General Instructions*
A. Begin with Group I and add a new group of exercises until your routine includes all five groups (e.g., add Group II after two weeks, add Group III after four weeks, etc.). Do the exercises in the order they are given.
B. Start with 7 repetitions of each exercise and build to 20, unless instructed to do otherwise.
C. Exercises should be done in both directions (i.e., flexion/extension, right/left, etc.) and in one continuous motion. This constitutes one repetition.
D. Movements should be smooth, effortless and painless.
E. Take a hot bath or shower for 10 minutes at the conclusion of your exercises.
*Exercise treatments from The Bad Back Book as summarized by Daniel F. Royal, DO, CTP, JD.
Group I
(Hands/Knees on the floor and spread apart)
1. Arch back as high as you can in flexion/extension.
2. Look around upper arms while side-bending hips to the same side.
3. Alternate raising outstretched arms toward the ceiling.
Group II
(Standing Position)
1. Twist from side to side at waist level. Keep arms outstretched and legs stationary. Pick a spot on the wall directly behind you and try to look at the end of each twist.
2. Start with fists touching and in front of you, elbows out. Pull arms back briskly and attempt to touch your elbows.
3. Raise and lower shoulders briskly. Start with 17 repetitions and build to 30 (e.g., add 2 each day).
Group III
(Standing Position)
1. Back Extension.
a) Arch back and roll shoulders up and forward in a circular motion. Begin with 17 reps and build to 30.
b) Reverse directions.
2. Twist from side to side with elbows close to sides and legs together. Begin with 17 reps and build to 30.
3. “Stripteaser’s Grind”.
a) Place hands on a chair at waist level and spread feet wide apart. Rotate hips slowly in a circular fashion making as big of a circle as you can. Begin with 17 reps and build to 30.
b) Reverse directions.
Group IV
1. “Traction.” Hang from a bar or the top of a door with your hands (may have to bend your knees and/or put towel over the top of the door). Feel the weight in your lower back (not arms). Hang for as long as possible. Repeat X 3 and build to 5 reps. Rest for 15 seconds between reps.
2. Begin on all fours. Extend opposite arm/leg outward, raise chin up and arch your back. Hold for 10-15 seconds, return to starting position and, without pausing, repeat in opposite direction. Do 5 reps and build to 10 (e.g., add 1 each day). Increase time held to 30 seconds.
3. “Swan Dive.” Place a pillow or stool under the pelvis. Extend arms sideways and stretch them upward/outward, head back, legs upward/outward and apart. Keep toes pointed. Hold for 10 seconds. Repeat X 5. Increase time held to 30 seconds.
Group V
(Prone Position–see Group IV #3)
1. “Scissor’s Kick”.
a) Grasp edge of a stool, push trunk of your body upwards, tilt head back and arch your back as much as you can. Slightly raise legs, separate and bring together quickly in a continuous, scissor-like motion. Do in bursts of 15-30. Rest for 10 seconds between bursts. Repeat X 5.
b) Repeat (a) in an upward/downward scissor like motion.
2. Anchor extended legs under an immovable object (i.e., table, sofa, bed, etc.) or have someone hold them. Clasp hands behind your head, hold head back and raise trunk into high arch (stool should be positioned so that your trunk has free
3. Sway to move up and down; It should take great effort to hold your back up into an arch and the strain should be felt in the small of the back). Hold for 10 seconds then rest. Repeat X 5 and increase to 10. Increase time held to 20 seconds.
4. Extend stiffened arms in front of you, tilt head back and raise your trunk into a high arch. Hold for 10 seconds and then rest with arms extended in front of you and on the floor. Repeat X 5 and increase to 10. Increase time held to 20 seconds.
Helpful Hints
1. Never lift heavy objects! Lift light objects by bending your legs, keeping your back straight, then straightening your legs.
2. Do not make quick, jerky movements from the waist or hip. Move only in one direction at a time by turning your whole body in a smooth movement.
3. Do not slouch! Imagine yourself being pulled up and forward by a string attached to your breastbone (e.g., like a puppet on a string).
4. Sleep on a hard mattress (preferably orthopedic) or place a board under it.
5. When watching long hours of television, lie comfortably on a hard surface (i.e., bed, sofa, floor) supported by pillows under your neck and in the small of your back or sit up straight in a good firm chair.
6. For back pain, use moist heat which increases circulation of the blood to the painful area and relaxes the spasm that caused the pain.
7. Only exercises (like those above) will bring you permanent relief of your back pain. Make them a part of your daily routine.
Piriformis Syndrome
The pyriformis muscle is deep in the buttocks and may trap the sciatic nerve in its course down the back of the leg. This is often worsened by prolonged sitting (e.g., working at a computer), strenuous twisting of the torso (e.g., shoveling snow), or even by falling on one’s backside (e.g., the pyriformis muscle goes into spasm). This may lead to lower backache, weakness of the hip (on the affected side), difficulty walking, pain down the back of the thigh, and numbness of the lower leg–In short, all the classic signs of a herniated disc.
This syndrome will not be evident on CT or MRI Scan. Rather, the diagnosis is made clinically by a specific examination of the piriformis muscle. Here’s how it works:
In a sitting position (or while lying flat on the back), flex the knee on the painful side, and pull the knee across the body and slightly upward. as the hip rotates, the tight piriformis muscle is stretched, yielding increasing pain as the spastic muscle is stretched. (In contrast) a herniated disc usually causes pain when, lying on the back, the patient flexes one knee against the chest and then straightens the leg).
There are two home exercises which will help to relieve pain by stretching both the piriformis muscle and the hamstring muscles (the hamstrings muscles are located in the back of the thigh and can also increase pressure on the sciatic nerve):
1. Lie down, face up, on a comfortable, flat surface (such as a thick rug on the floor). Make sure that your shoulders, legs, and mid-back are flat against the surface. Bring the knee up (on the affected side) to waist level and plant the foot next to but just outside the opposite knee. Then gently pull the bent knee down toward the floor, across the body, without moving the anchoring foot. In the presence of piriformis spasm, this maneuver will cause some pain. Carefully continue pressing the bent knee downward, releasing the pressure if the pain becomes too intense. Do this 8-10 times per session, twice a day. As the piriformis spasm lessens (from the stretching), the exercise will hurt less and the hip will rotate more easily.
2. Again, lie down face up on a flat surface. Flex the affected knee up toward the chest, keeping the “good” leg flat, thus forming a right angle with the thighs. Gradually, straighten the affected knee, while keeping the “down” leg flat. Repeat 8-10 times, twice a day.
