Low back pain is a very common problem that affects millions of people globally. It occurs in the lumbar region of the vertebral column especially L4-L5 and L5-S1, where it develops in the weakest part of the intervertebral disc which is the posterolateral side. Low back pain can occur at any age, most commonly in males at ages between 30-50 years.
Low back pain usually subside by itself but if didn’t after 3 days, the patient should visit a physician. It os called chronic low back pain if it lasts more than 3 months without subsiding to the pain.
Low back pain is most often the result of a gradual, aging-related wear and tear to the disc called disk degeneration. As people age, their disks become less flexible and more prone to tearing or rupturing with even a minor strain or twist.
Sometimes, using back muscles instead of leg and thigh muscles to lift heavy objects can lead to a herniated disk which cause low back pain eventually, as can twisting and turning while lifting. Rarely, a traumatic event such as a fall or a blow to the back is the cause.
Risk factors for low back pain:
- Heavy lifting.
- Hard working.
- Sitting for long time.
- Office work.
- Driving for long time (occupational driving).
- Strenuous physical exercises.
- construction work.
- Accidents as falling.
- Hard mattress.
A)Abdominal strengthening exercises:
1.Curl up exercise:
This exercise is for the rectus abdomenis muscle. The patient is instructed to lay down on his back with both knees flexed (crock-line position) and his arms are straight beside him.
Then ask him to try to raise his head and shoulders from the plinth/ mat as far as he can and touch his knees with his hands while contracting his abdomen. Be sure that his breathing is normal and he doesn’t hold his breath to avoid valsalva maneuver.
This is considered as the first graduation of the exercise. Then try to raise his whole back from the mat/plinth as a progression of the exercise. The next graduation is as the previous exercise but with his arms behind his head. Repeat this exercise for 20 times.
2.Oblique crunch exercise:
This exercise is for the internal and external oblique muscles. The patient is in the same position as in the previous exercise. The therapist asks the patient to try to raise his head and shoulders from the plinth/ mat and touch his right knee with his left hand while contracting his abdomen.
Repeat the same exercise to the other side ( touch the left knee with his right hand). Be sure that his breathing is normal and he doesn’t hold his breath during the exercise. This is considered as the first graduation of the exercise. Then try to raise his whole back from the mat/plinth as a progression of the exercise.
The next graduation is as the previous exercise but with his arms behind his head and the patient try to touch his knees with his elbows. Repeat this exercise for 20 times.
This exercise is for the whole abdominal and back muscles. Ask the patient to lay down on his abdomen with his elbows bent underneath him and his legs are straight and together then ask him to raise on his elbows and his toes with his back straight.
If this position is painful or hard for him, the patient may do the exercise over his knees instead of his toes. Hold this position for 30 seconds or for as many seconds possible for the patient. Repeat this exercise for 5 times or according to the patient.
4.Side plank exercise:
This exercise is for obliques, transverse abdominus, latissimus, and quadratus muscles. The patient is asked to lay down on his side with his elbows bent underneath him and his legs together and then raise on his elbows and the side of his foot that’s touching the mat, his other hand is straight over his body or he could raise it for stability if he wants.
If this position is painful or hard for the patient, he could do the exercise but raise over his knee that is touching the mat instead of his foot. Hold this position for 30 seconds or for as many seconds possible for the patient. Repeat this exercise for 5 times or according to the patient for each side.
B)Back extensor exercises:
The patient lays down on his back with his feet flat on the mat and his knees bent for 90 degrees (crock-line position) and his arms are straight beside him. Then ask the patient to push against his heels and lift his pelvis off the mat to form a bridge. Hold this position for 5 seconds and repeat it for 20 times or according to the patient.
2.Bird dog exercise:
The starting position is quadriped (the knees bent at 90 degrees and touching the mat, and his arms are straight and his hands flat on the mat).
The patient is asked to raise one hand off the mat firstly, hold for 5 seconds and then repeat the same exercise but raise the other hand.
The next progression is by raising one knee off the mat, hold for 5 seconds and repeat the same exercise but raise the other knee off the mat.
The following graduation is by raising one hand off the mat with the opposite knee, hold for 5 seconds and repeat the same exercise but tot the opposite side.
2) Instructions for the patient:
-The patient should rest till the pain subsides.
–He can use hot back over his lower back to help relieve the pain.
-Use soft mattress.
-If he is an office worker, he should stand up, stretch his body, and move his leg every hour to avoid developing low back pain in the future.
-Use the right way during lifting: squat down in front of the object and hold it close to his body and rise slowly from the squat with his back straight.
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