Stretching & Core Strengthening


The following sections review some of the principles of physical therapy.  Physical therapy can be a very important part of your pain management regimen.  Physical therapy itself involves multiple different treatment options, which we will not cover here.  We will review a few general stretches and exercises for the lower back and neck.  These general recommendations do not apply to everyone, so please consult with your physical therapist to determine a specific program for your particular chronic condition.

Although stretching may be beneficial for many conditions, core strengthening may not be appropriate for some pain conditions.  Core strengthening may be difficult for the elder population who may find more benefit from a combination of stretching and aerobic exercises.  Please consult with your doctor and physical therapist before beginning any physical therapy program.

CORE STRENGTHENING

Routine back exercises performed correctly and regularly will go a long way to a healthier back.

Start off slow and be patient and warm up your muscles with aerobics before you start your strength training.

Strengthening exercises should be done about every second day; your muscles need a day off to rest and recover.

STRETCHING

Stretching the muscles and tissues around your spine, pelvis and legs helps keep your spine flexible and limber.

Always use proper stretching technique, which means stretching the muscles only to the point of mild tension.  Holding the stretch without bouncing for at least 10-30 seconds, and then let the muscle totally relax.  Repeat each stretch 3-4 times and also repeat the whole stretch routine several times a day. Stretching exercises may be done daily but every second day is usually enough.

Warm up your muscles with aerobics before you start your stretch training, and start slow.

IMPORTANT MUSCLES FOR THE LOW BACK

  • Primary Core Stabilizers
    1. Transverse Abdominus
    2. Multifidus
    3. Pelvic Floor/Diaphragm Muscles
  • Other Muscles
    1. Quadriceps
    2. Gastrocnemius
    3. Soleus
    4. Hamstrings
    5. Gluteus Medius
    6. Gluteus Maximus
    7. Rectus Abdominus
    8. Abdominal Obliques
    9. Piriformis
    10. Iliopsoas
    11. Latissimus Dorsi
    12. Quadratus Lumborum

IMPORTANT MUSCLES FOR THE NECK

  • Primary Neck Muscles
    1. Splenius Muscle
    2. Semispinalis Muscle
    3. Multifidi Muscles
  • Other Muscles
    1. Levator Scapula
    2. Rhomboids
    3. Sternocleidomastoid
    4. Trapezius
    5. Scalene Muscles

NECK STRETCHES

1) Cervical Flexion

This stretch is performed by bringing your chin to your chest

2) Cervical Extension

This stretch is performed by looking up at the ceiling

3) Lateral Neck Bend

This stretch is performed by bringing your right ear close to your shoulder and repeating on the left side

4) Rotation of the Neck

This stretch is performed by turning your head to the right as far as possible.  Try to touch your chin to your shoulder and repeat on the left side

NECK EXERCISES

The neck exercises involve similar movements as the neck stretches with the addition of resistance.

1) Cervical Flexion

This exercise is performed by placing your hands on your forehead and gently pushing your head into your hands, without allowing movement of the head.

2) Cervical Extension

In this exercise place your hands on the back of the head and gently push the head back into your hand without allowing movement of the head.

3) Lateral Neck Bend

In this exercise place your hand on the side of the head and gently push the head into your hand like when you bring the ear to the shoulder, but without allowing movement of the head.

4) Rotation of the Neck

In this exercise place your hand on the side of the head and gently turn the head into your hand without allowing movement of the head.

LOW BACK STRETCHES

1) Lumbar Flexion Stretch

While seated lean forward between your legs with your arms stretched outwards towards the ground until your feel a comfortable stretch.  Avoid lumbar flexion from the standing position as it may aggravate low back pain.

2) Lumbar Extension Stretch

Lie on your stomach then prop yourself up on your elbows extending your back.  Continue straightening your elbows until a gentle stretch is felt.

3) Lumbar Rotation Stretch

Lie on your back then bring your left knee to your chest and slowly bring the bent leg across your body until you feel a comfortable stretch then repeat for the right side.

4) Lumbar Lateral Flexion Stretch

Place your hands along your sides and then run your left hand directly down the side of the left leg, being sure to bend laterally while avoiding forward bending, until you feel a comfortable stretch in the lateral rib cage region.  Repeat on the right side.

5) Pelvic Tilt

Lie on your back with both knees bent and feet flat on the floor.  Keep your legs together and cross your arms over your chest.  Tilt your pelvis and push your low back to the floor then slowly lift your buttocks off the floor as far as possible without straining until a comfortable stretch is felt.

6) Cat Stretch

Position yourself on your hands and knees on a matt on the floor. Very slowly, raise your head. As you do this, allow your belly to open downward toward the floor, and your back to fall into an arch until you feel a comfortable stretch. Then stretch your spine in the opposite direction by dropping your head.  Move your chin toward your chest, while your back rises toward the ceiling, until your feel a comfortable stretch.

7) Hamstring Stretch

Clasp your hands behind the thigh and pull it towards your chest. Keep the opposite leg flat on the floor, until a comfortable stretch is felt ad repeat on the other side.

8) Hip Flexor Stretch

Kneel on your right knee; consider using a pad on your kneecap for comfort.  Then place your left foot in front of you, bend your knees and place your left hand on your left leg for stability.  Then place your right hand on your right hip to keep you from bending at the waist.  While keeping your back straight and abdominal muscles tight lean forward shifting more body weight onto your front legs until you feel a comfortable stretch.

9) Piriformis Stretch

Lie on your back. Put your left ankle on your right knee. Keep your head down on the ground. Reach around the right thigh and pull your knee towards you as you push against the left knee with your left hand, until your feel a comfortable stretch. Repeat on other side.

10) Latissimus Dorsi Stretch

Kneel on the floor then lean forwards with the arms outstretched as far as possible and hands on the floor.  Push your buttocks down towards your feet keeping your hands still until you feel a comfortable stretch.

11) Iliotibial Band Stretch

Lay on your back and with your hands grasp the outside of the opposite knee.  Keeping your back and shoulder flat on the floor and the arms extended for support, gently pull the knee and thigh across to the opposite side of the body until you feel a comfortable stretch along the lateral aspect of the thigh and repeat for opposite side.

12) Calf Stretch (Gastrocnemius & Soleus)

Lean forward against the wall using both your hands for support.  Extend the calf to stretch behind the torso while the other leg is placed with the knee bent.  To stretch the gastrocnemius, keep the back leg straight and slowly lean towards the wall allowing the front knee to bend until you feel a comfortable stretch in the calf of the rear leg.  To stretch the soleus keep the back leg slightly bent and slowly lean towards the wall allowing the front knee to bend until you feel a comfortable stretch in the calf of the rear legs.

LOW BACK EXERCISES

1) Straight Leg Raise

Lie on your back with one leg straight and one knee bent.  Then tighten your abdominal muscles to stabilize your low back and slowly lift the leg straight up about 6-10 inches and hold for 5 seconds then slowly lower the leg and repeat for other leg.  Do not lift both legs at the same time as this may make your back pain worse.

2) The Bridge

Lie flat on your back with your feet flat on the floor.  Bend your knees 90 degrees.  Next raise your pelvis off the floor while keeping your abdominal muscles and buttocks tight.

3) Prone Extension

Start in the prone position and place your arms behind your back and keep the pelvis and legs in contact with the floor.  Keep your chin tucked and then slowly lift the torso off the floor.

4) Opposite Arm and Leg Extension

Begin on all fours, hands directly under your shoulders and knees directly under your hips.  Keep head aligned with spine and keep buttocks and abdomen tight.  Do not let your back arch.  Lift one arm up and forward until it is level with torso; simultaneously lift the opposite leg in the same manner.

5) Wall Squats

Start with your back against the wall.  Slowly bend the knees and allow the back to slide down the wall until the thighs are approximately parallel to the floor. Then, slowly push with the legs to return to the starting position.

6) Scared Cat

Start with hands and knees on floor.  Slowly arch the back upwards and tuck the chin by flexing the head forward and tightening the abdominal muscles.  Then, lift the head upwards and extend the lower back so that the abdominal section hangs downward.

7) Therapy Ball Balance

Sit on an exercise therapy ball with both feet planted on the floor and arms on the side.  Sit tall with good posture, and keep your shoulders square. Your chin should be tucked in.  Slowly rock back-and-forth, side-to-side and in circular motions.  This is an easy exercise to do while sitting at your desk at work or home.