One of my clients is experiencing low back pain when doing crunches on the ball. I have changed her body position, but she still complains of the discomfort. It appears that only crunches aggravate her low back, not other exercises. I also have had many other members complain of the same low back pain while using the ball. Can you help?
Without an individualized assessment we could not give exact recommendations, but we can explore possibilities. The suggestions are not intended to replace medical advice. Consult with your clients’ health care provider, keeping in mind that many treatments dispersed by physicians, chiropractors and physical therapists are prescribed for symptoms and are not directed toward preventing future problems. It is important to communicate with the medical world; however, your role should concentrate on the prevention of your client's low back complaint.
WHERE TO START PREVENTION
Step 1: Assess the flexibility of your client.
Refer to the article A Simple Guide to Stretching for assessment instructions and stretching solutions. Often w/low back pain there is tightness in the iliopsoas, erector spinae musculature. If excessive tightness exist in the erector and iliopsoas musculature than extension over the ball (backwards movement) can be an aggravating factor to your clients complaint. This tightness also results in inhibition (lack of recruitment) of the deep stabilizers that control the vertebrae (bones of the spine). When the deep muscles of the spine are not working properly the movement system muscles do more work. Using the crunch exercise as an example; the rectus abdominus, external obliques, and portions of the internal obliques overwork placing greater stress on the low back. An easy rule to remember: STABILITY PRECEDES MOBILITY.
Step 2: Start your client on stabilization exercises.
Stabilization exercises involve little joint motion and are primarily designed to improve intrinsic stabilization with optimal neuromuscular control for the lumbo-pelvic-hip complex. Examples of stabilization exercises include:
- Draw In Maneuver: Lay flat on floor with knees bent and feet pointing straight ahead and arms by your side. While maintaining a normal breathing pattern, attempt to "draw" you belly-button inward towards your spine.
- Knees to Chest: Laying flat on your back with your knees bent and your feet pointing straight ahead perform a drawing in maneuver. While maintaining you drawing in position begin to march with your legs (lift one leg, return it to the ground and then lift the other).
- Floor Bridging: Begin by lying flat on floor with knees bent and feet flat. Squeeze your glutes together and lift hips to form a straight line between your knees and shoulders. Hold three seconds and slowly return back to floor.
- Quad. Arm/Opp. Leg Raise: Begin on all fours and slowly raise one arm (thumb up) and the opposite leg (toe pointed away). Keep both your arm and leg straight as you lift to body height and then return them slowly to the ground and repeat alternating sides.
- Floor Cobra: Lying face down on the floor with your arms at your side, palms down, squeeze your glutes and abdominals and pinch your shoulder blades together lifting your chest off the floor. Hold for two seconds and slowly return your upper body to floor.
- Tube Walking: Place tubing around ankles. Stand with toes pointing straight ahead, knees over feet, and hands on hips. Draw-in abdomen and side step maintaining optimum alignment. Avoid rocking upper body. Take 10 steps in one direction and then 10 steps in the opposite direction.
Step 3: Progress to strength exercises that do not cause discomfort.
Listed below is a sample program that can be performed two to three days per week.
||Foam roll & Stretch
- Hip flexors
- Latissimus dorsi
- 1 min per foam roll
- 1-3 stretches
|Hold each stretch 30 sec
- Tube walking
- Quad arm/opp leg raise
- Floor bridging
||Perform a normal stabilization oriented workout (IST)
*E=eccentric; I=Isometric; C=Concentric
Perform Self myofascial Release techniques on the following regions:
- Hip Flexors
- Latissimus Dorsi
Followed by a five minute warm up on the Elliptical, followed by static stretching of the calves (standing wall stretch), psoas (kneeling hip flexor stretch) and latissimus dorsi (ball stretch-one arm).
Perform three to four of the exercises mentioned above (your choice) for 12-20 repetitions at a slow tempo. If your client reports no back discomfort after the first week (two to three sessions), progress to strength exercises for the core musculature such as:
- Ball Crunch-starting slow w/small ranges of extension
- Ball Russian Twist
- Ball Pullover Crunch
Always remember stabilization training before strength training and strength training before power training.