L1: What to prescribe them for
What to prescribe them for
The following conditions can respond favourably to this series of exercises:
- Annular tears, disc bulges and herniations
- Facet joint sprains
- Sacroiliac joint sprains
If you have identified any of the following during your physical examination these exercises may be appropriate:
- Faulty bending technique1
- Poor side bridge endurance2
- Poor back extensor endurance3,4
- Weak lower limb muscles
- Reduced walking endurance5
- You can use these exercises to:
- Reduce pain
- Improve movement behaviours
- Reduce any anxiety or fear avoidance behaviours
- Reduce the risk of repeat episodes
There has been increasing but at times conflicting evidence that trunk muscle function is an important consideration in cases of lower back pain. Factors considered in the literature include:
- Extensor muscle endurance
- Altered patterns of activation of multifidus 6,7
- Multifidus muscle atrophy8
- Altered feed forward muscle activity of transversus abdominis9,10
- Poor proprioception11
- Altered ability to produce appropriate intra-abdominal pressure that contributes to trunk stability while simultaneously minimising compressive loading12-17
- Excessive long-term trunk stiffness18,19
- Postural dysfunction20,21,22
In chronic lower back pain (where a specific cause cannot be identified) many types of regular muscle training have been shown to have positive outcomes for reducing pain and improving function.23,24 This may be due to direct effects and/or secondary effects such as increased endorphin levels25 or improved coping strategies.26 Systematic reviews generally find that, in the long term, stabilisation or ‘core stability’ exercises are as effective, but not necessarily more effective than other forms of active exercise.* 27-31 Therefore, in this exercise prescription we have incorporated both stabilisation exercises that address trunk muscle function as well as those that improve a patient’s capabilities to perform activities of daily living.
These exercises build upon those prescribed in beginner exercises for the lower back.
*Laird et al. provide a possible explanation for this outcome suggesting: “As there is no standardisation in the reporting of exercise type, intensity, duration or frequency, one possibility is that some exercises are effective, but when trial outcomes are pooled, method heterogeneity in included studies precludes identification of trial-specific effectiveness.”8