LOW BACK PAIN EXCERCISES

WILLIAM FLEXION EXERCISE

 Rationale GOALS
Williams believed that the basic to open the
cause of all pain is the stress
induced on the inter-vertebral disc intravertebral
by poor posture. He theorized that foramina and
the lordotic lumbar spine placed
inordinate strain on the posterior stretch the back
elements of the inter-vertebral disc extensors, hip
and caused its premature
dysfunction. He was concerned flexors, and facets;
about the lack of flexion in daily
activities in the accumulation of
to strengthen the
extension forces that hurt the disc. abdominal and
gluteal muscles; and
to mobilize the
lumbosacral
 1. Pelvic tilt exercise
• Pt position:
Hook lying position.
Flatten the small of your
back against the floor,
without pushing down
with the legs. Hold for 5-
10 seconds.
 2. Partial sit-ups
• Pt position:
Hook lying position. With hands
behind his or her head, the pt
elevates the upper torso until the
scapulae clear the resting surface
and stress is placed on the rectus
abdominis. After returning to the
start position, the sit-up is
repeated for a prescribed number
of repetitions.
 3. KNEE-TO-CHEST
 SINGLE KNEE TO CHEST.

• Pt position:
Hook lying position. Slowly pull
your right knee toward your
shoulder and hold 5-10 seconds.
Lower the knee and repeat with
the other knee.
 DOUBLE KNEE TO CHEST.

• Pt position:
Begin as in the previous
exercise. After pulling right knee
to chest, pull left knee to chest
and hold both knees for 5-
10seconds. Slowly lower one leg
at a time.
 4. HAMSTRING STRETCH
Pt position:
• Lying supine.
• Pt places both hands around the
back of one knee.
• Pt straightens his or her knee and
pulls the thigh toward his or her
head so the hip goes into flexion.
 5. STANDING LUNGES
Pt position:
• Pt begins the forward lunge in a standing
position with the feet shoulder width
apart.
• Pt then takes a big step forward with the
right leg and plants the foot out front,
keeping the body relatively straight.
• The knee should stay over your ankle and
not extend out over the toes to minimize
stress on the knee joint.
 6. SEATED TRUNK FLEXION
Pt position:
• Sitting in a chair.
• Flexing forward in a slumped
position.
 7. FULL SQUAT
Pt position:
• Feet placed shoulder width apart,
the hip and knees are flexed to the
maximum available ROM, and the
lumbar spine is rounder into
flexion.
• Upon reaching maximum depth,
the athlete “bounce the buttocks
up and down” 15-20 times, with 2-
3in of excursion on each bounces,
then repeats 3-4 times.
MCKENZIE METHOD
 McKenzie Method
• Mechanical Diagnosis and Therapy (MDT)
• Goals: reducing pain, centralization of symptoms (symptoms
migrating into the middle line of the body) & complete recovery of
pain
• Indications:
– HNP
– Sciatica
– Spinal stenosis
– Hip disorders
– Sacroiliac disorders
– Zygapophyseal disorders
– Spondylolysis and spondylolisthesis
– Post-surgical problems
 Extension direction preference
• Prone Position
– Lying Prone
– Prone on elbows
– Prone Full Press Ups

• Standing Position
– Standing Extension
LYING PRONE
• Lying on stomach w/ your arms close to your
body and your head turned to one side
PRONE ON ELBOWS
• Keep your back and buttocks relaxed and rise
up on elbows as high as possible.
• Concentrate on keeping your hips down
PRONE PRESS UPS
• Place hands beside shoulders
• Keep your back and buttocks relaxed and use
your arms to press up.
• Concentrate on keeping your hips down
• Push up your upper body as high as possible.
STANDING EXTENSION
• Stand with your feet apart and hands on the small
of your back with fingers pointing down and
towards the spine. (thumbs pointing forward)
• Slowly bend backwards at the waist, supporting the
trunk with your hands.
• Keep your knees straight.
 Flexion direction preference
• Supine position
– Lying supine
– Knees bent
– Knees to chest

• Seated position
– Flex with hands
beneath seat

• Standing
– Flex to floor
FLEXION IN SUPINE
• lie on your back with
bent knees and feet
on floor/bed
• Bring knees to the
chest
• Gently bring both
knees to the chest
with arms (as can
tolerate)
FLEXION IN SITTING
• Sit on the edge of a chair with knees and feet more than shoulder
width apart and let the hands hang down to the floor between the legs
• Bend forwards at the trunk to touch the floor
• Return immediately to the starting position.
• Do reps smoothly and rhythmically, going further down each time as
can tolerate
FLEXION IN STANDING
• Stand with feet shoulder width apart and bend forward at
the trunk, running hands down legs towards the ground
• Return immediately to the starting position.
• Do reps smoothly and rhythmically, going further down
each time as can tolerate
BACK STABILIZATION AND CORE
STREGTHENING EXERCISE:
HOOK-LYING STABILIZATION
EXERCISE
 NEUTRAL POSITION
Px position: supine w/ knees bent and feet flat on the
floor
Procedure: Find your neutral position by gently arching
and flattening your back until you find a position where
you are most comfortable. Gently tighten your stomach
muscles without moving your back out of neutral position.
Indication: low back pain
 BEND KNEE TO SIDE
Px position: Lie on your back with one knee bent and the
other leg straight.
Procedure:
A. One Knee Bent: Find and hold your neutral position
throughout the exercise. Slowly let your bent knee
move out to the side without moving your other hip.
 HEEL SLIDES
Px position: Lie on your back with your knees bent and your feet flat on
the floor. Find and hold your neutral position throughout the exercise.
Procedure:
A. Heel slide: Keep your heel on the ground and slowly slide your foot
forward until your leg is almost straight. Return to the start position
by sliding your heel back. Repeat the movement with your other leg.
B. Heel lift and slide: Repeat exercise A with your
heel lifted 1 to 2 inches from the floor. Continue
by alternating right and left sides.
BENT KNEE LEG LIFT (SMALL STEPS)
Px position: Lie on your back with your knees bent and your feet
flat on the floor. Find and hold your neutral position throughout
the exercise.
Procedure:
A. One leg: Slowly lift one foot about 3 to 5 inches from the floor.
Lower slowly. Repeat with the other foot and continue
alternating legs as if taking small steps.
 ALTERNATE ARM AND LEG LIFT
Px position: Lie on your back with your knees bent and your feet flat on
the floor. Find and hold your neutral position throughout the exercise.
Procedure: Slowly lift one arm overhead and lift your opposite foot 3 to
5 inches up from the floor. Slowly lower your arm and foot back to the
floor. Repeat with your other arm and leg. Continue to alternate sides.
 CURL-UP
Px position: Lie on your back with your knees bent and your feet flat on
the floor. Find and hold your neutral position throughout the exercise.
Do not do this exercise if you have osteoporosis (thinning bones).
Procedure:
A. Hands on thigh: Place your hands on your thighs. Gently tighten your
stomach muscles. Slowly lift your shoulders as you slide your hands
toward your knees. Keep your neck muscles relaxed by holding your
chin tucked in. Return to the start position.
B. Hands behind head: Place your hands behind
your head. Gently tighten your stomach
muscles. Slowly lift your shoulders up from the
floor. Support your neck with your hands but do
not pull on your head. Return to the start
position.
 CURL-UP W/ROTATION
Px position: Lie on your back with your knees bent and your feet flat on
the floor. Find and hold your neutral position throughout the exercise.
Do not do this exercise if you have osteoporosis (thinning bones).
Procedure:
A. One hand behind head: Place one hand behind your head. Gently
tighten your stomach muscles. Lift your shoulder and reach with
your free hand toward the opposite knee.
B. Both hands behind head: Place both hands
behind your head. Gently tighten your stomach
muscles. Lift one shoulder and bring it toward
the opposite knee. Support your neck with your
hands but do not pull on your head. Return to
the start position.
HANDS AND KNEES
STABILIZATION
PROGRESSION
 NEUTRAL POSITION
Px position: Get on your hands and knees.
Procedure: Your hands should be directly below your
shoulders and your knees should be directly below your hips.
Find your neutral position by gently moving your back up and
down until you find the most comfortable position. Gently
tighten your stomach muscles to hold your neutral position.
 ROCKING FORWARD AND BACKWARD
Px position: Start on your hands and knees. Find and hold
your neutral position throughout the exercise.
Procedure:
A. Rocking forward: Slowly move your body forward over
your hands and then slowly return to the start position.
B. Rocking backward: Slowly move your body backward
over your heels and then slowly return to the start position

C. Rocking forward and backward: Combine exercise A and

B by moving forward and backward in one smooth
movement while maintaining your neutral position.
 ARM SLIDE AND REACH
Px position: Start on your hands and knees. Find and
hold your neutral position throughout the exercise.
Procedure:
A. Arm slide: Slowly slide one hand forward on the
floor and then back to the start position. Repeat
with your other side.
B. Arm reach: Lift one arm and reach forward.
Slowly lower your arm to the start position.
Repeat with the other arm, alternating sides.
 LEG SLIDE AND REACH
Px position: Start on your hands and knees. Find and hold
your neutral position throughout the exercise.
Procedure:
A. Leg slide: Slide one leg back, keeping your toes on the
floor. Return to the start position. Repeat with the other
leg. Alternate sides.
B. Leg lift—bent knee: Lift one leg 3 to 5 inches from the
floor with your knee bent. Slowly lower leg to the start
position. Repeat with the other leg. Continue alternating
sides

C. Leg reach: Slide one leg backward until the knee is straight. Lift your
straight leg 3 to 5 inches from the floor. Slowly lower to the start
position. Repeat with the other leg. Continue alternating
 OPPOSITE ARM AND LEG SLIDE AND REACH
Px position: Start on your hands and knees. Find and hold your
neutral position throughout the exercise.
Procedure:
• Arm and leg slide: Slowly slide one leg backward keeping your toes
on the floor. Slide your opposite arm forward at the same time.
Return to the start position. Repeat with the other leg and arm.
Continue alternating sides.
B. Arm slide with bent knee lift: Slowly lift one leg
keeping your knee bent. Slide your opposite hand
forward at the same time. Return to the start
position. Repeat with the other leg and arm.
Continue alternating sides
C. Arm and leg reach: Slowly slide one leg backward
keeping your toes on the floor. Lift your foot 3 to 5
inches from the floor. At the same time, slide your
opposite arm forward and lift 3 to 5 inches from the
floor. Return to the start position. Repeat with the
other leg and arm. Continue alternating sides.
BRIDGING STABILIZATION
PROGRESSION
• Basic Bridge
• Bridge with Arm Lift
• Bridge with Leg Lift
 • Basic Bridge
Px position: Pt lying on his/her back with the knees bent and feet flat
on the floor, hands at the sides.
Procedure: Ask pt to gently tighten his/her stomach muscles.
Lift hips 3-5 inches from the floor without arching his/her
back. Hold bridge for seconds, and then slowly lower hips to
the floor.
Indication:
Rationale:
Basic Bridge
 • Bridge with Arm Lift
A. One arm lift:
Px position: Start with a Basic Bridge and maintain this position throughout
the exercise.
Procedure: Hold the bridge position and move one arm overhead and back
to the side. Alternate the arms, continuing to hold the bridge.
Indication:
Rationale:
 • Bridge with Arm Lift
B. Both arms lift:
Px position: Start with a Basic Bridge and maintain this position throughout
the exercise.
Procedure: Hold the bridge position and move one arm overhead and back
to the side. Alternate arms, continuing to hold the bridge.
Indication:
Rationale:
 • Bridge with Leg Lift
A. Heel lift
Px position: Start with a Basic Bridge and
maintain this position throughout the exercise.
Procedure: Lift one heel up keeping toes on
the floor. Slowly lower the heel to the
floor. Repeat on the other side. Continue
alternating while holding the bridge.
Indication:
Rationale:
 • Bridge with Leg Lift
B. Marching
Px position: Start with a Basic Bridge and
maintain this position throughout the
exercise.
Procedure: Lift one foot 3 to 5 inches,
keeping the knee bent. Slowly lower the
foot to the floor and repeat with the
other side. Continue alternating as if
marching in place.
 • Bridge with Leg Lift
C. Leg lifts
Px position: Start with a Basic Bridge and
maintain this position throughout the exercise.
Procedure: Ask pt to lift one leg with the knee
bent, and then straighten the knee. Hold ___
seconds. Slowly bend the knee and lower the
leg, returning to the Basic Bridge position.
Repeat the movement with the other leg.
Continue alternating sides while holding the
bridge.
 PLANK EXERCISES

• Side Support Plank

• Face-down Plank
 • Side Support Plank
A.On knees
Px position: Pt lying on one side with both of the
knees bent and the hips in line with the shoulders.
Support weight on the forearm with the elbow
directly under the shoulder. Rest the top hand on
the hip.
Procedure: Ask the pt to tighten his/her
stomach and buttocks muscles and keep
them tight throughout the exercise. Lift hips
3-4 inches from the floor. Hold seconds.
Slowly lower to the start position.
 • Side Support Plank
B. On Feet
Px position: Pt lying on one side with the
knees, hips, and shoulders in line. Rest
the top hand on the hip.
Procedure: Ask the pt to tighten
his/her stomach and buttocks
muscles and keep them tight
throughout the exercise. Lift hips 3-4
inches from the floor. Keeping knees
straight during this exercise. Hold
seconds. Slowly lower to the start
position.
 • Face Down Plank
A. On knees
Px position: Ask pt to lie facing down with
his/her weight supported on the forearms
and knees. Make sure the elbows are directly
under the shoulders. Pt may also cross
his/her ankles.
Procedure: Ask the pt to tighten his/her
stomach and buttocks muscles and keep
them tight throughout the exercise.
 • Face Down Plank
B. On feet
Px position: Ask pt to lie facing down with
his/her weight supported on the toes and
forearms.
Procedure: Ask the pt to tighten his/her
stomach and buttocks muscles and keep
them tight throughout the exercise. Do
not let pt’s back sag. Hold seconds. Slowly
lower the knees to the ground.