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Low Back Pain
Julia DelNero & Sara Siedman
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Anatomy of the lower back
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Consist of L1-L5 in the lumbar region
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Support the weight of the entire torso
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In-between each of L1-L5 are discs
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Discs act as shock absorbers
L5 meets with the sacrum to allow considerable rotation so pelvis
and hips are able to swing when walking and running
31 nerves are rooted to the spinal cord in itself
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Risk Factors
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Age
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Diet
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The more weight you carry the more stress you place on your
back, therefore a healthy diet is key
Sedentary lifestyle
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The older you get the more wear and tear goes on your back
Desk jobs
Not active
Mental health factors
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Stress
Anxiety
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Muscle Involvelemt
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Rectus abdominis
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Transverse abdominis
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Internal oblique
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External oblique
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Cont.
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Latissumus Dorsi
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Quadratus Lumborum
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Gleuteus Medius
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Latissumus Dorsi
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Quadratus Lumborum
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Gleuteus Medius
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Causes & Daily reasons for pain
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Muscle imbalances
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Training one side of the body more then the other
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Focusing more on dominate sides
Sedentary lifestyle
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Trauma
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If you are not exercising and sitting at a desk all day
Car accidents
Manual Labor
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Lifting with your back instead of your legs
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Mechanisms of Dysfunction
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Gait
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Postural Analysis
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Biomechanics of stress
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Flexibility
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Gait
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Studying the motion and mechanics of how a person moves.
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Used to assess, plan, and treat people with conditions that are
hindering their ability to walk
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Postural Analysis
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Locates if a person has any form of scoliosis, reduced
lordorsis, kyphosis, etc
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Loads acting on the lower back
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Sitting at a 90 degree angle has no advantage for anyone
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This shows the loads acting on the spine with different
backrest angles showing that the load is the minimum when
backrest is around 120 degrees.
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Spin in relation to standing upright
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Spine in relation to standing upright:
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The more weight you carry the more stress it puts on ones
back
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How to asses the client
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See if there is pain, how intense it is and how long it lasts
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Physical examination, check posture, check for anatomical
abnormalities such as scoliosis or kyphosis
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Palpation/percussion of spine to check for soft tissue or vertebral
tenderness
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Straight leg raise
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Neurological exam if needed
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Get client history
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If pain is severe they should not exercise but there are some
exercises client can do to help relieve them of lower back pain
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Sample exercise program
Since the core is constantly supporting the lower back we will
place a heavy emphasis on training core specific muscles
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Reverse crunch- NO counterweight
1- Crunch teaches people to properly tilt their pelvis
2- When performing this exercise think about curling your belly
button to the top of your ribcage
3-When unrolling think about unrolling from the top position one
vertebra at a time
6 rounds of 6
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Dragonfly
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This exercise comes into play
once the reverse crunch
becomes too easy
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Teaches you to posteriorly tilt
your pelvis but also hold that
position throughout a range of
motion
 Essentially it’s a great antiextension challenge
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Get as tight as possible
 Squeeze butt and core hard
and maintain a straight line
from ankles to hips to
shoulders
4 rounds of 5
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Split stance-Cable shop
• Standing, in a split stance with inside
foot forward, back foot directly in line
with the front foot and knees slightly bent
• Trains body to avoid rotation and
reinforces good breathing patterns
• Working your chest, arms and hips as
well as challenging your stability
• Holding rope handle with both hands
from high cable position
6 rounds of 6 (each
side)
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Wide stance-anti rotation chop
6 rounds of 6 (each side)
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Helps to avoid rotation
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Get tight and don’t let anything out of place’
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Assume extra-wide stance with a cable machine to your
right. Hold the rope attachment in front of your chest with
your arms extended
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Rotate your upper body to the right as far as your range of
motion allows. Keep your arms directly in front of your
chest—do not move your lower body
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Reverse the movement and rotate your upper body toward
the left as far as you can, pulling rope attachment with you
as you move. Keep your arms directly in front of your chest
and do not move your lower body
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Continue rotating your torso in each direction
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Core assisted push-up
• With a resistance band under the core this will help to correct proper
form
• Work on lightening up resistance to eventually not have to use the
band for help
• The band will allow you to load the upper body while doing your
push up without compromising your form.
6 rounds of 6
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Butterfly sit-ups
• Brace and squeeze core while sitting up
• Hands should point toward or past toes
6 rounds of 12
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Elevated pushups
• Use lowest height and least resistance while maintaining
form
• Elbows aimed backwards hands facing forward
• Keep head, neck, back, and hips all in a straight line
6 rounds of 6
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Side planks
3 rounds of 15 second hold on
each side
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Assume a plank position, then slowly drop your hips to the
ground and pull back into proper alignment
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Align shoulders, hips, and knees
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For an easier/assisted use one of your legs as a “kick stand”
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Leg raises
• Start lying on the ground, you may use hands placed under
glutes to help brace lower back. Once you begin each set do not
set the feet down in-between reps
• The leg raise is the perfect exercise for the somewhat neglected
lower abdominals and hip flexors
4 round of 8
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How can this program be used?
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Gain and maintain normal range of motion
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Reduce risk of injury by staying healthy
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Stabilized core which helps stabilize spine
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Improves posture so there is less stress on your spine
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Helps maintain flexibility
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Effective for mobilizing hips to increase stabilization
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What are short and long term goals
of this program?
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Short term pain relief
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Improve ability to achieve self sedation
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Abdominal and lumbar muscle strengthening
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Increase hip and lumbar spine mobility
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Improve lumber and pelvic priori overprice sensibility
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Intervertebral joint stabilization
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Lumbar posture modification
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Improved general fitness
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Resources
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http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm#290513102
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http://www.healthline.com/symptom/low-back-pain
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http://www.aahf.info/pdf/SN_Training_clients_with_Low_Back_Pain.pdf
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http://www.spine-health.com/wellness/exercise
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http://www.agape-biblia.org/plugins/pract-ministries/Lect502.htm
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http://www.nismat.org/services/orthopedic-surgery/therapeutic-exercise-programs/lowback-exercise-program
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Web MD
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http://www.spine-health.com/conditions/spine-anatomy/lumbar-spine-anatomy-and-pain