/ Core exercises for back problems

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Si dH - on 24 Mar 2013
Hi all, my wife has been having back trouble recently and the Dr and physio have both said she needs to strengthen her core. Seems sensible as she has an office job and outside of work is writing a book, so spends a lot of time sitting. However the 4 exercises prescribed by the Dr are just 3 variants on sit ups, and leg raises. This concerns me as ive always thought sit ups could be bad for your back, and that you were better off doing crunches, and various static exercises such as the plank. Certainly I have tended to stick to variations on crunches, planks and leg raises over the years and it has served me well, but ive never had a bad back. I dont want to contradict the Dr unless im sure im right. Are there any experrts out there?
Thanks
Rob Parsons on 24 Mar 2013
In reply to Si dH:

I am *not* an expert. But I have had back problems over the years, so maybe my experience might help.

I think you are right to be very wary of sit-ups, in particular.

What I was finally recommended for core strengthening, and what proved to be very helpful to me, was a set of exercises which I later discovered were the same kind of thing taught as 'pilates'. They are very subtle exercises: I couldn't try to describe them here; ideally, you want to have them explained in person so that you fully get the idea.

My suggestion is to investigate those. A physio will be able to help you.

Good luck.
Skol on 24 Mar 2013
In reply to Si dH:
It's hard to say which ones are best , and impossible to diagnose and prescribe exercises for back pain on the tinternet.
However, probably best to start with the basics of core stability before progressing to more dynamic stuff.
My girlfriend was prescribed Pilates for back pain and went to a class. What she was taught was scary!!!!
Drs have little clue of exercise rehab so I would stick with the physio, be it NHS or private.(have you seen on yet)?
Basics of Pilates include finding and holding pelvic neutral and pelvic floor exercises.
If ok, this could progress to bridging with pelvic neutral held. once competent and stable, single legged could be attempted.( ie just lift one foot from floor for a second).

Don't forget posture , both sitting and standing, and desk/ car ergonomics. No prolonged postures also.
Hope this helps?
freerangecat - on 24 Mar 2013
In reply to Si dH:

Pilates was recommended by a physio for my back problems, but its important to go to a good class-start in a small beginners class where she can learn the basics properly to get benefit from it and not do any damage, with a teacher who will adapt exercises for her-a good pilates teacher will ask about problems and if necessary give you something else to do if the rest of the class are doing an exercise which may not be good for you. Hope that makes sense-only half awake, sorry!
shark - on 24 Mar 2013
In reply to Si dH:

Not an expert but I've had 35 years of back issues stemming I believe from kyphosis and sclerosis exacerbated by a stiff upper back, flexible lower back and compounded by a desk job, climbing strength imbalances and learnt (proprioception) inefficient postural and movement habits.

Strengthening core is unlikely to be a golden bullet and anyway "core" is a whole range muscles and capabilities. I would never dream of doing sit-ups - it is a narrow stressy exercise and used alone could create rather than solve problems. The range you get with yoga exercises and stretches would be far far better. She might baulk at it - but I believe that deadlifting has been the single biggest contributor to improving my lower back strength/core. Form is key where youtube is your friend.

With an office job some opposite movements regularly will help. Ensuring that the pelvis is engaged/tilted forward is another regular problem. One of those sit-up-and-beg type chairs can help. Even relearning how to stand up from seated might be required. Soemtimes the muscles are strong enough but have just been switched off by habitual bad movement and posture.

Above and beyond all of the above I recommend you get a seccond opinion from a physio who will take a whole view and in this respect I can't recommend Steve Hodgson at Hallamshire Physiotherapy highly enough.
mick taylor - on 24 Mar 2013
In reply to Si dH: I've had most of a disc removed and suffer now and then quite badly (currently suffering well bad at the mo) but still manage to climb a bit when on form. My advice would be don't consider doing any sit ups until fully recovered, and even then other exercises are better (planks, crunches). Mobility exercises very important (and they must develop strength as well) Part of reason my back got so bad was bad advice from a GP
dale1968 - on 24 Mar 2013
In reply to shark: +1 for deadlifting, just don't start out with the weight of a baby elephant
Climbing Pieman on 24 Mar 2013
In reply to shark:
> (In reply to Si dH)
> Strengthening core is unlikely to be a golden bullet and anyway "core" is a whole range muscles and capabilities. I would never dream of doing sit-ups - it is a narrow stressy exercise and used alone could create rather than solve problems. The range you get with yoga exercises and stretches would be far far better. She might baulk at it - but I believe that deadlifting has been the single biggest contributor to improving my lower back strength/core. Form is key where youtube is your friend.
>
> With an office job some opposite movements regularly will help. Ensuring that the pelvis is engaged/tilted forward is another regular problem. One of those sit-up-and-beg type chairs can help. Even relearning how to stand up from seated might be required. Soemtimes the muscles are strong enough but have just been switched off by habitual bad movement and posture.
>
> Above and beyond all of the above I recommend you get a seccond opinion from a physio who will take a whole view and in this respect I can't recommend Steve Hodgson at Hallamshire Physiotherapy highly enough.

Well said, but I don't agree with the chair nor the deadlifting though! Just because they are not for my problems though may suit others with their specific problems. The important thing is to know what is actually the problem. Pain is pain but for many reasons and huge variety of causes. I shake my head in despair if the GP/Physio are just trotting out standard advice on basis of assumptions. If they are not specialists, then get it checked out by someone with more knowledge. Part of my long term problems are down to the casual advice trotted out by the uninformed medical folk. If you are sure there are no other likely causes other than postural, muscle weaknes, etc, then get her to a sport physio, and not just a standard physio, if that suits her (she could just take up more general first to see if her problem goes away itself). You will be amazed at the knowledge and expertise of a good sports physio. And never assume that a particular exercise is right or wrong as a one suits all is nonsense. It's is often precisely how it is done that is critical, for example you can do the same movement/excercise but with different sets of muscles, and one way will cause pain whilst another will not. I am current relearning to use sets of muscles that have habitually been switched off over time as others have got stronger and possibly too strong.
Skol on 24 Mar 2013
In reply to Climbing Pieman:
' shake my head in despair if the GP/Physio are just trotting out standard advice on basis of assumptions. If they are not specialists, then get it checked out by someone with more knowledge. Part of my long term problems are down to the casual advice trotted out by the uninformed medical folk. If you are sure there are no other likely causes other than postural, muscle weaknes, etc, then get her to a sport physio, and not just a standard physio, if that suits her (she could just take up more general first to see if her problem goes away itself). You will be amazed at the knowledge and expertise of a good sports physio.'

Hi Pieman, you cannot assume that they're trotting out standard advice.
Sure, exercise prescription is specific, and down to the person diagnosing and prescribing.
Sorry if you have had a bad experience, and hope your back is better, but not all back problems are solve able with exercise.
Sports physio is a loose term , and generally describes the private sector.
Standard or specialist NHS physio will keep you under the umbrella, and allow easier access to free scans and orthopaedic consultants should the problem not resolve.
Most NhS trusts have specialist back physios with access to a host of diagnostic tools and treatments.
Ali - on 24 Mar 2013
In reply to Si dH: Using a swiss ball may be better for her back than normal situps. My Dad had problems with his back and was recommeded to just do some upper body strength work - he previously just ran and walked and now goes to the gym which has helped.

Given time is presumably at a premium, maybe a circuits class or similar might work and give spome general fitness too? Obviously as long as that doesn't aggrevate her back....

I find if I don't exercise I get back ache from office job and bad posture - as long as I'm running/climbing/BMF-ing I'm usually ok. Hope she manages to get it sorted :-)
Climbing Pieman on 24 Mar 2013
In reply to Skol:
Hi. I am not assuming, I did say "if" :-). Otherwise we seem to be in general agreement I think? I dont think i said private and maybe I should have used specialist instead of sports. Thanks for pointing out my error, and sorry if it was unclear. The most important thing IMO is to get appropriate advice and treatment whether that be NHS or private.
BTW irrelevant to the OP, my back problems are long term and need to be managed for life, but thanks for your comments.
as646 on 24 Mar 2013
In reply to Si dH: I can't see how core work would help with back problems. If anything you would exacerbate the problem through creating muscle imbalances if you don't also train your back. Strengthening your posterior chain seems like a better option to me, so I'll also agree with the dealifting suggestion.

I'm no expert, but I had minor back problems before I started squatting/DLing. Never came back.
dale1968 - on 24 Mar 2013
In reply to Si dH: avoidance is a big problem when you have a bad back and exacerbates the problem
Skol on 24 Mar 2013
In reply to Climbing Pieman:
Thanks Pieman.
Yes we're in agreement, just read a lot of negative things about NHS therapies. Main thing is a firm diagnosis. My girlfriend spent 2 years going to GP and physio. She wasn't palmed off but, GP was poor , giving pain killers and telling to lose weight. When we eventually paid 400 for private scan, it showed disc sequestration occluding 90 per cent of spinal canal!!!
Dead lifting or excessive flexion could certainly exacerbate a disc problem.
Some good papers on core strengthening for back pain relief and prevention of reoccurrence .
Also general exercise as good as most other interventions.
Back pain is too loose a problem for anyone on here to give advice, and, to the original poster, if the problem is not going away with the Dr or therapists recommendations, do not be afraid to ask for scans.( especially with any weight loss/bladder bowel dysfunction/general unwellness/pain that is constant and unremitting even when flat)

andyco13 - on 24 Mar 2013
In reply to Si dH:

Core exercises are key, I recommend 'The Body Control Pilates Back Book' by Lynne Robinson.

The book includes all the Pilates type exercises for strengthening and improving the flexibility of the core*, and has loads of routines to follow. I found they really helped me.

In reply to as646:

*core isn't just abs, your 'core' includes a lot of the posterior chain muscles as well.
lost1977 - on 24 Mar 2013
In reply to Si dH:

sounds like you have a reasonable idea of the causes and this would be my front line when looking to resolve the problem
luke obrien - on 29 Mar 2013
In reply to Si dH: I had a bad back for over 10 years. Everyone is different but here my experience,

2 things that made a huge difference for me were: 1. Planking (a 3 minute routine, 1 min normal plank, 15 secs left arm out, repeat right hand, then left foot, then right, then opposite left hand right foot for 15 secs, then opposite followed by 30 sec normal plank) this really improved my posture without trying - I felt like I was 6 inches taller. 2. A decent mattress. I went from popping pills daily and nightly to none at all.

My experience is that sit ups aggravate bad backs...
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Paul Troon - on 30 Mar 2013
In reply to Si dH:

Hi there i have found this site very helpful start slow and build up your time

http://physicalliving.com/the-5-minute-plank-for-core-strength-stability-and-rock-hard-abs/

Paul

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