Stages of Lower Back Rehabilitation

As noted by Dr Stuart McGill (Prof. Spine Biomechanics) "The first step in any exercise progression is to remove the cause of the pain, namely the perturbed motion and motor patterns". It is important to identify, diagnose and address the pain causing structures, why they are causing pain and what pre-disposed them to this in the first place (postural overload/aberrant movement patterns are often common pre-cursors). 

Once the initial phase acute or chronic injury management has been performed there a few stages that must be incorporated into a rehabilitation program to ensure a full recovery.

1. Corrective exercise; this is entirely dependant on what motor patterns are faulty and what the patient can tolerate, if the patient can tolerate and perfect the exercise there is progression, if they cannot the exercise must be re-examined and adjusted until it is able to be tolerated.

  • In the case of lower back injury the hip stabilizing gluteal muscles are usually under-active or inhibited. Gluteal reactivation helps to unload the lower back allowing the pain causing structures to mend leading to a decrease in pain presentation.
  • It is important to note that in order to progress the patient must not merely perform these exercises but perfect them!
2. Groove appropriate and perfect motion and motor patterns; this phase is looking to develop both joint and whole body stability.
3. Build whole body and joint stability (mobility at some joints such as the hips and stability through the lumbar spine)
4. Increase endurance

  • Stabilisation exercises (core exercises) such as the curl up, side bridge and bird-dog exercise help to spare the spine of many injury mechanisms and pain exacerbators, and are designed to build muscle endurance. It is this endurance that helps to improve spinal stability as it isn't overall strength that protects our lower back from injury but our ability to be able to hold these contractions for a reasonable amount of time.
  • McGill notes that one of the take home messages is to "keep the duration of isometric exercises under 10 seconds and build endurance with repetitions, not by increasing the duration of the holds". Of course there will be an increase in strength as the exercises progression, this is inevitable, but this is not the determining factor! 
Spinal stability exercises and in a way whole body stability exercises are "an endurance and motor control challenge – not a strength challenge" consider this when initiating a rehabilitation program, ensure the exercises are perfected before progressing and forget about building strength!

There are so many more contributing factors and specifics that have not been addressed in this short write up so please feel free to contact us here @ Synergy Healthcare and we will be happy to discuss in further detail. Contact us on (02) 9522 2125 or email us at clinic@synergyhealth.com.au


Resources:
McGill, S. (2007). Designing Back Exercise: from Rehabilitation to Enhancing Performance. Guide to training the flexion-intolerant back.