting
no benefit from the easy version. These exercises don’t require maximal intensity
contractions so try to keep the intensity throughout to what feels ‘gentle – moderate’ for
you. There’s no danger of ‘over-doing’ it with these exercises, you could do them
everyday if you choose, but try to repeat them at least 3 times every week.

The exercises consist of:

1. The side bridge

2. The bird dog
3. The abdominal curl

© 2011 PTDirect.com 13
1. The side bridge: This exercises works all your mid-section muscles, and in particular
the muscles on the side of your torso.

Start position

Support your weight on your hip and knee,

use your free hand to grasp your opposite
shoulder as shown and pull down firmly.
This will help to support and stabilise your
shoulder during the exercise.

End position (easy version)

Now straighten your torso so your body is

supported on your elbow and knee. Hold
this position for a slow count of 5 seconds;
gently squeeze your tummy muscles
throughout. Lower back to the start
position and repeat this exercise 5 times.

End position (not so easy version)

The only difference with this version is that

your legs are straightened and your weight
is supported by your elbow and feet/lower
leg. Make sure you hold each repetition
for a slow count of 5 seconds, squeeze
your tummy muscles gently and repeat 5
times.

© 2011 PTDirect.com 14
2. The Bird dog: This exercise also works all the muscles in your torso, in particular the
muscles that run up and down your spine and the muscles that attach your hips to your
spine

Start position

Start with your hands directly under your

shoulders and your knees directly under
your hips as shown here. Gently squeeze
your tummy muscles to help prevent your
back from sagging or arching

End position (easy version)

Raise one leg out behind you as shown

here. Hold this position for a slow count of
5 seconds and lower to the start position.
Repeat the above for each remaining limb
independently. For each limb – hold the
end position for a slow count of 5 seconds,
ensuring you gently squeeze your tummy
muscles throughout. Repeat this exercise twice for each limb.

End position (not so easy version)

Raise your opposing arm and leg at the

same time as shown here. Hold the end
position for a slow count of 5 seconds,
then return to start position and repeat for
alternate arm/leg. Repeat three times for
each arm/leg. Gently squeeze your tummy
muscles throughout.

© 2011 PTDirect.com 15
3. The abdominal curl: This exercise focuses particularly on the muscles on the front
and of your torso

Start position (and virtually the end

position for easy version)

Lie on your back with one leg

outstretched and the other bent as
shown. Place the palms of your hands
facedown under your lower back, and
have your elbows on the floor. Squeeze
your tummy muscles and gently raise
your head and shoulders 1 cm off the
floor. Hold this position for a slow count of 5 seconds then lower back to the floor. Repeat
this 5 times. Your elbows should remain on the floor throughout. Try to make sure that
your neck remains motionless throughout the movement – this may be helped by placing
your tongue on the roof of your mouth and gently pushing it into the roof of your mouth.

End position (not so easy version)

In this version try to raise your head and

shoulders slightly higher (up to 5cm off
the floor) and also raise your elbows off
the floor. Hold the end position for a slow
count of 5 seconds, lower back to the
start position and repeat 5 times.
Remember to gently squeeze your tummy
muscles throughout. You should feel no
movement or downward pressure on your hands during this exercise as there should be
no movement in your lower back. If there is – revert back to the easier option and check
you are not raising your head or shoulders to far from the floor.

As a side note here – please remember to keep breathing during all these exercises. It’s
important that you hold the ‘tummy squeeze’ but please do not hold your breath!

© 2011 PTDirect.com 16