Do You have Lower Back Pain and You Want to Exercise? No Problem!
Dr. Joseph Kurnik, D.C., better known as Dr. Joe, created a video series program called “Danger and Safer Resistance Exercises” designed for individuals with spinal injuries, degenerative conditions and for people who wish to minimize spinal stress during resistance exercise training.
These exercises and concepts are not specifically aimed at developing the “core group” of muscles, but to overall groups of muscles or specific muscles needing to be toned and strengthened. Standard core training is excellent training; but at a certain point, standard exercising and training can exacerbate or irritate existing bad back conditions. At that point, a different model of exercise is needed. It is called low compression resistance exercise. It allows the exercise of core muscles but also the other groups of muscles besides the core. It is done by minimizing the compression on the intervertebral disc, facet joints and other ligaments of the spine. There are never any guarantees of preventing back irritation during exercise, but this program offers a more flexible choice of less dangerous resistance exercises.
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Historically, Dr. Joe developed these exercise concepts over a 30 year period of working as a doctor of chiropractic. The ideas developed from working with injured patients and patients with existing spinal pathologies. Patients would come to him with back pain often aggravated by gym exercising and the use of athletic advisors. The concept of strengthening muscles to support the spine is valid, but when applied to injured backs, at a certain level of injury, the condition is aggravated with attendant frustration. This caused countless hours reviewing exercises with patients on spinal mechanics and pathology which is usually not considered with standard training methods, consequently developing a program to strengthen major body areas and minimize insults to vulnerable areas.
The objective of low compression exercise is to reduce the vertical pressures exerted on the intervertebral disc and facet joints (small joints in the spine behind the disc). There are two (2) facet joints behind each disc, except at the upper neck, Standing and sitting increases the vertical pressure in the discs and facet joints, while reclining on your back decreases spinal disc pressures. Bending forward at the wait and above increases disc pressures, especially when coupled with twisting and pulling. Bending backwards increases facet pressure and reduces spinal canal dimensions. Bending forward or backward, while standing or sitting, can cause compression on the sciatic nerve branches where there has been a history of nerve compression or spinal injury. While exercising on your back, keeping the knees up reduces spinal pressures in the low back.
This program can be applied to those with spinal injuries, degenerative conditions and to people who wish to minimize spinal stress during resistance exercises. General principles involve the following:
Avoid unnecessary low back and sciatic nerve injuries by considering the following three actions to be potentially dangerous:
- Loading the spine in the standing or sitting positions. This happens when you use weights. The result is increased spinal compression. The lumbar discs and facet joints become more compressed.
- Flexing (bending forward) at the waist in the standing, sitting, or lying down positions. This increases the lumbar disc pressures too much.
- Extending (bending backwards) at the waist in the standing, sitting or lying down positions. This increases the facet joint (small joints behind the disc) pressure too much. It can also increase the pressure at the back of the disc too much. It also narrows the size of the central and lateral nerve canals of the spine.
The caution Dr. Joe gives here does not mean that you cannot load, flex and extend the spine. It means that during exercise or daily routines, there is increased danger of hurting your low back and increasing sciatic nerve irritation. The exercises that he recommends will minimize loading of the spine with weights, flexing and extending positions of exercise. There will be some reference to abdominal and low back exercises, but with a caution and warning that they can cause injury.
It is impossible to give an exercise program to all people which exactly it suits all people. There are exceptions to every rule or statement. There has to be latitude, flexibility, yet understanding of principles and dangers. Dr. Joe has found that even the safest exercise for most can be irritating to a few. For example, some people have back problems for which extensions and flexion actions or movements are helpful. This has to be determined by trials and observations of results.
Additional examples:
- The individual has low back pain while bending backwards, but feels relief bending forwards. Well, then avoid low back strengthening which involves arching the low back. Abdominal crunches involving flexion can probably be done safely but has to be cautiously tried.
- The individual has low back pain while bending forward and none while bending backwards. Abdominal crunches involving flexion are more likely to be irritating and must be regarded with great caution, while doing extension exercise for the low back might be more safely done.
Other potentially dangerous actions are:
- Hamstring stretching if sciatica is present.
- Exercising with the arms being raised about the shoulder level.
- Picking up free weights off the floor.
- Hard impact exercises.
- Twisting movements.
Keep in mind another point. Any exercise may feel all right at the moment, but it may cause a reaction which causes discomfort later or the next day. So, the principle is to play it safe and as you add to you exercises, do so slowly and cautiously.
More on How to Exercise Safely when you have Lower Back or Sciatica Pain:
This program can be applied to those with spinal injuries, degenerative conditions and to people who wish to minimize spinal stress during resistance exercises. General principles involve the following:
1) Create no harm.
2) Exercise in positions of minimal spinal stress and according to mechanically safe postures.
3) Avoid standing and sitting free weight training, as much as possible. These increase vertical spinal pressures. Go to lying positions as much as possible.
4) Avoid standing extension and flexion exercises. These increase vertical spinal pressures. Extension is bending backwards. Flexion is bending forwards.
5) If sciatic pain or numbness is present, avoid hamstring stretching.
6) Avoid standing or sitting neck extension positions. Extension is bending the neck backwards.
7) Avoid exercises where the arms are raised higher than shoulder level.
8) Avoid picking up free weights when standing or sitting.
9) Avoid hard floor impact exercises.
10) Avoid standing and seated free weight exercises which exert increased vertical spinal pressures, whenever possible.
11) When lying on your back, keep your knees up and your feet flat.
The objective of low compression exercise is to reduce the vertical pressures exerted on the intervertebral disc and facet joints (small joints in the spine behind the disc). There are two (2) facet joints behind each disc, except at the upper neck. Standing and sitting increases the vertical pressure in the discs and facet joints, while reclining on your back decreases spinal disc pressures. Bending forward at the waist and above increases disc pressures, especially when coupled with twisting and pulling. Bending backwards increases facet pressure and reduces spinal canal dimensions. Bending forward or backward, while standing or sitting, can cause compression on the sciatic nerve branches where there has been a history of nerve compression or spinal injury. While exercising on your back, keeping the knees up reduces spinal pressures in the low back.
In order to give more perspective, consider an experiment conducted in Sweden [Nachemson AL. “The Lumbar Spine, an Orthopaedic Challenge.” Spine, 1976;1(1);61], that demonstrated relative spinal pressure in lower lumbar discs in various positions and with various exercises. These are listed below with their relative values. They are relative values, but for illustration, think pounds per square inch in the lower lumbar spine.
- Standing: 100
- Walking: 100
- Side-sending: 120
- Coughing: 140
- Straining: 150
- Laughing: 150
- Extending (backwards): 150
- On your back, lifting legs 45 degrees: 150
- On your stomach, arching backward: 180
- Abdominal crunch 45 degrees: 210 ( sit-up, knees up)
- Lying on back (legs up on chair, etc.): 35
- Lying on back, flat: 25
- Lying on side: 75
- Bending forward 20 degrees: 220
- Lifting small weight, sitting upright: 14
- Lifting small weight, Slumped sitting: 185
- Sitting and picking up a small weight: 275
Again, these numbers represent the relative change in pressure (or load) in the 3rd lumbar disc in various positions, maneuvers and exercises. What emerges from these facts and considerations are some principles and suggestions when trying to tone the body as a whole in the presence of back problems:
Compression affects all back problems negatively. Therefore, avoid vertical and other compression exercising especially using weights or loads (sitting or standing).