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Lumbar Spine Fitness Guidelines

Janet injured her lower back while exercising in her local gym.  She was taking a trip through her favorite “ab ciruit” when she felt a snap in her lumbar spine.  The next day she was unable to stand up straight.  Two weeks later, we met her in physical therapy for her initial evaluation.  She was ready to return to her fitness program three weeks later.  Janet was very concerned she may suffer another exercise induced back injury and requested some advice.  These are the simple guidelines I give to physical therapy low back patients returning to exercise.

Mobilize the Thoracic Spine and Hips

Movement is supposed to happen at the thoracic spine and hips.  Unfortunately, prolonged sitting, deconditioning, and poor training choices tends to restrict mobility in these areas.  If you are unable to rotate and extend at the hips and thoracic spine, your brain will use other joints to make up for the deficit.  Pushing extra rotation and extension forces into your lumbar spine is never a good thing.  Dedicate some training time to improving thoracic spine rotation and hip extension / internal rotation range of motion.  If you sit for a living, work on your mobility everyday.

Make the Lumbar Spine Stable

Most fitness clients believe that more lumbar spine movement is a good thing.  They perform toe touches, back twists, and the many breeds of up and down dogs.  Unfortunately, greater lumbar spine range of motion is positively correlated with a higher incidence of lower back pain.  The incidence of low back pain escalates even further when we move those hypermobile lumbar spine segments against a resistance.  What does keep lumbar spines healthy is high level of lumbar spine strength endurance.  Can you hold the lumbar spine stable and prevent movement from occurring at the pelvis and five lumbar vertebrae.  Your lumbar spine stays happy and healthy when you focus training efforts on planks, roll outs, crawls, carries, and Pallof press exercises.  Avoid the sit ups, crunches, sidebends, toes to bar, and other assorted “ab” exercises that create lots lumbar spine motion.

Avoid Muscle Isolation Exercise Activities

The muscles that support the lumbar spine work together as part of a neurally connected team.  Training activities that support better communication between the team members will create optimal performance.  The neuroanatomy saying is “What fires together, wires together”.  Ditch the “upper abs”, “lower abs” baloney and sprint away from anyone who trys to strap you into a machine in an effort to “isolate your obliques”.

On her discharge from therapy, Janet was unable to perform a single roll out and fatigue fairly quickly with a twelve pound suitcase carry.  For the last three months, she has followed the guidelines and her progress has been excellent.   Janet is currently performing a suitcase carry with fifty pounds and has worked up to ten full reps on an ab wheel roll out.

Michael S. O’Hara, PT, OCS, CSCS

Every physical therapist gets these questions:

  • My doctor told me to “just walk.”  Why do I need to do resistance training?
  • What can I do, so I don’t get a hump on my back?
  • The trainer said I should do the elliptical because it is low impact. Will that help?
  • Water aerobics is my favorite activity.  Will it help my balance?
  • I take Vitamin D. Will it help improve the strength in my legs?

Fitness clients and physical therapy patients are looking for assistance in the prevention of falls and reducing the risk of osteoporosis.  It does not help when health care and fitness professionals give inappropriate answers.  Health care and fitness professionals need to establish consensus on questions commonly asked by patients, so that we can give appropriate answers.  In 2012, an international team of researchers and clinicians launched Too Fit to Fracture, an initiative aimed at synthesizing best evidence and developing recommendations for both exercise and physical activity for individuals with osteoporosis.

Two primary recommendations came out of their efforts:

1. Individuals with osteoporosis (with or without vertebral fractures) should engage in a multicomponent exercise program that includes resistance training in combination with balance training.

2. Individuals with osteoporosis should not engage in aerobic training to the exclusion of resistance and balance training.


Too Fit To Fracture Training Guidelines

  • Encourage daily balance training.
  • Include resistance training, twice a week, to improve strength.
  • Teach spine sparing strategies, such as hip hinging and proper lifting mechanics.
  • Encourage activities that increase back extensor muscle endurance.
  • Encourage moderate to vigorous aerobic physical activity for individuals at moderate risk of fracture, but only moderate intensity for those at high risk.

The answers to the fall prevention / bone health questions should sound like this:

  • Balance train for ten to twenty minutes every day of the week and strength train for 30 to 45 minutes twice a week.
  • Make sure your strength training teaches you how to move correctly and improves the endurance in your back muscles.
  • If you have mild to moderate osteoporosis and you balance train and strength train first and foremost then spend the extra time on some cardio training.
  • If you have been told you are high risk for fracture, keep the cardio training at a lower intensity.

This is what the latest and greatest research and clinical findings tell us about preventing fractures and improving bone health with exercise.  Visit osteoporosis.ca for more information, and use their guidelines to determine your fitness plan of action.

-Michael O’Hara, P.T., OCS, CSCS