Back rehab exercises

Join Dr. Chris Erickson as he explains why these exercises are important in the rehabilitation of your back.

Back rehab exercises video transcript:

Hello. How are you, Chris with EHS Physical Therapy, along with Essential Motion Spine and Sport. I really want to talk to you today about some exercises, some progression, some important things to know about low back. You know how herniated disc, bulging disc, sciatica piriformis–whatever you want to call it–it’s very misunderstood.

It’s very misdiagnosed in a lot of cases. The other thing I want to talk about is the differences and exercises that we commonly see so many times. You’ll say, “Well, I tried the physical therapy. I did this. I did that.”

And I asked, “Okay, what the hell did you do?”

“Well, I did a couple of core exercises and a little bit of this.”

Okay. Even among professionals, the core is misunderstood. It’s not well defined, so engaging those muscles–whatever you want to call it, whatever part of the body–is part of the process.

But we also need to think about how to essentially–first we have to diagnose or whittle our way down to the mechanical cause of the low back pain. Mechanical low back pain is not well understood. You can’t just diagnose it based off of one advanced image. You can’t say, “Well, I’ve had an MRI and it showed I have these bulging discs,” or “I had an x-ray, and it shows that I have these arthritic changes.” Those are considered normal findings in many people.

It’s a combination of factors. What makes you better and worse? How long have you had it? Where are the symptoms? In the leg? Just in the back?

Those kinds of things, along with some advanced imaging, that we can kind of put the pieces together, but we can’t diagnose for sure and say this is for sure what’s causing your pain based off of one image. It’s not good medicine, and it’s not the way to do things. So I’m going to give you some basic exercises. These, by no means, will be right for everyone.

They may be right for a good majority, but think about I’m going to throw in some of the common, like core ones with some of the planking and the easy ones. But also you have to remember: moving through space with your feet on the ground and squatting and lifting and those kind of things–those are normal functional movements, things that we do and should do throughout the day. So they’re also good at keeping yourself and your core or your muscles strong. So it’s important to do those things as well and not be scared of those things.

Not be told like, “Oh, you should never squat again. You should never deadlift again.” Well, that’s not true. If you get up from a chair, you’re squatting. If you pick something up off the ground, you’re deadlifting.

I know that can be scary, but those are normal things that people without pain–and you–should be able to do eventually as well. So we’re going to go through some things with squatting and some different movements. I’m also going to throw in some of the lower level ones. I’m going to try to scale them up and down based on your ability. So you have to be very conscious and very aware of what’s happening with your pain.

So a few things to start with:  better and worse are two very…you have to understand what better and worse means. Better would be, well, it can hurt even while you’re doing it. As long as when I’m done with that movement, that exercise, whatever it is, I kind of feel like I’m moving better and the pain is less. Or if you have any kind of pain, like down a side, if it feels like okay, it was here even though it hurt to do while I was doing it when I was done, it’s actually up higher.

It’s less in the leg or it’s less in the buttock or hip, and it’s moved more to the middle. That’s better, even if the intensity is slightly increased.

Worsening. Okay, by definition, for what we’re going to do here would have to be a progressive, either like down or a steady increase in the pain level. That does not calm back down quickly. Once you’re done that’s, a worsening. Worsening is not, “I do one thing and oh, that hurts. It’s the same as it was.” That’s not worse. That’s increase. Not worse. Because it’s like I pull my finger back, that hurts when I’m done it. Calms down right away. I’m not worse off because of it. So think of it as a net result kind of thing. There’s going to be lots of increase, no worse increase, no worse.

With all these things, you may find some that actually make you better. You may find some that actually make you overall worse, but I think the vast majority will kind of be increased, a little bit of pain, but then I’m no worse or that kind of decreases the pain a little bit. But I know better right afterwards, but the ones that decrease and then the pain kind of comes back after a few minutes or it’s no worse overall. That’s good. That’s okay.

That’s good information. Keep doing those. You just probably need more reps or to go deeper into an end range. So let’s start with for the purpose of this video, let’s assume that you the watcher is only having pain in the low back, maybe off to one side, a little bit hip, buttock, but nothing that’s down below the knee. Nothing weakness-weird, like sciatica-type symptoms down below, into the ankle or foot.

That’s going to be a different video more than likely. I got to show you how to fix that. First resolve that, centralize that, then we move to the other things. But let’s check it out. First.

I got a couple of things written down. I would start with a brief warm up of just either hands together, like by the chest and probably just sitting back and you’re going to sit on a chair and just some nice air squats up and down. You don’t have to go as low as I’m going to stop here and come back up. But think about keeping your stomach tight, your hips and butt tight. And when you come up, push forward and really get some extension in the hips and glutes.

So we’re strengthening all of the muscles around that low back with the glutes, the hips. And then, of course, the core muscles because you have to engage those to be an active, dynamic, functional person. Okay. The other way that I would do this is either hang on to something so you can sit back for them, like the kitchen sink or a bar. That way you can really sit back and then you don’t have to worry about your balance.

I don’t want you to feel like you’re losing balance. So if you feel like it’s hard to do without hanging on, then hang on. Or sometimes I use with our clients. I’ll use these TRX bands. And so this is something they can hang on to.

And then they can really kind of sit back, sit low and go low, go low, and they can use their arms to help themselves up. So it’s actually less than your body weight because you’re helping back up with your arms. This is actually a much easier way to do this. You can adjust where your legs are. You can go a little bit wider, turn your feet out.

You get a little bit more of a Sumo squat. And that might be important if you have issues with mobility in your hips, your knees, your ankles just change the angle a little bit just so you’re getting down there. But I’m keeping my back as I’m doing it. I’m keeping my back nice and straight. I’m not squatting this way.

I’m really sitting back and using my hips. Okay, next one I would do is let’s just do, like, a bit of a what’s called a pal off press. I’m going to take a band that’s attached to my rig right here. I’m going to tighten everything in through stomach and hips. The band is going to be by my chest, and then I’m going to push out towards you.

Okay. So the resistance of the band is making me want to twist that way, but I’m resisting that force or that twist with my muscles. So I’m using my chest, my arms, my stomach muscles, my butt muscles to resist that twist. Of course we do that both ways, and I turn this way for me. I’m going to switch hands to see that.

There we go here. It’s wanting to twist me that way. I’m not going to let it. I’m going to resist that twist and press out. And I got a slight squat in my legs.

I’m not all the way straight. I’m not locked out. We got a slight bend in the knees. So I’m really focusing in my mind is really focusing in on feeling what my body is doing, what’s contracting, what muscles are activating tightening. Okay.

So that’s the power of press that way. And then I’d go into a slouchover. Correct. I’m going to grab a ball here quick with sitting, sitting is often a problem for us that have a lower back issue. So I’m going to use a ball.

Hopefully, there we go. So I’m going to try to work on keeping my chest and shoulders kind of straight. I’m only going to use my hips and my pelvis is going to rock. I’m going to kind of rock under and slouch. We don’t want to be there, but see, my chest and shoulders aren’t moving.

I’m moving from here. Okay? And I’m going to rock back up. I’m going to rock down slouch and then back tall, just back and forth. We don’t want to spend too much time here.

We don’t want to spend too much time all the way locked out. But if you relax off, that about 15% to 20%. There’s that spine neutral. So you can use this to kind of find a neutral sitting position in your chair at home or work or in the car by slouching and then over. Correcting.

Real tall, back and forth. What this does is the discs themselves do not get very good blood supply, so the blood carries oxygen. We need the oxygen for healing. They get their nutrition and oxygen through Loading and unloading like a sponge. You got to kind of squish them and move around, which is why too much inactivity.

You feel stiff. I know when you first stand up, it’s oftentimes it’s very difficult. I feel stuck and it takes a few steps to get going. But as you move, most of us generally feel better because we get that movement through the spine and we need the blood flow and the oxygen. So that’s why I would do that one.

Okay. Next, let’s go. I’m going to do a little bit of a combination of movements here, from a high plank into a shoulder, tap into an extension into a maybe a twist. I’m going to bring you down so you can see me on the ground here. I think this will be better if we’re on the ground with each other.

Let’s try. There is that pretty straight. Let’s go that way. Okay. So let’s go into a little bit of an angle.

Move this ball out of our way into a bit of a high plank, like a push up. Okay. So I would either just stay here and again. Think about don’t twist or go side to side. Just tall a push up position.

You can go from knees. That’s fine. Don’t let it for the purpose of this one. Don’t let it sag too much. And don’t be too like but in the air too much. Try to find somewhere in that middle ground and hold and feel what your hips are doing. Your shoulders, your shoulder blades, your stomach muscles. What’s happening with your back pain? Okay.

And then when you need to come down, that’s fine. You can kind of sit back on your heels, stretch a little bit through that mid back. That’s fine. I like this one. I feel very good when I go from this kind of someone call the child’s pose and a yoga type thing, but I get that mid back and low back stretch.

So then come back to the high plank. If you want to advance it a bit back to here. And then I want to work on going nice and strong with the stomach muscles, work on shifting your weight and just tapping that opposite shoulder. Now you’re putting all this weight through one arm and you have to have to engage your obliques and stomach muscles or you’ll fall over. So use your stomach muscles, your glutes hips to do this side plank.

Sorry. A shoulder tap. All right. So that one again, come down, rest when needed. The other one that we could do.

That would be a bit of an advanced or to move up a little bit again. If it’s too hard or it’s hurting, go down to just plank from the knees and you can kind of just rock into it. You can just come from here. You can just kind of get in. And actually we’ll get into an extension later.

But let’s just go neutral and then back. And then if you can just try to hold right there. But think about those rules that we talked about at the beginning. The worsening if something is going down the leg or it’s overall feeling worse as you do more of them and you have to stop and you have to rest. It’s not worse until it lasts for 10, 15, 20 minutes later.

Like, okay, I’m still increased pain. Then it’s worse. Then it’s worse. Then stop. Okay.

All right. So then we could go into from that high plank position, we could twist slightly into, like, kind of a side plank T position, and then we have to kick in more of our side muscles down here. All right. So we got that one into a tee.

I would use that if you’re feeling pretty good, you could go into that position like that. All right. So from a plank to a side plank and then what I typically do for my lower back and have many people do. The majority of people vast majority are going to respond with extension. So after those, I would drop down into kind of that hips down what I would call extension and lying.

You can just maintain this. Here the key. The trick. What you have to do with this is you can’t have your stomach tight and your glutes tight on this one. Okay.

The exercises that we’re doing, those you want to stay like your muscles tight. But for the extension and line part, we don’t want the muscles tight. We actually want it to breathe out, to SAG, to let those bones and that disc that’s in between there get to endrange. I want to put some pressure on that disc that’s in the way. So this one, we do want to get all the way kind of down through here.

Glutes hips, relax, looking high, breathing out. Put that sag, sag, sag. And if you want to just come down and then you can come, just rest, make sure you assess it, see how you feel, then come back up, breathe out. So you can either go that way up and down like this.

Just do sets of about eight or ten. Now that we’ve gotten into this a little bit and we’re a little bit warmed up with the squats and everything else, I definitely want to get in the head. This is about the halfway point. I want to use some of these extensions, or you can rock back and forth. You can go back and kind of sit back and stretch that mid and upper lumbar spine with this part.

Kind of sagging down and then just come back and let it fall this way as far as you can breathe out and then just kind of rock back into it. This is what I would normally do for myself. I kind of just go back and forth, but the key is you have to get to end range here. It can’t be up here. It’s got to be as far down as you can.

Okay, now we’re about that halfway point. Let’s get a couple more new ones here and then we already worked on the side plank, although here we could do the side plank could be modified as well. Instead of off on your hands, you could just go in this. I got to move this microphone. Okay.

So you could just go elbow as well and then just come up into this side plank here and hold. This is another way to work on shoulder muscles as well as your AB muscles. Okay. And then do both sides of those, if that one’s bothersome at all. Don’t worry.

That’s definitely a bit of a next level or an advanced thing because of the change for us right now, I want to keep us mostly in what’s called the sagittal plane, which means going forward and backwards. We haven’t done a bunch of rotation or side to side stuff yet a little bit with that other side plank. But for the most part, we’ve been in the sagittal plane moving in this direction. Okay, let me set you back over this other way.

Here’s some of those old ones that you guys have probably been used to from past experience. All right. I’m going to put you up here, see if we can make sure we see that bed there. There we go. Okay.

So let’s go ahead and we’ll lay down. Some of these ones are pretty standard. I don’t do them very often, but let’s throw them in case you’re really having a rough day and you need a little bit of relief from here. I would probably just work on letting the knees just fall to the side, like a little bit of rotation to the right, back over to the left. If anything, this one tends to be very safe.

Not a lot of things. Bad things happen with this. You might feel a little bit extra pain when you’re over to one side, but typically, as soon as you get back to neutral here, things aren’t any worse. It’s just like, yeah, it’s about the same. So just try to get a little bit of rotation and movement through that spine again.

We’re just trying to increase some blood flow. These are not ones that are like, oh, I’m going to strengthen my whatever muscle or, like, fix my core. That’s nothing to do with that. At this point, we just need some blood flow. Your body is going to do a good job of healing itself.

The other strengthening ones we did earlier with the squatting and the other press the stuff with the planking and moving. That’s going to be more strengthening. This is just more nice movement for a day when it’s a little bit tougher. Now, you could work on tightening here, so kind of tighten those muscles and flatten that back a little bit and then work on nice, easy heel and then just back and forth. So, like, some marching here, keeping everything tight again.

These are the days when things are going pretty awry, having quite a bit of pain. The nice part about this one is that I’m not moving from the lumbar spine. I’m moving from my hip. So this shouldn’t be too bad for most. It’s not very advanced.

It’s not going to do a ton, but it is pretty good to get some movement and start to work on those AB muscles. Okay. The other one we could do then is to take one up and I sometimes lightly just push and hold against there that gets more of the AB muscles kicked in. So push your knees this way. Your hands are pushing down, push and hold 2345 slowly and then switch to kick it in 12345.

So not pushing as hard as I can. I mean, submaximally don’t push as hard as you can, but just push in. Still should be able to talk and breathe. Three, four, five, switch 12345. Okay, so for right now, I’m going to end there.

I think that’s about all I want to talk about. Gosh, I really thank you guys for watching this video. I really think that if we do a combination of them, you can pick and choose. You don’t have to do all of them out of that exact or in that sequence. But try it.

Take from it. What’s valuable to you, which you can use, and then just go with that. If you have any other questions or need some more advice, just let me know and I’ll stick you in the right direction. Okay? Thanks.