Back pain is the most common reason for seeing a doctor in the United States. More than 85 percent of Americans will experience back pain at some point in their life. Back pain is the leading cause of disability worldwide. Yet surgery is rarely needed to treat back pain.

The following exercises can reduce back pain, when completed slowly and on a regular basis. The exercises should not increase pain.  If pain increases with exercise, ease off, if pain still increases discontinue the exercise, if no increase in pain continue the exercises. When one has leg pain the goal is to decrease the leg pain back into the low back. Decreased leg pain means the nerve irritation is subsiding. If leg pain increases discontinue the exercise and try another exercise if unsuccessful with the exercises discontinue the exercises and schedule appointment with physician to determine the cause of the pain. The goal is to select the exercises that reduce the pain.  People are different, so they benefit from certain exercises, not all exercises are to be completed, be selective with pain reduction. Exercises should not increase the pain. 

There are 3 levels of exercises to lengthen and strengthen muscles.

  • Level one are lengthening exercises.
  • Level two are strengthening exercises.
  • Level three advanced lengthening/strengthening exercises.

Add 2 exercises every third exercise session.  Eliminate the exercises that increase pain. Start with Level 1 exercises initially, which are exercises that increase flexibility. Stay with Level 1 exercises 1-2 weeks.  If pain is subsiding start Level two, which are for strengthening muscles. If pain increases with strengthening exercises, only do Level 1 exercises an additional week, then resume Level 2 exercises adding 2 exercises every third exercise session, if pain increases avoid pushing to far, back off on the exercise ,the pain you have should not increase, if it stays the same continue to exercise. Do not advance to Level 3 if you are still experiencing pain

The concept of lengthening and strengthening muscles was initiated by Joseph Pilates, who died in 1967.   He based this technique on extremely sound principles.  He devised his unique conditioning program after looking at various forms of yoga,ballet and martial arts.  The method lengthens muscles while strengthening them, stabilizing the lumbar spine and pelvis along with controlled breathing, facilitates deep abdominal contraction.  All energy for the Pilates exercises flows outward to the extremities.

The core muscles are a large group of muscles  encompassing the abdomen, lower back, hips and buttocks.  These muscles stabilize the spine,pelvis and shoulders and provide a solid foundation for movement  in the extremities.  These muscles help control movements,transfer energy, shift body weight  and move in any direction.

A strong core distributes the stresses of weight bearing and protects the back.

Stabilize the pelvis with breathing in to prepare for the exercise, breathing out as the exercise is executed. Review  the procedures under Video’s. Practice Pilates Posture throughout the day, avoiding increased pain. 

Sitting in a chair: Push the low back against the back of the chair.
Inhale to prepare. Blow out and pull the belly button up and back, pushing the back against the chair, (think of pelvis as a bucket, getting it level) elongate the spine ,pull head back on shoulders and sit up straight. Inhale to relax and repeat.

Standing up:
1. Inhale to prepare
2. Stand up straight keep the head on the shoulders, not the chest.
3. Blow out forcefully, like blowing out a candle at the same time pull the pubic bone to the ribs and drive the belly button inward towards the spine, pause and breath in slowly.
4.  Repeat every 5 seconds
5..Visualize your pelvis is a bucket of water, pull up on the bucket and keep it level.
6..Repeat through out the day with daily activities including recreational.
7.  As the core muscles become stronger less effort is required to “keep your bucket level”

LEVEL 1  Stretching /Lengthening Exercises

Level 1 double leg pull

Grasp both ankles and pull evenly . If the pain increases, ease off slightly. If pain continues to increase discontinue the stretch. If pain is unchanged, or decreases continue the pull for 30 seconds. Repeat 2-3 times.

 

Level 1 hip rotation stretch

Place right ankle above left knee joint, push right knee away, hold for 30 sec, if increased pain, ease off, if pain continues to increase, discontinue. If pain unchanged or decreases repeat 3reps

 

Level 1 hip abd stretch

Place left foot on right knee/outside right knee, with the right hand pull the left knee over until stretch is felt in buttocks. Do not overstretch. Hold for 30 seconds. Alternate legs hold for 30 seconds. If increase in leg pain ease off, if pain increases stop the exercise. Repeat 3 reps

Level 1 Dog/Cat Stretch

Get into quadruped position, shlds over hands, hips over knees. Inhale to prepare. exhale and stabilize pelvis pulling pubic bone to ribs & belly button towards the spine. Hold 5 sec. Bend head down looking at belly. Inhale to relax, raise head to neutral position for 5 seconds. Repeat 6 reps.

Level 1 hamstring stretch supine

Raise leg slowly keeping the knee straight, stop when the knee starts to bend. Place belt around the foot and pull the foot towards you and push the heel to ceiling . Hold for 20 seconds, alternate legs. Repeat 3 reps .

Level 1 hamstring stretch sitting

Sit with leg straight, bend forward at the waist, keeping the back straight grasp the foot and pull the foot toward you. Straighten the knee towards the table. Hold stretch 30 seconds. Repeat 3 reps. Use belt around the foot if unable to grasp foot, walk hands down

Level 1 hip flex stretch

Hang leg over side of bed , wrap a belt around the ankle, pull ankle to buttocks. Bend opposite knee. Hold 30 seconds. Repeat with opposite leg. Repeat 3 reps.

Level 1 trunk rotation with golf club

Bend knees, keep ankles and knees together. Grasp golf club, rotate trunk in one direction, rotate knees in opposite direction. Repeat 10 reps.

 

Get on hands and knees,bend at waist slide hands forward, try to sit on heels. (yoga childs pose). Hold 30 seconds, rest 10 seconds. Repeat 3 reps.

Level 1 Child’s yoga pose

 

LEVEL 2  Strengthening Exercises

Level 2 plank prone

Begin in the plank position with forearms toes on the table/floor. Keep torso straight and rigid, body in a straight line from ears to toes, no sagging or bending. head relaxed. Pull the belly button to your spine as you breathe in & out. Hold this position 10 sec Repeat 3 reps. Every 2 weeks increase 5 sec until doing 30 or 45 sec then repeat 1 rep. Add variations of the regular Plank. Plank with alternating leg lift. PlankW/ alternating arm lift.

Level 2 plank sidelying

Lie on side, shoulder over elbow, and toes on table/floor lift both legs up. Keep torso straight and rigid, body in a straight line from ears to toes, no sagging or bending with head relaxed. Pull the belly button to your spine as you breathe in & out. Hold this position10 sec. Repeat 3 reps. Every 2 weeks increase 5 sec, until doing 30 or 45 sec then repeat 1 rep.

Level 2 Prone press

Lie prone on stomach, raise up on elbows, with elbows under shoulders, pinch shoulder blades together, breathe 10 seconds out pull belly button to the spine, relax, breathe in 5 seconds and lower trunk flat. Repeat 10 reps

Level 2 Prone press up

Repeat Prone Press, add straighten elbows, attempting to keep hips down on table, if back tightness hips will raise up, straighten elbows until hips come off the table or floor.  do not lock elbows in straight position unless the hips stay down.  Relax lower trunk flat, breathing in for 5 seconds. Repeat 10 reps,

 

 

LEVEL 3 Advanced Strengthening/Lengthening Exercises

Level 3 strength core/hip muscles stand W/ tubing

Attach one end of tubing to table leg or object that will not move. Place chair next to you to hold on to for balance. Stand erect move leg in 4 different directions. Each time you move the leg against resistance breathe out and pull the belly button to the spine, breathing out for 5 seconds and breathe in 5 seconds when relaxing taking the leg back to original position. Repeat 12 reps each of the 4 directions. As you get stronger replace the tubing with heavier resistance or move further away from the attachment for increased resistance.

Level 3 Strengthen core muscles W/ tubing.

Sit on table or edge of chair bend knees up to your chest. Breathe out and pull belly button to spine, breathing out for 5 seconds at the same time take both arms overhead and pull the tubing out. Relax bring arms together and lower legs and breathe in for 5 seconds Repeat 10 reps.

 

 

 

Level 3 hip abd stretch sitting

Sit in chair and bend forward at waist keeping the back straight with head on shoulders not the chest. Cross one leg over the other with the ankle above the knee. Grasp the leg with both hands and pull the crossed knee to the opposite shoulder. Hold for 30 seconds. Alternate and change legs repeat for 30 seconds. Repeat 3 reps alternating legs. Repeat at home when you develop leg or low back pain or at end of day.

Level 3 hip rotation stretch sitting

Sit in chair and bend forward at waist keeping the back straight with head on shoulders not the chest.  Cross one leg over the other with the ankle above the
knee.  Pull up on the ankle and push down on the knee. Hold for 30 seconds. Alternate and change legs repeat for 30 seconds.
Repeat 3 reps alternating legs.
Repeat at home when you develop leg or low back pain or at end of day.

Level 3 Hip Raise

Breathe out 10 seconds and pull the belly button to spine raise the hips hold for 10 seconds. Relax lower hips and breathe in for 5 seconds. Repeat 10 reps

Level 3 Hip Raise W/ Leg Raise

Repeat exercise hip raise and raise left leg keeping knee straight  5 seconds, pull belly button to the spine breathing out,  lower hips and breathe in 5 seconds.  Repeat 6 reps. Repeat with right leg.