Hello, my name is Jeff Mitchell. I'm a Physical Therapist and Clinical Spine Specialist for
Kaiser Permanente in the Roosevelt and Sacramento area. Through this program, we've talked quite a
bit about exercises to help strengthen and stretch the low back, the legs, and the abdominal region.
This is also known as the core. Maintaining a healthy back requires all of these muscles to work
together while you do your activities during the day. The following group of exercises are designed
to decrease your pain; they are called unloading exercises. They are designed to decrease the load
off of your spine, which may be causing your pain in your back or your leg. When your back pain is
bad, it may be necessary to unload several times every hour. It's not necessary to perform all of
the positions every time you exercise; find the ones that work best for you and do them often.
Remember, these exercises should not increase your pain. If your symptoms get worse or you develop
other symptoms, it is a good idea to contact your doctor. I'd like to show you an unloading
exercise using a table. Slowly lean forward over the table, bend your knees and slowly take some of
the weight off of your feet and into your hands. How does that feel? It feels better. Good. You can
slowly take more weight off of your feet until it feels good to you. I'd like you to hold this
position for twenty to thirty seconds and repeat it two to three times as often is necessary in
order to decrease your pain. This is an unloading exercise that you can do while you're lying down.
Place your hands on the top part of your thigh and gently push down into your thighs, just like
that. How does that feel? It feels good. Good. I'd like you to hold this for twenty to thirty seconds
and repeat it two to three times or more often if you need to, to help manage your pain. This is an
unloading exercise using a chair. Go ahead and put your hands on the armrests of the chair and
slowly push down into the armrests, taking some of your buttock weight out of the seat. I don't
want your butt to lift completely off the seat, but just enough weight off so that it feels good
to your back. How does that feel? That does feel good. Good. I'd like you to hold this position for
20 or 30 seconds and repeat it two or three times as often as necessary to help manage your pain.
Hello, my name is Dr. Josh Rittenberg from the Department of Physical Medicine and Rehabilitation
and Kaiser Permanente Oakland Medical Center. When you experience an episode of low back pain,
it's common that certain directions of movement make your pain feel worse. It's also common that
specific movements in the opposite direction will make your pain feel better. This is called
directional preference and can be an important tool in relieving your pain. Some people prefer
bending forward, which is called flexion. Some people prefer bending backward, which
is called extension. If activity is like sitting, driving, or bending forward make your pain worse,
than the first set of exercises called extension exercises may be helpful. Extension exercises work
by moving your back in the opposite direction from a slouched position and help promote good posture.
But if your pain gets better when you're sitting and occurs mostly when you're standing or walking,
then the second set of exercises called flexion exercises may be more appropriate for you. Flexion
exercises work by bending your back forward to relieve pressure on painful areas of your back.
Please keep in mind that these exercises are meant to relieve your pain. Certain exercises aren't
appropriate for everyone. If any of the exercises caused your pain to worsen or travel down your
leg, then please stop immediately and try some of the other pain relief positions. Extension
exercises can be helpful for people who have pain with sitting or bending forward. This first
exercise is called prone on elbows. I usually start with my patients lying on their stomach with
arms at their sides and head turned. Okay Sheila, I want you to completely relax in this position.
You can take a couple of nice slow deep breaths, you can stay in this position for as long as two
or three minutes. Once you're completely relaxed, go ahead and prop yourself up onto your elbows,
just like you're watching TV in front of you. Your elbows should be directly below your shoulders. I
want you to go ahead and take a nice slow breath and allow your back to sag down. You can hold this
position for about thirty seconds. Now go ahead and return to the starting position and you're
gonna repeat this three times. How does this feel? I feel a little tightness in my back. Okay,
tightness is okay, as long as you don't feel any increased pain or pain going down your leg and
it's okay to continue this exercise. If standing feels more comfortable than sitting, then this
next exercise, known as standing extension, may provide you with quick pain relief. I especially
like this exercise for patients who spend a lot of their time sitting in front of a computer. We'll
start by bringing our feet to shoulder-width apart, hands on our back, knees straight,
and we'll bend back as far as you can comfortably. Hold this for about two seconds and then return
to the starting position. I'm going to repeat this ten times, trying to bend back a little
bit farther with each repetition. How does this feel so far? It feels pretty good. Okay, great.
It's okay to feel some tightness during this, but as long as your pain isn't worse, as long as your
pain isn't traveling down your leg, then it's okay to continue with this exercise. That looks great.
If your pain feels better sitting or bending down, then a flexion exercise may be helpful for you.
This first exercise is called knee to chest. Okay Sheila, I want you to get into a nice comfortable
position with your feet flat on the table, knees bent. You should either have a pillow behind your
head if you're doing this at home or in this case we have the exam table, so that that will help to
support your head. Next, go ahead and grab your knee with both hands and pull towards your chest.
Hold this for about 20 seconds and then slowly lower your leg down, tightening your abdominal
muscles as you lower your leg down. You're going to repeat this exercise for a total of
three repetitions. This same exercise can be done using a towel to pull your leg towards your chest
rather than your hands. So let's go ahead and take the towel and wrap it behind your knee and you're
gonna use the towel to bring your knee towards your chest this time. And same thing, we're
going to hold it in this position for 20 seconds and then slowly lower your leg back down to the
table. How's this feeling? So far feels pretty good. Good, as long as you're not feeling any
increased pain or pain traveling down your leg, then it's okay to continue this exercise. The next
exercise is called double knee to chest and may further relieve your pain if the first exercise
was helpful. This time Sheila, I want you to go ahead and bring one knee at a time towards your
chest. So go ahead with your right knee and now bring your left knee up; so you're gonna have both
knees up okay and both knees towards your chest. Hold this for about 20 seconds and then you're
going to slowly lower your legs back down, one leg at a time, again tightening your abdominal muscles
as you lower your legs down. Great, we're gonna repeat this for a total of three repetitions.
Okay, this same exercise can be repeated using a towel behind your
knees rather than using your hands in front of your knees. So we'll go ahead
and we'll take the towel and you're gonna wrap this around around your knees; great.
Again, we'll repeat this for a total of three repetitions, holding the position twenty seconds
each time. How does this one feel? Feels good. Okay, great. Again, as long as this doesn't cause
your pain to worsen or pain to travel down your leg, then it's okay to continue this.
It is important when icing your back to have a thin cloth layer in between the ice and the skin,
like wearing a t-shirt. Place the bag of ice on the floor or on your bed and roll over on
top of it, so the ice hits you in the low back. Stay on the ice for 10 to 15 minutes,
two or three times a day as needed for pain.