Therapy Exercises

For patients who are suffering from leg pain or arm pain due to a disc herniation (a radiculopathy), extending the spine with McKenzie back and neck exercises may also help reduce the leg and arm pain by "centralizing" the pain (moving the pain from the leg to the back or arm to the neck). For most patients, back pain is usually more tolerable than leg pain, and if a patient is able to centralize the pain, they may be able to continue with non-surgical treatment (such as exercise) and avoid a surgical discectomy.

When the pain is acute, the exercises should be done frequently (every two hours). To be effective, patients should try to avoid flexing the spine (bending forward). McKenzie exercises may also be helpful for those individuals who have back pain due to degenerative disc disease. While sitting or flexing forward can accentuate low back pain for patients with degenerative disc disease, extending the spine can serve to relieve the pressure on the disc. Note that the opposite is true in elderly patients who have facet osteoarthritis and/or lumbar stenosis (extending the spine jams the facet joints on the back and increases pressure across the joints, so these patients will typically feel better sitting and have more pain with extension).

Wait Until You Are Ready 
Exercise can help speed the healing of a herniated disc or other injuries, but you must wait until sufficient healing has occurred. Rushing can result in added pain and an aggravated injury. If certain movements are too painful, then they are best avoided. Remember to breathe normally throughout your exercises and to relax your muscles. Use gentle, deliberately slow movements to prevent injury while exercising your neck and back. Remember to stretch only until you feel a mild stretch, and stop if pain occurs. Always consult your physician before starting any new exercise.

Neck Strengthening
Isometrics can be used as strengthening exercises for a pinched nerve. Isometrics involve muscle contractions that apply force without lengthening or moving the joint. Do an isometric exercise that increases cervical strength by placing your right hand onto your right temple. Slowly but firmly try to turn your head to your right side. Use your right hand to press against your head to resist any head movement. Hold this position for five seconds. Release the tension and relax 10 seconds. Repeat this exercise five times. Do the exercise again using your left hand, resisting movement to your left.

Neck Flexion and Extension
To perform neck flexion exercises lie on your back on a flat surface and bring your head off the table forward so the chin goes halfway to the chest. Bring the head slowly back and repeat 5-10 times. To extend the neck lie on your stomach and slowly lift extend the head as much as possible without pain. Relax and repeat these exercises 5-10 times. This should not be done in the acute phase of an injury.

NECK ROLLS

Neck rolls help warm up the neck muscles and increase your range of motion to prevent pain and stiffness. Gently roll your head in circles, beginning in a clockwise direction. Do five rotations all the way around, then switch directions and roll your head counterclockwise five times. Repeat as necessary throughout the day to relieve pain and stiffness.

SHOULDER SHRUGS

Exercises such as the shoulder shrug help alleviate symptoms associated with pinched nerves in your shoulders, neck and upper back. To do a shoulder shrug, stand with your feet shoulder-width apart and your arms down at your sides. Gently bring your shoulders upward toward your ears, then move them back. Do two sets of 15 repetitions.

Shoulder Squeezing
Exercises that strengthen your upper back will help increase your neck strength. Do some shoulder presses as part of your neck-strengthening exercises for a herniated cervical disc. Either stand or sit upright to start the exercise. Slightly tuck your chin and stand with your shoulders slightly back. Gently and slowly move your shoulder blades together as far as possible without experiencing pain or discomfort. Keep your elbows as close to your body as possible. Hold this position for five seconds. Return to the original position. Relax 10 seconds. Repeat this exercise 15 times. Do the exercise three times throughout the day.

Shoulder Exercises
These exercises are aimed at strengthening the rotator cuff. Increasing cuff strength can decrease symptoms and effects of instability, impingement, and tendinitis as well as prevent some injuries. Repeat each exercise 10 times and do two sets. Stop if pain worsens. (See Figures 1, 2 and 3.)

Initially, treatment consists of anti-inflammatory medications and a stretching and strengthening program. Stretching is a key component in treating epicondylitis. Hold each stretch for at least 10 seconds, then relax the arm and repeat several times a day and in between activities. (See Figure 4.)

Greater Trochanter Bursitis
When inflamed, this bursa (fluid-filled sac) causes pain in the outer aspects of the hip. There is a band of tissue called the iliotibial band (ITB) that runs directly over the bursa and can cause irritation when it becomes tight. Stretch this band, taking the position as shown below. To stretch the left ITB, pull the left knee to the right side of the body and toward the head. Repeat on the right side. Hold this stretch for 10-15 seconds. Repeat 10 times. (See Figures 5 and 6.)

Psoas Muscle Stretches 
This muscle is notorious for causing back pain that can radiate into the groin and entrap nerves, causing pain in the abdomen and down the leg. To stretch the right side, move into the posture shown below and bend your left knee. Repeat on the right knee. Hold this stretch for 10-15 seconds. Repeat 10 times. (See Figures 7 and 8.)

Piriformis Muscle Stretch 
When tight, this muscle can squeeze on the sciatic nerve and cause buttocks pain as well as a shooting pain that radiates down the leg. There are two ways to stretch this muscle. Lying on your back, pull your left knee to the right side of your body. Hold this stretch for 10-15 seconds. Repeat 10 times. (See Figures 9 and 10.)

Although this may stretch the muscle, there is a better, but more difficult stretch. First, you get down on your hands and knees. Then stretch your left piriformis muscle by rotating your left inward and crossing your left shin over and in front of your right thigh. Hold this stretch for 10-15 seconds, then repeat on your right side. Repeat 10 times. (See Figure 11.)

Quadratus Lumborum Stretch 
This muscle, when tight, can cause pain in back joints. To stretch this muscle, bend away from the side where you are feeling pain. Hold 10-15 seconds, then repeat 10 times. (See Figures 12 and 13.)

A second way to do this stretch is to lie on your side opposite the side to be stretched. Move to the edge of the bed or exercise table. Allow your top leg to hang off the edge by having your knee clear the bed or table. Hold 10-15 seconds, then repeat 10 times.

Hamstring Stretch 
This muscle, located in the back of the leg, can cause pain in front of the knee (pes anserine bursitis), pain in the buttocks (ischial tuberosity bursitis, also known as Weaver's Bottom), or pain along the hamstring itself. (See Figure 14.)

To stretch, lie on your back. Make a cloth sling from a towel or sheet and hook it under the ball of your foot. Bend your hip and knee 90 degrees. Then, by pulling on the towel or sheet, straighten the leg until the knee is completely straight. Hold for 10-15 seconds, repeat 10 times. (See Figure 15.)

Achilles Stretch
Stand facing a wall, with both feet facing forward. Neither foot should be twisted inward or outward. The ankle to be stretched will be the one moved furthest away from the wall. Bend the knee closest to the wall. Keep the knee farthest from the wall straight and firmly on the floor. Hold 10-15 seconds, then repeat for each ankle 10 times. (See Figure 16.)

Straight Leg Raise
Use this exercise to strengthen your quadriceps, which is the muscle mass in front of your thigh, as well as to strengthen the psoas muscle. This exercise helps alleviate pain from arthritis of the knee, patella-femoral syndrome, anterior cruciate ligament (ACL) irritation or meniscal tears. Either recline, using your bended arms to support you, or lie down with a pillow supporting your back. Raise your leg while keeping your knee straight to 45 degrees. Hold in place for 5-10 seconds, then slowly drop your leg down to the table or bed surface without your leg back up. Repeat this exercise for 3-5 sets of 10 leg raises each. Expect a burning sensation in front of your knee. (See Figure 17.)

HOW IMPORTANT IS EXERCISE IN PREVENTING LOW BACK INJURY?

In order to prevent lower back injury and pain, whether work-related or not, is by physical conditioning. "Getting into shape" involves the overall conditioning of the body and the cardiovascular system. Aerobic exercise plus the exercising of the core muscles (those of the spine and the abdomen that are responsible for stabilizing the spine) are both critical for developing healthy and pain-free backs.

The Plank Abdominal Exercise
The basic plank exercise is the starting place if you want to improve your core strength and stability. Here's how to do it right.

  • Begin in the plank position shown in Figure 18 with your forearms and toes on the floor.
  • Keep your torso straight and rigid and your body in a straight line from ears to toes with no sagging or bending.
  • Your head is relaxed and you should be looking at the floor.
  • Hold this position for 10 seconds to start.
  • Over time work up to 30, 45 or 60 seconds.

Plank with Leg Lift
Start in the same plank position as above with your forearms and toes on the floor.

  • Slowly raise one leg 5-8 inches off the floor
  • Count to two and slowly lower your leg to the floor.
  • Switch legs and repeat.
  • Do about 2-3 sets of 10 reps.

Side Plank: (Do three reps; rest one minute between reps)

  • Lie on your side with legs straight and spine aligned. Place your elbow directly under your shoulder for support.
  • Tightening your abdomen, lift your torso off the floor so your body forms a straight line. Hold for 30 to 60 seconds, then lower to the floor.

Supine Bridging (Do three sets of 20 reps; rest one minute between sets)
This movement works the abdominal area.

  • Lie on your back with your knees bent, feet flat on the floor and shoulder-width apart, toes pointing straight ahead and arms at your sides. Activate your core by bracing your stomach muscles — as if you were about to be punched in the gut— and squeezing your glutes.
  • Lift your hips off the floor so your body forms a straight line from knees to shoulders. Hold and slowly return your hips to the floor, touching down momentarily, then repeat. Your hips should remain even.

Prone Cobra: (Do three sets of 15 reps; rest 90 seconds between sets)
This works the upper extensor muscles of the spine and counteracts the hunched-forward riding position.

  • Lie on your stomach with your arms at your sides, palms on the floor.
  • Tighten your glutes and slowly peel your upper body off the floor for 5-10 seconds, stopping when you feel tension. Pause, then slowly lower back down. Easier option: Perform the move with your hands resting on the back of your head and your stomach on top of a stability ball.
Plantar Fasciitis
One way the plantar fascia can be stretched is by pulling up on the foot and toes. Hold the stretch for about 30 seconds. Repeat five times and aim to stretch two times a day. Another way is to use a towel to pull on the foot and toes and follow same directions. (See Figure 19.)
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Berkower Pain & Spine Rehabilitation
1 SW 129th Ave., 305
Pembroke Pines, FL 33027
Phone: 954-430-9972
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