Low Back Pain; Causes, Symptoms, Diagnosis, Treatment

Low back pain








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Low back pain is a pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, with or without leg pain (sciatica), and is defined as chronic when it persists for 12 weeks or more. Non-specific low back pain is a pain not attributed to a recognizable pathology (such as infection, tumor, osteoporosis, rheumatoid arthritis, fracture, or inflammation). This review excludes chronic low back pain with symptoms or signs at the presentation that suggests a specific underlying condition. People solely with sciatica (lumbosacral radicular syndrome) and pain due to herniated discs, or both, are also excluded. People in this review have chronic low back pain (>12 weeks’ duration).

Types of Low Back Pain

Low back pain can be broadly classified into four main categories

In addition, symptoms of lower back pain are usually described by the type of onset and duration

  • Acute pain  This type of pain typically comes on suddenly and lasts for a few days or weeks, and is considered a normal response of the body to injury or tissue damage. The pain gradually subsides as the body heals.
  • Subacute low back pain  Lasting between 6 weeks and 3 months, this type of pain is usually mechanical in nature (such as a muscle strain or joint pain) but is prolonged. At this point, a medical workup may be considered and is advisable if the pain is severe and limits one’s ability to participate in activities of daily living, sleeping, and working.
  • Chronic back pain  Usually defined as lower back pain that lasts over 3 months, this type of pain is usually severe, does not respond to initial treatments, and requires a thorough medical workup to determine the exact source of the pain.

Causes of Low Back Pain

Cauda equina syndrome

  • History: Progressive motor/sensory loss, new urinary retention or incontinence, new fecal incontinence
  • Physical exam: Saddle anesthesia, anal sphincter atony, significant motor deficits of multiple myotomes

Fracture

  • History: Significant trauma (relative to age), Prolonged corticosteroid use, osteoporosis, and age greater than 70 years
  • Physical exam: Contusions, abrasions, tenderness to palpation over spinous processes

Infection

  • History: Spinal procedure within the last 12 months, Intravenous drug use, Immunosuppression, prior lumbar spine surgery
  • Physical exam: Fever, wound in spinal region, localized pain, and tenderness

Malignancy

  • History: History of metastatic cancer, unexplained weight loss
  • Physical exam: Focal tenderness to palpation in the setting of risk factors

Pediatric red flags are the same as adults with a few notable differences:

Malignancy

  • History: age less than 4 years, nighttime pain

Infectious

  • History: age less than 4 years, nighttime pain, history of tuberculosis exposure

Inflammatory

  • History: age less than 4 years, morning stiffness for greater than 30min, improving with activity or hot showers

Fracture

  • History: activities with repetitive lumber hyperextension (sports such as cheerleading, gymnastics, wrestling, or football linemen)
  • Physical exam: Tenderness to palpation over spinous process, positive Stork test

Lumbosacral muscle strains/sprains

  • Presentation: follows traumatic incident or repetitive overuse, pain worse with movement, better with rest, restricted range of motion, tenderness to palpation of muscles

Lumbar spondylosis

  • Presentation: The patient typically is greater than 40years old, pain may be present or radiate from hips, pain with extension or rotation, the neurologic exam is usually normal.

Disk herniation

  • Presentation: usually involves the L4 to S1 segments, may include paresthesia, sensory change, loss of strength or reflexes depending on severity and nerve root involved.

Spondylolysis, Spondylolisthesis

  • Presentation: similar to pediatrics, spondylolisthesis may present back pain with radiation to buttock and posterior thighs, neuro deficits are usually in the L5 distribution.

Vertebral compression fracture

  • Presentation: localized back pain worse with flexion, point tenderness on palpation, may be acute or occur insidiously over time, age, chronic steroid use, and osteoporosis are risk factors.

Spinal stenosis

  • Presentation: back pain which can be accompanied with sensory loss or weakness in legs relieved with rest (neurologic claudication), neuro exam normal.

Tumor

  • Presentation – a history of metastatic cancer, unexplained weight loss, focal tenderness to palpation in the setting of risk factors
  • Clinical note – 97% of spinal tumors are metastatic disease; however, the provider should keep multiple myeloma in the differential
  • Infection: vertebral osteomyelitis, discitis, septic sacroiliitis, epidural abscess, paraspinal muscle abscess

    • Presentation: Spinal procedure within the last 12 months, Intravenous drug use, Immunosuppression, prior lumbar spine surgery, fever, wound in spinal region, localized pain, and tenderness
    • Clinical note: Granulomatous disease may represent as high as one-third of cases in developing countries.
  • Fracture

    • Presentation: Significant trauma (relative to age), Prolonged corticosteroid use, osteoporosis, and age greater than 70 years, Contusions, abrasions, tenderness to palpation over spinous processes

Pediatrics:

Tumor

  • Presentation: fever, malaise, weight loss, nighttime pain, recent onset scoliosis
  • Clinical note: Osteoid osteoma is the most common tumor that presents with back pain – classically, the pain is promptly relieved with anti-inflammatory drugs such as NSAIDS.

Infection – vertebral osteomyelitis, discitis, septic sacroiliitis, epidural abscess, paraspinal muscle abscess

  • Presentation: fever, malaise, weight loss, nighttime pain, recent onset scoliosis
  • Clinical notes: Epidural abscess should be a consideration with the presence of fever, spinal pain, and neurologic deficits or radicular pain; discitis may present with a patient refusing to walk or crawl.

A herniated disk, slipped apophysis

  • Presentation: Acute pain, radicular pain, positive straight leg raise test, pain with spinal forward flexion, recent onset scoliosis

Spondylolysis, spondylolisthesis, lesion or injury to the posterior arch

  • Presentation: Acute pain, radicular pain, positive straight leg raise test, pain with spinal extension, tight hamstrings

Vertebral fracture

  • Presentation: acute pain, other injuries, traumatic mechanism of injury, neurologic loss

Muscle strain

  • Presentation: acute pain, muscle tenderness without radiation

Scheuermann’s kyphosis

  • Presentation: chronic pain, rigid kyphosis

Inflammatory spondyloarthropathies

  • Presentation: chronic pain, morning stiffness lasting greater than 30min, sacroiliac joint tenderness

Psychological Disorder (conversion, somatization disorder)

  • Presentation: normal evaluation but persistent subjective pain

Idiopathic Scoliosis:

  • Presentation: positive Adam’s test (for larger angle curvature), most commonly asymptomatic
  • Clinical note: Of note, no definitive evidence that scoliosis causes pain, but patients with scoliosis have more frequently reported pain; therefore the provider should rule out other causes before attributing pain to scoliosis

The Symptom of Low Back Pain

The main symptom of back pain is, as the name suggests, an ache or pain anywhere on

  • Pain in the back, and sometimes all the way down to the buttocks and legs. Some back issues can cause pain in other parts of the body, depending on the nerves affected.
  • In most cases, signs, and symptoms clear up on their own within a short period. If any of the following signs or symptoms accompany back pain, people should see their doctor:
  • Pain. It may be continuous, or only occur when you are in a certain position. The pain may be aggravated by coughing or sneezing, bending or twisting.
  • Patients who have been taking steroids for a few months
  • Drug abusers
  • Patients with cancer
  • Patients who have had cancer
  • Patients with depressed immune systems
  • Stiffness.
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According to the British National Health Service (NHS), the following groups of people should seek medical advice if they experience back pain:

  • Weight loss
  • Elevated body temperature (fever)
  • Inflammation (swelling) on the back
  • Persistent back pain – lying down or resting does not help
  • Pain down the legs
  • Pain reaches below the knees
  • A recent injury, blow or trauma to your back
  • Urinary incontinence – you pee unintentionally (even small amounts)
  • Difficulty urinating – passing urine is hard
  • Fecal incontinence – you lose your bowel control (you poo unintentionally)
  • Numbness around the genitals
  • Numbness around the anus
  • Numbness around the buttocks
  • Dull ache,
  • Numbness,
  • Tingling,
  • Sharp pain,
  • Pulsating pain,
  • Pain with movement of the spine,
  • Pins and needles sensation,
  • Muscle spasm,
  • Tenderness,
  • Sciatica with shooting pain down one or both lower extremities
  • People aged less than 20 and more than 55 years
  • Additionally, people who experience pain symptoms after a major trauma (such as a car accident) are advised to see a doctor. If low back pain interferes with daily activities, mobility, sleep, or if there are other troubling symptoms, medical attention should be sought.

Risk increases with

  • Biomechanical risk factors.
  • Sedentary occupations.
  • Gardening and other yard work.
  • Sports and exercise participation, especially if infrequent.
  • Obesity.

Preventive measures

  • Exercises to strengthen lower back muscles.
  • Learn how to lift heavy objects.
  • Sit properly.
  • Back support in bed.
  • Lose weight, if obese.
  • Choose proper footwear.
  • Wear special back support devices.

Red flag conditions indicating possible underlying spinal pathology or nerve root problemsw9

Red flags

  • Onset age < 20 or > 55 years
  • Non-mechanical pain (unrelated to time or activity)
  • Thoracic pain
  • Previous history of carcinoma, steroids, HIV
  • Feeling unwell
  • Weight loss
  • Widespread neurological symptoms
  • Structural spinal deformity

Indicators for nerve root problems

  • Unilateral leg pain > low back pain
  • Radiates to foot or toes
  • Numbness and paraesthesia in the same distribution
  • Straight leg raising test induces more leg pain
  • Localized neurology (limited to one nerve root)

Diagnosis of Low Back Pain

Suspected disk, nerve, tendon, and other problems – X-rays or some other imaging scan, such as a CT (computerized tomography) or MRI (magnetic resonance imaging) scan may be used to get a better view of the state of the soft tissues in the patient’s back.

  • Blood tests – CBC ,ESR,Hb, RBS,CRP, Serum Creatinine,Serum Electrolyte,
  • Myelograms
  • Discography.
  • Electrodiagnostics
  • Bone scans
  • Ultrasound imaging
  • X-rays – can show the alignment of the bones and whether the patient has arthritis or broken bones. They are not ideal for detecting problems with muscles, the spinal cord, nerves or disks.
  • MRI or CT scans – these are good for revealing herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles, and bones.
  • Bone scan – a bone scan may be used for detecting bone tumors or compression fractures caused by brittle bones (osteoporosis). The patient receives an injection of a tracer (a radioactive substance) into a vein. The tracer collects in the bones and helps the doctor detect bone problems with the aid of a special camera.
  • Electromyography or EMG – the electrical impulses produced by nerves in response to muscles is measured. This study can confirm nerve compression which may occur with a herniated disk or spinal stenosis (narrowing of the spinal canal).
  • Straight leg raise (SLR) – performed by raising the patient’s leg to 30 to 70 degrees. Ipsilateral leg pain at less than 60 degrees is a positive test for lumbar disk herniation. Likelihood ratio (LR) of 2, negative likelihood ratio (NLR) of 0.5. If the pain reproduction occurs contralaterally, it is a positive test for a lumbar disk herniation with LR of 3.5 and NLR of 0.72.
  • One leg hyperextension test/stork test – Have the patient stand on one leg and (while being supported by the provider) have them hyper-extend their back. Repeat this maneuver on both sides. Pain with hyperextension is positive for a pars interarticularis defect.
  • Adam test – Have the patient bend over with feet together and arms extended with palms together. The practitioner should observe from the front. If a thoracic lump is present on one side or the other, it is an indication of scoliosis.There are numerous other examination techniques; however, they have mixed evidence for inter-practitioner reliability and poor sensitivities or specificities.

Red flag historic or physical exam features that, when present, should raise the provider’s suspicion for a process that may require imaging for proper diagnosis. These differ slightly from adults to children based on the incidence of diseases in these age groups

Specific types of low back pain that require further diagnostic evaluation
Types of low back pain associated with physical findings of no clear pathoanatomical significance
SyndromeFindingsAssessment/Plan
Facet syndromeHistory and physical examination:

  • local and pseudoradicular symptoms and signs
  • pain on movement
  • facet tenderness
  • pain on reclination
  • positive injection test
  • joint dysfunction on manual diagnosis

Radiological findings (not indicated on initial evaluation):

  • differentiation from high-grade or activated spondylarthrosis (possibly, juxtaforaminal cyst) or
  • axial spondylarthritis
Differential diagnosis:

  • major joint dysfunction (blockage)
  • activated spondylarthrosis

Treatment:
analgesics (1–3 days), muscle stabilization,
manual medicine, facet injection if indicated

Sacro-iliac joint syndromeHistory and physical examination:

  • Sacro-iliac joint symptoms, a positive provocation test
  • functional leg length discrepancy
  • injection test

Radiological findings (not indicated on initial evaluation):

  • differential diagnosis: inflammation (sacroiliitis in seronegative spondylarthritis)
Functional disturbance:
muscular imbalance
Treatment:
stabilizing exercises, analgesics (1–3 days) if needed, manual medicine, sacroiliac joint injection if indicated
Myofascial pain syndromeHistory and physical examination:

  • muscle trigger points: local pain with peripheral radiation
  • peripheral and central sensitization

Radiological and histological findings:

  • not indicated
  • no clear evidence from MRI or biopsy
  • pathogenesis and definitive diagnosis still unclear
  • (low intra- and interrater reliability)

Local treatment:
active physiotherapy, manual therapy, infiltration, acupuncture

Functional instabilityHistory and physical examination:

  • “snapping” feeling
  • generalized deconditioning
  • pain on movement, possibly accompanied by ‧sensory and motor deficits (reversible)
  • impaired proprioception

Radiological findings:

  • no direct evidence
  • unclear pathogenesis and definition
  • treatment with manual medicine
  • physiotherapeutic stabilization program
  • caveat: surgery, differential diagnosis, structural instability

 

Treatment of Low Back Pain

Not all treatments work for all conditions or for all individuals with the same condition, and many find that they need to try several treatment options to determine what works best for them. The present stage of the condition (acute or chronic) is also a determining factor in the choice of treatment. Only a minority of people with back pain (most estimates are 1% – 10%) require surgery.

Non-medical

Treatment for back pain generally depends on how long your pain lasts

Acute (short-term) back pain – usually gets better on its own. Exercises or surgery are usually not recommended for this type of pain. There are some things you may try while you wait for your pain to get better:

  • Acetaminophen, aspirin, or ibuprofen will help ease the pain.
  • Get up and move around to ease stiffness, relieve pain, and have you back doing your regular activities sooner.

Chronic (long-term) back pain – is typically treated with nonsurgical options before surgery is recommended.

Nonsurgical Treatments

  • Pain relievers – that are taken by mouth or applied to the skin. Examples include acetaminophen and aspirin. Your doctor may suggest steroid or numbing shots lessen your pain. Involves using pulleys and weights to stretch the back, which may allow a bulging disk to slip back into place. Your pain may be relieved while in traction, although pain returns once you aren’t in traction.
  • Practice healthy habits – such as exercise, relaxation, regular sleep, proper diet, and quitting smoking.
  • Manipulation – Professionals use their hands to adjust or massage the spine or nearby tissues.
  • Acupuncture This Chinese practice uses thin needles to relieve pain and restore health. Acupuncture may be effective when used as a part of a comprehensive treatment plan for low back pain.
  • Acupressure A therapist applies pressure to certain places in the body to relieve pain. Acupressure has not been well studied for back pain. Move your body properly while you do daily activities, especially those involving heavy lifting, pushing, or pulling. Back pain is generally treated with non-pharmacological therapy first, as it typically resolves without the use of medication. Superficial heat and massage, acupuncture, and spinal manipulation therapy may be recommended.
  • Heat therapy –  is useful for back spasms or other conditions. A review concluded that heat therapy can reduce symptoms of acute and sub-acute low-back pain.
  • Regular activity and gentle stretching exercises – is encouraged in uncomplicated back pain, and is associated with better long-term outcomes. Physical therapy to strengthen the muscles in the abdomen and around the spine may also be recommended.
  • These exercises  – are associated with better patient satisfaction, although it has not been shown to provide functional improvement. However, one study found that exercise is effective for chronic back pain, but not for acute pain. If used, they should be performed under the supervision of a licensed health professional.
  • Massage therapy – may give short-term pain relief, but not functional improvement, for those with acute lower back pain. It may also give short-term pain relief and functional improvement for those with long-term (chronic) and sub-acute lower pack pain, but this benefit does not appear to be sustained after 6 months of treatment. There does not appear to be any serious adverse effects associated with massage.
  • Acupuncture – may provide some relief for back pain. However, further research with stronger evidence needs to be done.
  • Spinal manipulation is a widely-used method of treating back pain, although there is no evidence of long-term benefits.
  • Back school – is an intervention that consists of both education and physical exercises. A 2016 Cochrane review found the evidence concerning back school to be very low quality and was not able to make generalizations as to whether back school is effective or not.
  • Heat Or Ice Therapy: Applying heat pads, ice packs or using both alternatively can help to relieve stiffness, inflammation and muscle spasms in the back. Cold compresses can be used to reduce swelling in the back.
  • Braces: For patients with chronic back pain or a deformity in the spine, the doctor may recommend wearing a brace to provide support. Back braces can help to maintain proper posture, limit strenuous movement and realign the spine to provide relief from pain.
  • Physical Therapy: The physical therapist may apply heat, ice, electrical stimulation and other mechanisms to release stiffness from the back muscles. He may also help the patient learn posture correction techniques to prevent the pain from recurring.
  • Exercise: The orthopedic doctor may advise the patient to perform light stretching exercises to increase the flexibility of the muscles in the back. He may also recommend certain or exercises to strengthen the core and improve overall well-being of the patient.
Recommendations for the oral drug treatment of nonspecific low back pain, with evidence-based doses*
Drug recommendationDosageRecommendation*2Recommendation grade
Nonsteroidal anti-inflammatory drugs
Ibuprofen
Diclofenac
Naproxen
1.2 g/d, at most 2.4 g
100 mg/d, at most 150 mg
750 mg/d, at most 1.25 g
Positive (“should”)
(“should”)
(“should”)
B
B
B
COX-2 inhibitors
(off-label use for acute low back pain)
Celecoxib 200 mg/d
Etoricoxib 60–90 mg/d
Open (“can”)
Paracetamol (acetaminophen)500–1000 mg/d, at most 3 gOpen (“can”)
Low-potency opioids
Tramadol
Tilidin N
Depending on the preparation
50–100 mg
50–100 mg
Open (“can”)

modified from [

The recommendations and grades listed here (positive [“should”] and open [“can”]) are derived from the German National Disease Management Guideline for Low Back Pain [,which employs the evidence classification of the Centre for Evidence-Based Medicine (CEBM) at the University of Oxford.

 

The Medication of Back Pain

If non-pharmacological measures are not effective, medications may be tried.

  • Muscle relaxants – and some antidepressants may be prescribed for some types of chronic back pain.
  • Transcutaneous electrical nerve stimulation (TENS) – A small box over the painful area sends mild electrical pulses to nerves. TENS treatments are not always effective for reducing pain.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) – are typically tried first. NSAIDs have been shown to be more effective than placebo, and are usually more effective than paracetamol (acetaminophen).
  • In severe back pain not relieved by NSAIDs  – or acetaminophen, opioids may be used. However, long-term use of opioids has not been proven to be effective at treating back pain. Opioids have not always been shown to be better than placebo for chronic back pain when the risks and benefits are considered.
  • Skeletal muscle relaxers – may also be used. Their short term use has been shown to be effective in the relief of acute back pain. However, the evidence of this effect has been disputed, and these medications do have negative side-effects.
  • In people with nerve root pain and acute radiculopathy – there is evidence that a single dose of steroids, such as dexamethasone, may provide pain relief.
  • Epidural corticosteroid injection – (ESI) is a procedure in which steroid medications are injected into the epidural space. The steroid medications reduce inflammation and thus decrease pain and improve function. ESI has long been used to both diagnose and treat back pain, although recent studies have shown a lack of efficacy in treating low back pain.
  • Carisoprodol – This muscle relaxant was investigated in two high-quality studies on acute low back pain. The first study compared carisoprodol with diazepam [. Carisoprodol was superior in performance on all the outcome parameters measured. A comparison of carisoprodol with cyclobenzaprine‐hydrochloride in the second study revealed no statistically significant differences between the two treatments [.
  • Chlorzoxazone – This muscle relaxant was compared with tizanidine in one high-quality study in a very small sample of patients with degenerative lumbar disc disease [. No differences were found between the treatments.
  • Cyclobenzaprine‐hydrochloride – Cyclobenzaprine was compared with diazepam in a low-quality trial on chronic low back pain, but no significant differences between the treatments were identified [. There was also no significant difference between cyclobenzaprine and carisoprodol in one high-quality study on acute low back pain [.
  • Diazepam – In comparison with carisoprodol, diazepam was found to be inferior in performance on muscle spasm, global efficacy and functional status in a high-quality trial on acute low back pain [. In a very small high-quality trial (30 people) comparing diazepam with tizanidine, there were no differences in pain, functional status and muscle spasm after seven days [.
  • Tizanidine – This muscle relaxant was compared with chlorzoxazone and diazepam in two very small high quality [. Both trials did not find any differences in pain, functional status and muscle spasm after 7 days.
  • Pridinol mesylate – One low-quality trial showed no differences between this muscle relaxant and thiocolchicoside on pain relief and global efficacy.

Surgery of Low Back Pain

  • Surgery for back pain is typically used as a last resort when the serious neurological deficit is evident. A 2009 systematic review of back surgery studies found that, for certain diagnoses, surgery is moderately better than other common treatments, but the benefits of surgery often decline in the long term.
  • Surgery may sometimes be appropriate for people with severe myelopathy or cauda equina syndrome. Causes of neurological deficits can include spinal disc herniation, spinal stenosis, degenerative disc disease, tumor, infection, and spinal hematomas, all of which can impinge on the nerve roots around the spinal cord. There are multiple surgical options to treat back pain, and these options vary depending on the cause of the pain.

Lower back pain exercises

https://www.rxharun.com/low-back-pain-exercise

A series of exercise routines you can do to help reduce any lower back pain (occasionally referred to as low back pain), including tension, stiffness, and soreness. These exercises from physiotherapists and BackCare expert Nick Sinfield help to stretch, strengthen and mobilize the lower back. When starting out, go gently to get used to the movements and work out how far you can go into each position without feeling pain.

Aim to do this routine at least once a day if the pain allows. You can complement this routine with walking, cycling and water-based activities. You are advised to seek medical advice before starting these back pain exercises and to stop immediately if you feel any pain.

Bottom to heels stretch

Stretches and mobilizes the spine

exercise-low-back-pain

Start position: Kneel on all fours, with your knees under hips and hands under shoulders. Don’t over-arch your lower back. Keep your neck long, your shoulders back and don’t lock your elbows.

Action: Slowly take your bottom backward, maintaining the natural curve in the spine. Hold the stretch for one deep breath and return to the starting position.

Repeat 8 to 10 times.

Tips:

  • Avoid sitting back on your heels if you have a knee problem.
  • Ensure correct positioning with the help of a mirror.
  • Only stretch as far as feels comfortable.

Knee rolls

Stretches and mobilizes the spine

backpain-knee-roll

Start position: Lie on your back. Place a small flat cushion or book under your head. Keep your knees bent and together. Keep your upper body relaxed and your chin gently tucked in.

Action: Roll your knees to one side, followed by your pelvis, keeping both shoulders on the floor. Hold the stretch for one deep breath and return to the starting position.

Repeat 8 to 10 times, alternating sides.

Tips:

  • Only move as far as feels comfortable.
  • Place a pillow between your knees for comfort.

Back extensions

Stretches and mobilizes the spine backward

backpain-exercise/Back extensions

Start position: Lie on your stomach, and prop yourself on your elbows, lengthening your spine. Keep your shoulders back and neck long.

Action: Keeping your neck long, arch your back up by pushing down on your hands. You should feel a gentle stretch in the stomach muscles as you arch backward. Breathe and hold for 5 to 10 seconds. Return to the starting position.

Repeat 8 to 10 times.

Tips:

  • Don’t bend your neck backward.
  • Keep your hips grounded.

Deep abdominal strengthening

Strengthens the deep supporting muscles around the spine

https://www.rxharun.com/Deep abdominal strengthening

Start position: Lie on your back. Place a small, flat cushion or book under your head. Bend your knees and keep your feet straight and hip-width apart. Keep your upper body relaxed and your chin gently tucked in.

Action: As you breathe out, draw up the muscles of your pelvis and lower abdominals, as though you were doing up an imaginary zip along your stomach. Hold this gentle contraction while breathing from your abdomen for 5 to 10 breaths, and relax.

Repeat 5 times.

Tips:

  • This is a slow, gentle tightening of the lower abdominal region. Don’t pull these muscles in using more than 25% of your maximum strength.
  • Make sure you don’t tense up through the neck, shoulders or legs.

Pelvic tilts

Stretches and strengthens the lower back

Low back pain

Start position: Lie on your back. Place a small, flat cushion or book under your head. Bend your knees and keep your feet straight and hip-width apart. Keep your upper body relaxed and your chin gently tucked in.

Action: Gently flatten your low back into the floor and contract your stomach muscles. Now tilt your pelvis towards your heels until you feel a gentle arch in your lower back, feeling your back muscles contracting and return to the starting position.

Repeat 10 to 15 times, tilting your pelvis back and forth in a slow rocking motion.

Tips:

  • Keep your deep abdominals working throughout.
  • Don’t press down through the neck, shoulders or feet.

Modification
Place one hand on your stomach and the other under your lower back to feel the correct muscles working

References

Low back pain

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