Back on the ball - CEU - exercise helps relieve back pain

Four out of five adults experience back pain in their lifetimes. Impairment is most prevalent in the 45 to 64 year-old age group. The problem becomes chronic for 5 to 10 percent of sufferers. Acute back pain recovery can take from three days to six weeks. Unfortunately, once a back injury occurs, a person is four times more likely to re-injure it.

Why is the back so susceptible to injury? For the answer, let's look at how the back is constructed. The spinal column consists of 33 vertebrae stacked upon each other, 26 of which are movable. Abdominal and back muscles support the spine. If these muscles are weak or inflexible, the spine is pulled in an unnatural direction, usually resulting in pain. Some causes of back pain are:

* inactivity

* lack of flexibility in the hamstrings, causing a tight lower back

* weak abdominal muscles

* overweight body

* poor posture

* lifting improperly (i.e., without bending the legs)

* sleeping face down

* physical injury

* age, wear and tear.

Treatments

Doctors prescribe a variety of treatments to alleviate back pain. Some suggest pain medication, braces, traction, physical therapy, spinal manipulation, bed rest (the worst thing for the back) or surgery. Depending on the reasons for injury, the treatment will vary.

In his book Back Works, Timothy J. Gray, D.O., says exercise is the only accurate response to alleviate back pain. Enter the personal trainer. With a workout that focuses on the back, you can help back pain sufferers return to a pain-free life. Your goal is to design an exercise program that will strengthen the abdominal and back muscles, as well as stretch the back muscles and hamstrings. However, before working with a fitness trainer, clients with back pain should consult a doctor.

Stability balls will be used for the following back-training exercises, because muscles are challenged to maintain their alignment and hold the body upright, the greatest benefit of using the ball is the balance factor. Moreover, using the ball in an exercise program helps build postural endurance. Two sets of 10 to 12 repetitions are recommended for each exercise.

Warm-Up

Every exercise session should begin with a warm-up. The warm-up consists of eight to 12 minutes of rhythmic body movement (e.g., walking or marching in place). Movements should increase heart rate and warm muscles. Work towards full range of motion exercises to further increase the flow of blood and oxygen to the muscles and connective tissues. This leads to a gradual increase in muscle length for the duration of the workout. The increased blood and oxygen flow also increases endorphin release (i.e., the body's natural painkiller). It's no wonder most back pain sufferers feel better when exercising.

Transverse Abdominis

Begin by training the transverse abdominis--the deepest layer of muscle tissue in the abdomen. The transverse abdominus maintains core stability, helping provide support to the spine, rib cage and pelvis. Train the transverse abdominis by tightening the stomach. Teach the client to visualize pulling the belly button towards the spine. This muscle should be kept tight throughout the exercises.

The rectus abdominis, external and internal obliques can be trained with the following exercises:

Trunk Curl

Sit on the ball and walk your feet forward until the ball is beneath the small of your back. Place your hands behind your head or crossed on top of your chest (easier option). Press your lower back into the ball, curling the rib cage towards the pelvis. Return to starting position.

Standing Pelvic Tilt

Begin by standing with the ball between a wall and the small of your back. Knees are slightly bent and legs are hip-distance apart. The back is arched around the ball. Using the abdominal muscles, flatten the back by pulling the hips toward the rib cage, then slowly release to the starting position.

Erector Spinae

The erector spinae is the largest back muscle. It extends on each side of the spinal column, from the pelvic region to the cranium. Erector spinae strength and endurance are necessary for a healthy back and good posture. Use the following exercises to train the erector spinae:

Opposite Arm/Leg Lift

Lie face down with the ball in the center of your abdomen. Hands and knees are shoulder width apart on the ground. To maintain this position, you may need to adjust ball size accordingly. Keep the spine in a neutral position by holding the abdominal muscles tight. Slowly raise one arm, while raising the opposite leg to hip level. Return to the starting position and repeat, using the other arm and leg. Teach the client to reach away from the body in the sagittal plane and lengthen the spine.

Leg Lifts

Working in the same position with your stomach on the ball, keep hands on the floor and straighten your legs slightly so your toes touch the ground. Lift one leg to hip level, keeping the spine straight and abdomen contracted. Lower the leg to the floor and repeat with the opposite leg. For a more challenging exercise, lift both legs at the same time.

Arm Lifts

Again, working in a position with your stomach on the ball, knees slightly bent and toes on the floor, perform shoulder flexion to 180 degrees (i.e., arms straight out in front of you). You should make a straight line from your hands to the base of your spine. From this starting position perform spinal hyperextension (i.e., lifting your chest off the ball while keeping your arms in the same position). Return to the starting position.

Extensor Muscles

The lower spine connects the upper body to the lower body. For all daily activities this area must function properly. According to Louis Kuritzky, M.D., and Jacqueline White, for most people, lower back pain can result from too much flexion of the spine. Extension exercises can counteract this flexion. People with chronic lower back pain can sometimes increase the strength of the lumbar-extensor muscles tenfold. The following exercises can strengthen the extensor muscles:

Prone Push-ups

Lean with hands and hips against the ball, elbows bent behind your body, knees bent and feet on the floor. Theft, straighten the arms while lifting your head and chest towards the ceiling. Slowly return to the starting position, keeping the spine straight and abdominal muscles contracted.

Bridge

Lie on the floor with your lower back pressed into the mat, feet on the ball, arms at your sides and neck in neutral alignment. Then, extend your hips toward the ceiling. Keep the abdominal muscles tight, lifting your hips as high as is comfortable. Slowly return to the starting position.

Stretches

The final segment of the workout is the stretches. Each stretch should be held for 30 to 45 seconds and can be repeated as necessary.

Trunk Flexion

Sitting on the ball, spread your legs apart and relax arms at sides. Tuck your chin and slowly curl your torso downward allowing your hands to rest at or near your feet. Relax and don't hold your breath. Uncurl slowly, returning to a seated position.

This flexion is opposed with the following extension stretch:

Supported Back Bend

Sit on the ball and walk your feet forward until the ball is pressed against your lower back. Then, extend your arms overhead and gently roll backwards until your hands touch the floor. Your neck is relaxed and breathing controlled.

Hamstrings

For people with lower back pain, hamstring flexibility is essential. When the hamstrings are too tight, the muscles pull down on the hips, creating tension in the lower back. The following hamstring stretch can help.

Standing Hamstring Stretch

Standing, place one foot on the ball, keeping that leg straight. Slowly bend forward from the hips, while bending the supporting leg, until a stretch is felt in the hamstring. Hands should rest on the supporting leg.

The back enables us to participate in all the activities we enjoy. Since the chance of re-injury is great, strengthening the muscles which support the spine and stretching tight muscles are vital. Stress the importance of daily back care to your clients.

Questions:               Code No. 0053
"Back on the Ball:

1. -- experience back pain.
A. Three out of four adults
B. Four out of five adults
C. Ten percent of adults
D. People ages 45 to 64 years

2. Causes of back pain include all of the following,
except --.
A. lack of activity
B. lack of flexibility
C. weak abdominal muscles
D. sleeping on the back

3. -- is the best treatment for back pain.
A. Pain medication
B. Exercise
C. Bed rest
D. Spinal manipulation

4. The goals of a healthy back exercise program
are to:
A. stretch hamstrings and back as well as
strengthen abdominals.
B. stretch quadriceps and back as well as strengthen
abdominals and back.
C. strengthen abdominals, back and hamstrings.
D. strengthen abdominals and back as well as stretch
hamstrings and back.

5. A warm-up is not always necessary before participating
in a healthy back exercise program.
A. True.
B. False.

6. -- is the body's natural painkiller
released during exercise.
A. Oxygen
B. Hormones
C. Endorphin
D. None of the above

7. Stability balls provide which added benefit(s) to a
healthy back exercise program?
A. balance
B. postural endurance
C. muscle alignment
D. Both A and B.

8. The transverse abdominis is the deepest layer of
muscle tissue in the abdomen.
A. True.
B. False.

9. The erector spinae extends
--.
A. down the center of the spine
B. from the top of the spine to the hips
C. on each side of the spinal column, from the pelvic
   region to the cranium
D. on one side of the spinal column, from the pelvic
   region to the cranium

10. Lower back pain can be the result of
--.
A. too much extension of the spine
B. too much flexion of the spine
C. too much rotation of the spine
D. All of the above.

11. Clients should work on back health --
days a week.
A. four
B. five
C. six
D. seven

12. Which area of the body helps us perform all our
daily tasks?
A. arms
B. shoulders
C. back
D. legs

13. Acute back pain recovery can take from --.
A. three to six months
B. three to six weeks
C. three to six days
D. three days to six weeks

14. Approximately how long should each stretch be
held?
A. 10 to 20 seconds
B. 20 to 30 seconds
C. 30 to 45 seconds
D. 45 to 60 seconds

15. Extension exercises counteract too much flexion
of the spine.
A. True.
B. False.

References

ACE Personal Training Manual: The Resource for Fitness Instructors. ACE, 1991.

Gray, Timothy J. Back Works. Book Partners, Inc., 1993.

Kuritzky, Louis and White, Jacqueline. "Extend Yourself For Low-Back Pain Relief." The Physician and Sports Medicine, Volume 25, No. 1, January, 1997.

Steinmann, Marion. The American Medical Association Book of Back Care. Random House, 1982.

Swayzee, Nancy. Breathworks for Your Back. Avon Books, 1998.

Thompson, Clem W. Manual of Structural Kinesiology 11th Edition. Times Mirror/Mosby College Publishing, 1989.

Lisa M. Wolfe has an Associates Degree in Exercise Science and is a certified personal trainer and group fitness instructor. She has 12 years of experience in the fitness field, including owning a gym and participating in fitness competitions.

COPYRIGHT 2002 Aerobics and Fitness Association of America
COPYRIGHT 2002 Gale Group