In some cases, the pain from the back injury is too much to begin an exercise rehabilitation program immediately following the incident. While exercise therapy is the most effective method of rehabilitation for long-term improvement, there are other methods available for instances where some recovery must occur before an exercise program can be put in place.
Invasive vs. non-invasive techniques
Invasive techniques, or treatments that occur directly in the body, for lower back injuries are generally either injections or prolotherapy. Injections, also known as blocks, is the delivery of either steroids or anesthetics into the joints, ligaments, muscles, or near the nerves surrounding the injury. They are a temporary solution for back pain, but are incredibly useful for confirming the location of the injury, since its affect on the body is localized in one small area. Prolotherapy is another injection-based treatment, but interacts solely with the injured ligaments. It involves adding an irritant solution into the soft tissue surrounding the injury, causing an inflammatory response and increasing blood circulation to the affected area. Increasing circulation encourages proliferation, or cell growth, on the torn ligament, speeding up the natural healing process. It should be noted, however, that not many studies on the effectiveness of prolotherapy have been completed, and is not widely practiced in North America.
Non-invasive techniques are more widely accepted in North America for treating back injuries. The more common categories are exercise, manual manipulation, pharmacologic treatment, and superficial treatments. Exercise aims to increase strength, flexibility, and normal motion to the injured site, but does not always have to be traditional strength training exercises. One method that is becoming more popular is yoga, which is both gentle on the body but demanding on the stabilizers in the back and core, and also improves flexibility. Since using yoga to treat back injuries is a relatively new trend, few studies have been done to conclude its long-term effectiveness, however there have been some reports of decreased use of pain medication later in the treatment process. Manual manipulation is much more commonly referenced, most notably with chiropractics. Acupuncture, however, has started to migrate from Asia to North America as a popular treatment for back pain. Deep stimulation has greater results of immediate pain relief than superficial stimulation, as well as greater improvement in back function. While acupuncture is most effective as a short-term method of pain relief, significant improvement in long term results have been noted when combined with another form of non-invasive intervention. The most common method of non-invasive treatment, however, is applying superficial heat to the skin. This usually takes the form of heating pads or heated athletic strips. The application of heat works similarly to prolotherapy; The heat increases blood flow to the area, causing proliferation in the area that helps speed up the healing process. The drawback with this technique is that the heat is applied to the skin, so only the superficial portions of the injury will be affected. Anyone with a deep muscle injury in the back is likely not going to have good results using this method of treatment.
Non-invasive techniques are more widely accepted in North America for treating back injuries. The more common categories are exercise, manual manipulation, pharmacologic treatment, and superficial treatments. Exercise aims to increase strength, flexibility, and normal motion to the injured site, but does not always have to be traditional strength training exercises. One method that is becoming more popular is yoga, which is both gentle on the body but demanding on the stabilizers in the back and core, and also improves flexibility. Since using yoga to treat back injuries is a relatively new trend, few studies have been done to conclude its long-term effectiveness, however there have been some reports of decreased use of pain medication later in the treatment process. Manual manipulation is much more commonly referenced, most notably with chiropractics. Acupuncture, however, has started to migrate from Asia to North America as a popular treatment for back pain. Deep stimulation has greater results of immediate pain relief than superficial stimulation, as well as greater improvement in back function. While acupuncture is most effective as a short-term method of pain relief, significant improvement in long term results have been noted when combined with another form of non-invasive intervention. The most common method of non-invasive treatment, however, is applying superficial heat to the skin. This usually takes the form of heating pads or heated athletic strips. The application of heat works similarly to prolotherapy; The heat increases blood flow to the area, causing proliferation in the area that helps speed up the healing process. The drawback with this technique is that the heat is applied to the skin, so only the superficial portions of the injury will be affected. Anyone with a deep muscle injury in the back is likely not going to have good results using this method of treatment.
REHABILITATION program
As stated on previous pages, the major risks for lower back injury are improper form when lifting and excessive bending or twisting in the lumbar region of the spine. Measures can be taken to prevent injury, but sometimes, accidents happen. When that happens, the best method to recover is to strengthen the stabilizing muscles around the injury. This includes all three abdominal muscle groups (rectus, transverse, and obliques), back extensors, and hip flexors.
The following is an example of a back rehabilitation program for a general back injury. It is important to note that this program is not meant to emphasize strength training, but to instead build muscular endurance. Endurance offers greater protection of re-injury of the back, as it increases the time before muscle fatigues to the point where force movement control is compromised (McGill).
1. ‘Cat & Dog’: Kneeling on all fours, the individual slowly arches their back towards and away from the floor. Repeat 5-6 times.
This exercise warms up the muscle groups supporting the spine, to prepare them for the rest of the program.
The following is an example of a back rehabilitation program for a general back injury. It is important to note that this program is not meant to emphasize strength training, but to instead build muscular endurance. Endurance offers greater protection of re-injury of the back, as it increases the time before muscle fatigues to the point where force movement control is compromised (McGill).
1. ‘Cat & Dog’: Kneeling on all fours, the individual slowly arches their back towards and away from the floor. Repeat 5-6 times.
This exercise warms up the muscle groups supporting the spine, to prepare them for the rest of the program.
2. Lying Leg Raise: Lay flat on the ground, with hands on either side of the pelvis. Flex at the hips to raise the legs towards the chest, allowing the knees to bend so the lower leg stays parallel to the floor. Only raise the legs as high as you are comfortably able to. Return the legs to the floor. Repeat 9 more times.
This exercise is used to improve hip and knee mobility. In the video, the first set of leg raises demonstrated is the exercise discussed above.
This exercise is used to improve hip and knee mobility. In the video, the first set of leg raises demonstrated is the exercise discussed above.
3. 1-inch curl up: Lay flat on the ground with legs bent. Place hands under the curve of the lumbar spine, or lower back, to maintain a neutral spine position. Flex at the waist so the shoulders raise about one inch off the ground, then lower. Do not move too quickly: allow 2 seconds to complete the entire curl. Repeat for 1 minute. This exercise focuses on the anterior abdominals.
4. Side Bridge: Lay on side, with forearm on the floor under the shoulder. The arm should be perpendicular to the body. When first completing this program, the knee can touch the floor with the legs bent. Raise hips until the body is in a straight line, then lower back to the floor. As you progress, increase the time you remain suspended off the ground. Repeat 5 times for each side.
This exercise works the lateral musculature of the body.
This exercise works the lateral musculature of the body.
5. ‘Bird Dog’: Kneel on all fours. Raise one arm out straight until it is beside the head. At the same time, extend the opposite leg out behind the body. Lower the arm and leg to the original position. Repeat 5-6 times for each arm and leg combination.
This exercise is used to work the hip and back extensors.
This exercise is used to work the hip and back extensors.