A while back, I discusses some misconceptions on low back pain in the popular 7 Low Back Pain Confusions. This post I’ll break down a 10 minute routine which has helped countless people improve their low back pain, like I did for the shoulder and knee.

The 7 Low Back Pain Confusions discussed the importance muscle length, strength and timing in low back pain prevention and rehabilitation. First, I’ll give an overview for these three main categories and discuss the 10 minute program.

COR Physical Thearpy Low Back Pain Solution

COR Physical Therapy Muscle Length

Improving muscle length is essential and the most important aspect for rehabilitation, in my opinion. Tight muscles will inhibit other muscles from working properly.

For example, squeeze your finger as hard as your can. Next, maximally flex your wrist and squeeze your finger again. If you did this right, you should have felt a significant decrease in strength when your wrist was maximally flexed. The cause of this strength was an altered position of your muscle fibers, changing the length/strength relationship. Each muscle has a strongest joint position, unfortunately daily habits (posture, sitting, sports) put your body in suboptimal resting positions, causing impaired muscle firing. These impairments in muscle length not only cause weakness, but can cause symptoms. Poor resting position can cause myofascial adhesions (fancy term) more commonly known as “knots” in muscle causing symptoms. Self myofascial releases (SMR) are simple methods for improving myofascial adhesions. For these techniques you will need a baseball, tennis ball, or foam roll, but first, follow these rules:

COR Physical Therapy Muscle Length Analogy Part I
COR Physical Therapy Muscle Length Analogy Part II

COR Physical Therapy Self Myofascial Rules: 

  • Lie on the tennis ball focusing on the instructed areas 
  • The more sensitive or tender the area, the slower you should go 
  • Stop if the exercises causes pain, but a little discomfort is expected 
  • Perform for 30 seconds – 2 minutes 

SMR Quadratus Lumborum

Lie on your back, approximately 30 degree from vertical with the tennis ball one your side in between your rib cage and pelvis, in the “beach pose” position. The ball should be placed as close to the center of the spine as possible, without lying on the exact middle or “bumpy” part of the back.

SMR Piriformis

Long sit with one knee bent and the other straight. Put the tennis ball under the extended leg on the outside aspect of your hip. Roll the tennis ball around, avoiding the center of your glute.

SMR TFL

Locate the TFL by finding your iliac crest, then move two finger breadths behind the iliac crest. Lie directly on your side with the tennis ball directly on this muscle.
Lie on your side and place the tennis ball or baseball on the distal aspect of the leg. Determine your pressure by pushing through your arms, then roll over the distal aspect of this muscle.

COR Physical Therapy Stretching

These self techniques improve most muscle length issues. Unfortunately, stretching specific muscles also play a role in improving myofascial adhesions and muscular imbalances. The purpose of stretching is to make the muscle and surrounding fascia (outer covering of muscles, like a sac) more supple and increase in length. The most important aspect of stretching is compliance. When you stretch you get an immediate increase in tissue length. This is due to the elastic properties of the tissue and improved stretch tolerance. However, the term elastic implies, this change will not last long. When you repeatedly stretch muscle and its fascia; you get a ‘plastic’ change in the tissue – a lasting change. To achieve this you must stretch daily. Missing several days will put you back to square one. Everyone has the potential to do the splits, but not many of your muscles are trained to handle the stress. Compliance will improve your tolerance to stress. To improve we have found that stretching each muscle for 30 seconds daily will get you results. You should feel a stretch sensation, not pain. As with any exercise, if it causes your ‘pain’ – stop.

Standing Psoas Stretch

Put one foot up on a table or other high object (depending on your height – no higher than the knee). Point the foot that is on the floor into a pigeon toed position. In this position, do a pelvic tilt or “tuck under.” You may feel a stretch in then front of your thigh. If you don’t, lean forward, leading with your hip and keep your chest in the same position. You will feel a stretch on the front of you thigh, and in the groin area. Hold onto a object with your hand to stay balanced.
I recommend performing self myofasical before the following exercises and the stretch after the exercises.

COR Physical Therapy Muscle Strength, and Timing

Muscle strength and timing are closely related in early prevention and symptom resolution. These exercises are the basics, but I have seen them do wonders from grandparents to professional athletes. However, depending on the demand you are putting your body through, these may not adequately strengthen in every plane of motion. Most low back symptoms are from instability. Performing the following exercises in the compact position emphasized stability and minimizes movement. All the strength and timing exercises must be performed in this position. If these exercises hurt your back, it is likely you are performing them wrong or you have a more serious condition. Obtaining the compact position helps stabilize the low back, while allowing the hips to move freely. When performed properly there will be no low back pain. These exercises will maximally contract the abdominals, while preventing low back movement. This contraction will improve the resting position of weak, long musculature, by over-correcting the core. The theory is after the muscles are over-corrected, the muscles will lie in a better resting position optimizing life. The compact position also helps with muscle timing. Altering hip flexion, abduciton, extension, etc. with maximal abdominal contraction improves their timing and rhythm, preventing injuries. These exercises are the basics for proper stabilization, set the base today!

Abdominal Bracing Rules Rules

  1. Lie on your back with your knees bent. Posteriorly tilt your pelvis, “tucking under”, to maximally contract your abdominals.
  2. Do not let that position change AT ALL during the exercise.
  3. Stop if the exercise causes ‘your pain’.
  4. Stop if can not keep the correct back position.

March II: 3 sets of 5 repetitions

On your back, place your hands under the sides of your low back. This is your pressure reader, to ensure your low back isn’t moving. If the pressure changes during the exercise, try again and if it is still moving, try the March I (see below). Bring one knee to chest. Hold it there. Then bring the other knee to the chest. Let one leg down, then the other. Repeat.

If you have symptoms during this exercise or if you can’t keep the compact position try the alternative.

Alternative: Abdominal Bracing, 10 sets of 5 seconds

Lie on your back with your knees bent. Next, place your hand under your low back and tighten your abs as much as possible, by posteriorly tilting your pelvis and bringing your ribs and pelvis together. Hold, then repeat.

Hip Abduction with Band: 1 set of 30 seconds

Lie on your back with your knees bent. Obtain the brace your abdominals  with your hands underneath your low back. Put theraband loop around the thighs, above knees. Keeping the back position, pull knees apart and then let them come together slowly and under control. You will have a tendency to arch your back when you pull your knees apart. Do not let this happen.

Balanced Triangle

There you have it, the COR physical therapy low back pain solution. Muscle length, strength and timing are essential for back pain prevention and rehabilitation. Now, this won’t help every case of low back pain, but if you perform these at the onset of any low back irritation, you will undoubtedly be on the path to improvement in no time! All triangles contain 180 degrees, keep your back balanced to improve your symptoms and prevent low back pain today.
COR Physical Therapy Rehabilitation Theory
Written by G. John Mullen, DPT, CSCS