It seems the discs are put under a lot of load in sitting postures , even more load when a small amount of spinal flexion is added , and yet more still when hanging onto weights in this seated flexed posture . This body position , therefore , increases the risk of acute injury or aggravating a previous disc injury . This is important information to know , so we can start to think about formulating a new exercise program that can help Jack get back to full strength and function with minimal risk of re-injury .
Changing an exercise program to reduce risk and aid recovery from acute disc injuries
Please note : These are guidelines only . Every person is an individual . Always monitor and communicate with your clients regarding how their bodies respond to each exercise . Stop if they experience any pain and refer to a health professional .
A note on cardio training : Choose cardio equipment that helps to reduce impact on the lumbar discs and maintains the client in an upright position , e . g . include walking ( no incline ), cross trainer / elliptical trainer or swimming freestyle or backstroke . Avoid cardio such as cycling and the rower due to the seated spinal flexion postures .
Step 1 : Correct breathing techniques
After experiencing low back pain , many people change their breathing patterns . Instead of using their diaphragm and performing lateral basal breathing , they tend to hold their breath and breathe apically ( shallow breaths ) using their accessory muscles of breathing or neck muscles . If you are not using the diaphragm , your core muscles and pelvic floor muscles will not be working functionally , and furthermore it will increase the likelihood of low back pain through increased abdominal pressures .
So , before strength training ensues , encourage your client to practice breathing techniques such as basal breathing in upright standing or supine lying positions to minimise load on the lumbar discs . Once they feel comfortable with this breathing , make sure they do not hold their breath while performing their strength training .
Step 2 : Core and pelvic floor strengthening
Introducing a number of core exercises in a supine or prone position with a focus on keeping spinal neutral position is ideal . Have your client in supine to begin with , and educate them on the importance of being able to move their arms and legs in a number of planes while keeping their spine in neutral alignment . Supine core exercises that avoid spinal flexion ( and thereby reduce discal pressure ) include supine knee lifts , supine knee drops , leg slides , alternate arm and leg slides and pelvic bridge .
Core exercise in prone should also be included . Prone flutter , 4-point hand and leg extensions , and plank positions with arm and leg movements can all feature . Focus on breathing , core activation and controlling spinal neutral position .
Step 3 : Pelvic stability strengthening
Once awareness of controlling spinal flexion using the core muscles has been established , we can start to introduce more global muscular strengthening . Exercises that strengthen gluteus maximus and latissimus dorsi ( the posterior oblique system ), gluteus medius and quadratus lumborum ( the lateral system ), and adductors and oblique muscles ( the anterior oblique system ) should now be included . Care should be taken to avoid any sitting postures or forward bending weight postures to ensure safe exercise guidelines for those clients
Supine core exercises such as supine knee lift ( top ) and pelvic bridge ( bottom ) avoid spinal flexion and pressure on the discs
Prone core exercises such as prone flutter ( top ) and 4-point hand and leg extensions ( below ) should also feature in core and pelvic strengthening
who have experienced an acute disc injury . Some good alternative examples might be :
• standing lat pull down to replace seated lat pull down
• wall squats / smith machine squats to replace leg press
• planks to replace sit ups
• lunges to replace deadlifts
• standing cable rows to replace seated rows .
In all of the above exercises , the same muscle groups are working , however the posture the client assumes is a spinal neutral , upright standing or prone position .
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