McKenzie Exercises for Lower Back Pain

Are you having back pain that’s worse in the morning and/or with prolonged sitting? Does the pain frequently wake you up at night? Does it hurt to sneeze, cough, or laugh? Do you have pain, or numbness and tingling that travels down your leg?

These are symptoms that might indicate a disc bulge or herniation. Small disc bulges are fairly common, especially if you have a job in which you sit all day. Sitting places load on our discs, especially if we do not sit with good spinal alignment (please refer to our blog post on Posture for more information on this topic). Over time the disc begins to sustain micro-trauma and is no longer as stable as it once was. This is when disc bulges begin to occur. Even a small bulge can begin to irritate the nerve roots in our lower back and cause the muscles to tighten up. Small bulges can also begin to create pain.

The good news is that disc bulges and even small herniations are often fixable without steroid injections or surgery!

While it is strongly recommended you see a medical professional such as a physical therapist to thoroughly evaluate and treat you, there are some things you can try on your own to alleviate the pain. An intervention that has been successful in our experience is called the McKenzie Method. It is based on the concept of sustained and repeated spinal extension, or back bending. For those of you who practice yoga, it is akin to upward dog. However, there are some key differences to the McKenzie Method exercises and yoga’s upward dog pose. The movements must start out very small and then become progressively larger with each set versus going up into a large backbend from the get go. It is also extremely important that the exercise be completely pain-free as you do it. If this is not the case, then stop the exercise and consult with a physical therapist.

The McKenzie Method is a progression of ‘poses’ that begin with simply lying on your stomach with a pillow under your hips to relieve pressure off of your back. For those who have more intense pain, this may be all you can initially handle. And you may need to have two or even three pillows stacked up under your hips to alleviate stress from your lower back. This position is maintained for 5-10 minutes, just lying on your stomach and breathing, letting your back muscles relax. You should notice that after several minutes in this position that your back pain begins to diminish. Once your pain has lessened you can move on to the next phase of the exercise (wait at least 5 minutes even if you are not in a lot of pain).

The next position will be a repetitive movement. Place your hands palms flat on the table next to your shoulders and press your upper body off the table about ½ inch to one inch, then relax back down(this is called a press-up). You will perform 8-10 repetitions of this very small movement. Keep your lower back muscles as relaxed as you can – do not use your back muscles to raise yourself up. You are simply hinging yourself up and down slowly using your arms. This creates a small force to help “pump” the disc thereby decreasing inflammation around the disc and perhaps even helping the disc to bulge less.

Next, perform another set of 8-10 press-ups, this time pressing up just a little bit higher than your first set. Make the progression in height very small (about ½ inch to an inch higher than the first set). Let pain be your guide – there should be absolutely no increase in pain. If you do experience any increased symptoms, then try not pressing up as high.

On your third set of 8-10 press-ups, go another ½ inch to an inch higher than your second set. This is how you progress each set. Perform 4-5 sets of 8 total as long as there is no increase in discomfort. You should notice that your pain (or tingling) is decreasing in your leg if you had any radicular symptoms. And you will hopefully also be noticing less low back pain and muscle tightness.

Perform this McKenzie prone press-up progression for 2 to 3 days. If your condition is improving, continue the exercise. If it does not seem to be helping or seems to be aggravating your condition then cease the exercise and consult with a medical provider.

The McKenzie Method extension exercises is also a great exercise for almost everyone to do a few times a week to help maintain good spinal and disc health. This is especially true if you sit a lot during the day or perform activities such as gardening in which there is a tendency to bend forward at the waist (which also places an abnormal load on our spinal discs – see our Posture blog). There are a few conditions such as a spondylolisthesis or spinal stenosis in which extension exercises would be contraindicated. But if you listen to your body and never push through pain or discomfort, you should be ok.

Remember, by seeing a medical professional such as a physical therapist who specializes in hands-on manual therapy, you will get exercises and instruction tailored to your condition. Please do not hesitate to take care of your body!

More Core Stabilization Exercises

Here are 4 more Core Stabilization Exercises that are a little more advanced than the previous 6 exercise videos we posted earlier this fall. Please be sure that you are able to perform the Level One Core Exercises that we posted previously without difficulty before you attempt these new exercises. And remember that all exercises should be pain-free. Never push through pain or you might be creating injury! We have recommended starting with 8 repetitions of each exercise during the first several weeks. You may then perform 2 sets of 8 or rotate through the series twice resulting in 2 sets of 8.

Posture

Our lives are lived in front of us. We write, read, eat, talk, perform tasks around the house and at work, and type with our hands positioned where we can see them, which is in front of us. As a result, we develop what’s called forward head rounded shoulders posture. It occurs because of muscle imbalances that develop over time. For example, the pectoralis minor, as a result of always pulling the shoulders forward, becomes tight. This leads to weak upper back muscles (lower trap, middle trap and rhomboids) and tight neck muscles (suboccipitals) which causes the shoulder and neck to move differently. These adapted movement patterns can lead to pain in the neck, shoulder, and arm, cause headaches, and lead to a reduction in your quality of life. Therefore, it is important to take steps to prevent this:

  1. Sit with a neutral spine. In neutral, the low back (lumbar) region curves inward (called lordosis) and the upper back (thoracic) region curves outward (kyphosis). This evenly distributes the load of your upper body upon the intervertebral discs. Make sure you are sitting on your “sits bones” and not slumping back onto your tailbone and you will accomplish this.
  2. Be aware that your neck isn’t jutting forward. This will allow your cervical muscles to relax and not tighten up nearly as much. Imagine that a helium balloon is attached to the top of your head gently lifting you up. This gentle movement will help align your entire spine.
  3. Pull your shoulders down and back, but not up. Imagine gently placing the lower angle of each shoulder blade toward your opposite back pocket, and you will have it.
  4. Once you have done the above, perfect your alignment by keeping the tip of your shoulders in vertical alignment with your ear canal. This is neutral anatomic position and imparts the least amount of strain upon joints and muscles surrounding the neck and shoulders.

posture1posture2

There are some who cannot make large changes in posture. As you age, there are many reasons for the head to move forward and the upper back to round outward (due to genetics, faulty postural habits over decades and gravity pulling us forward). This creates stability within the neck. If this is you, being aware of future changes and beginning to make small postural changes will help optimize function and reduce pain.

If you have questions or are unsure if you are correcting your posture properly, we encourage you to see one of our physical therapists or our movement expert, Jeff Bickford. Learn more about Jeff and the Feldenkrais Method of Movement and Postural Integration on our website at www.peakperformancept.org. Or go directly to Jeff’s website at www.cosomatics.com.

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Active Warm-up vs. Static Stretching

An active or dynamic warm-up is a crucial part of athletic readiness. The right warm-up should accomplish two things: loosen muscles and tendons to increase range of motion of various joints, and literally warm-up the body so that it is at its full potential. When your muscles are “cold” there is less blood flow to the muscles and tendons and they stiffen. They will then be less responsive and make you more prone to injury.

We all grew up with “traditional static” stretching/sustained holding type warm-ups in gym class. The latest research over the past 10-15 years points to the fact that holding a series of 20-30 second stretches prior to sport is not only ineffective but can be potentially dangerous! The evidence shows that aggressive static stretching can cause a reflexive tightening of a muscle and can also cause as much as a 30% decrease in muscle strength or activation for a period of time after stretching (the exact opposite of what you want to achieve). This means that not only can static stretching create a window where you are more prone to injury, but may also affect your sports performance negatively.

So how do we warm-up correctly? The best way to achieve actual muscle flexibility and to thereby reduce your risk of injury is by dynamic warm-up activities and through what is termed “inhibitive” or “fascilitated” stretching.

Inhibitive or Fascilitated Stretching

One way to increase the flexibility in muscles is through inhibitive stretching. This is accomplished by gentle isometric contractions of any muscle you wish to be more flexible. This sends a signal from your nervous system to a sensor in the muscle called the Golgi Tendon Organ and it signals the tight muscle to release. This form of stretching can be incorporated into any “old school” stretch position. For example, obtain the position for a static hamstring stretch, but instead of actually stretching the muscle and holding this stretch for 20 seconds, gently contract the muscle instead for 10 seconds and repeat 3 or 4 times. This sends a signal to your hamstring from your brain to relax the hamstring and is has been proven to be much more effective than static stretching:

Inhibitive Hamstring Stretch

Lean forward until you just start to feel a stretch in your hamstring. Then lightly press your heel down into the floor or bench. Hold this isometric contraction of the hamstring for 10 seconds. Repeat 3 to 4 times on each leg.
Active Dynamic Warm-Up_Page_1_Image_0002 Inhibitive Hamstring Stretch

Inhibitive Groin Stretch

Place the soles of your feet together and your elbows on your knees. Then gently press your knees up into your elbows to contract your groin muscles (do the exact opposite of static stretching in which you would have tried to get your thighs to the ground). Hold this contraction for 10 seconds and repeat 3 to 4 times.
Inhibitive Groin Stretch

Inhibitive Quad/Hip Flexor Stretch

Standing upright grasp front of ankle and gently pull heel to buttock until you begin to feel a pull in your quadriceps muscle on the front of your leg. Keep shoulder, hip and knees in a straight line. Then gently press the top of your foot down into your hand and hold for 10 seconds. Repeat 3 to 4 times with each leg.
Inhibitive Quad/Hip Flexor Stretch

Inhibitive Calf Stretch

Place a towel or a yoga strap around the ball of your foot. Then gently press into the towel like you are pressing on a gas pedal. Hold for 10 seconds. Repeat 3-4 times with each foot.
Inhibitive Calf Stretch

Inhibitive Squat

This exercise is good for relaxing all of the major leg muscles. Stand with a wide base of support. Squat down keeping your back straight and making sure your knees don’t go past your toes. Hold this position for 10 seconds. Repeat 3 to 4 times.
Active Dynamic Warm-Up_Page_3_Image_0001 Inhibitive Squat

Some great examples of dynamic warm-up include light jogging and jumping rope for 10-15 minutes to increase blood flow to the muscles and tendons. Actual dynamic “stretches” may also be performed after jogging or jumping rope. This involves actively training a muscle to lengthen through movement. The benefits include increased power, flexibility, and range of motion.

Rules of dynamic stretching

  1. You should always warm-up prior to dynamic stretching (jogging, inhibitive stretching exercise,etc.)
  2. Movements should always be pain-free.
  3. Start with shorter, smaller motions and progress to larger motions later in the set (again in pain-free range).
  4. Perform 3 to 4 sets of 12 repetitions with each movement.
  5. Do not force anything – the flexibility will come over time.

Examples of a dynamic stretching routine

  1. Leg Swings: Flexion/Extension (increases flexibility in hip flexors and back extensors/gluteals): Holding onto something for support, gently swing your leg forward and back, gradually working your leg up higher and higher. Let you body gently lean forward as you are taking your leg toward the back. Repeat 12 times on each leg for 3 to 4 sets. Do not force the movement. Your leg should be relaxed and act like a pendulum.
    Active Dynamic Warm-Up_Page_3_Image_0003 Leg Swings: Flexion/Extension
  2. Leg Swings; Abduction and Adduction (increases flexibility in groin muscles and outer hip): Holding onto something for support such as a chair or wall, begin gently swinging your leg out to the side and then back across your body. Once again, gradually swing your leg up higher and focus on pulling down in the downward portion of the leg swing. Be sure to keep your toes pointing straight ahead/ do not let you leg roll out from the hip.
    Active Dynamic Warm-Up_Page_4_Image_0001 Leg Swings; Abduction and Adduction
  3. Standing Trunk Twists (increases spinal flexibility): Gently swing your arms side to side and allow your trunk to twist back and forth. Slowly increase the range of motion or the size of the swing. Repeat 12 times each way for 3 to 4 sets.
    Active Dynamic Warm-Up_Page_4_Image_0003 Standing Trunk Twists

Utilize these simple but effective active warm-up exercises to enhance your flexibility and reduce injury risk. Happy Trails!