This post is prepared by West 4th Physio associate Marj Belot
Extension Exercises for Low Back Pain: When, why, how?
Are you having low back pain? Have you heard that backward bending (extension) exercises are a good thing to do? Have you been told that backward bending and laying face down are bad for your back? It’s possible that you have read or heard both things and now you’re confused as to what exercises you should be doing?
What is the purpose?
To start, it’s important to consider the purpose of any new exercise you add. In this article, the focus is on exercises that can be done to reduce or centralize your symptoms. Centralization was a term first coined by a famous physiotherapist from New Zealand, Robin McKenzie. If your pain, numbness or other low back/leg symptoms are moving out of your leg and up towards the source, your lumbar region, this is called centralization. When your brain is mapping a smaller region of symptoms this indicates you are doing something positive for your condition. Even if you have less leg pain and MORE low back or buttock pain during or immediately after you perform an exercise, this is still considered a therapeutic win. Please read the previous statement again, and, be sure you understand it fully. This principle will help you decide what things you are doing in your day that are helping alleviate your symptoms. That includes exercises, activities such as walking, and choosing the best positions for your back, e.g. resting on your back with feet on the couch or face down with pillows under your hips.
When do extension (McKenzie extension) exercises help?
If your back/leg pain is aggravated by sitting, especially sitting slumped, bending and twisting then there is a stronger likelihood you will benefit.
Who should avoid extension exercises?
Some people have conditions in which backward bending exercises to relieve pain are not recommended and could be harmful! If you know you have one of these conditions DO NOT do the extension exercises described below as they could be harmful to you. These conditions include spondylolysis, spondylolisthesis, lumbar spinal stenosis, abdominal hernia, osteoporosis, spinal fractures, recent spinal surgery (unless approved by your surgeon), acute facet joint sprain. It is advisable to book an appointment with a physiotherapist to receive an evaluation and exercises that are customized to you. It is rare to experience low back pain in combination with groin numbness, extensive leg numbness or changes to bowel and bladder function but this is potentially a surgical emergency. If you are experiencing these problems, contact a doctor immediately!
Basic Extension Sequence
1. Check your posture in the mirror. If your hips and shoulders line up, continue to next step. If not, keep your shoulders level, place your hands on your hips and slide your hips underneath your shoulders until they line up. If your symptoms stay the same or improve/centralize, then maintain this position and move on to the next step. If your symptoms get worse when you align your shoulders and hips, leave your posture wonky as you move to the next step.
2. Stay standing, place your hands on your hips and arch your low back as far as you can. Hold for 2 seconds. Repeat 10 times. Now pause and evaluate the effect. If your symptoms have improved/centralized, then repeat this sequence every 1-2 hours while you are awake. If it had no effect or made your symptoms worse then try the alternative below.
Alternative Basic Extension Sequence
1. If the previous sequence did not help or aggravated your symptoms, try lying face down with two or more pillows under your hips and a folded towel or pillow under your forehead for 10 minutes. If your symptoms vanish in this position, or improve then plateau/stay the same, try taking out one of the pillows and remain in this position for another 5-10 minutes. Continue with this until you can lay face down comfortably, without any pillows under your hips. You may be able to achieve this in one session or you may find you need to gradually achieve this goal over a few days to a week.
If your symptoms are irritable enough to benefit from this sequence, then repeat it everyone to two hours.
I’ve outlined some very basic options for extension exercises. There are many other options. If you choose to explore them on your own, ensure you are not in the “avoid” group listed above and use the principles of centralization to guide your decision making. You can book an assessment and treatment with Marj at 6047309478.