It is difficult to lay out the exercise prescription for low back pain. Exercise for low back pain is differ person to person. This presentation will describe about the general layout for patient with low back pain.

1. Prof. Satyen Bhattacharyya
Associate Professor : BIMLS, Bardhaman
8348050005 www.fitofine.org fitofine fitofine
Exercise Prescription for LBP

2. Prevalence
• Other neck related problems are
with prevalence of 48% in lifetime
and yearly of 23% to 39%.
• 50-80% of adult population
experiences back pain in lifetime
and 40% of them has back pain in
any one year.

3. Normal individuals
• Disc bulge : 50% - 66%
• Disc herniation : 30%
• Degenerative changes : up to 90%

4. Layout of LBP rehabilitation
• Treat the cause (phase 1)
• Focus on ROM (phase 2)
• Train the Muscles (group wise) (phase 3)
• Prescribe Exercise with activities (phase 4)

5. Treat the cause
Phase 1

6. • Exercise
• Manual therapy
• Other adjunct

7. Which exercise
to choose &
how to
choose?
Assessment
Response to Range of
motion
Location of pain

8. choose your treatment according to that
With proper knowledge in BIOMECHANICS
Go by

9. Assessing and Decision making
• PAIN is your fiend
• Nature of pain will describe about pathology
• Types of Pain
by origin – by receptors-
local(intact outer annulus fibrosus)
referred (herniated disc)
thermal
radicular (herniated disc)
chemical (organ ref. pain)
central (intact outer annulus fibrosus)
mechanical(structural changes/positional fault etc)

10. Assessment is the
KEY
Symptomatic
changes
Mechanical
changes
• Site
• Constant/intermittent
• Severity
• Paresthesia
• Numbers of analgesic
intake
• Pain on movement
• ADL
• ROM
• Deformity
• Movement deviation
• Movement quality
• Curve reversal
• Functional loss

11. Range of
Motion
responce

12. Location of PAIN?

13. Exercise to be perform in
• Sagittal plane: Flexion – Extension
• Transverse plane: Rotational component
• Frontal plane: Side flexion

14. Several House of thoughts or
confusion?
• Which one to select?
• Should we assess first?
• Should we apply only one
house of thoughts?
• Or we should combine
and deliver?
• Hippocrates (460 BC – 370
BC)
• Cato, Galen
• Bone setter
• Hutton’s manipulation
• D.D.Palmer, B.J.Palmer
• A.G.Timbrell Fisher
• James Cyriax
• John Mennel
• F.M.Kaltenborn
• G. Maitland
• R. McKenzie
• B.R.Mulligan
MANUAL THERAPY

15. Mobilization
Therapist
overpressure
Patient
overpressure
Patient
generated
Manipulation
Totally
Independent
70%
Totally
Dependent
25% to 28%
Can apply Mulligan,
Maitland, Chiropathy
McKenzie is the best option here
1% to 3%

16. Patient generated
& Patient
overpressure
Can be done in
 Saggital plane:
Flexion – Extension
 Transverse plane:
Rotational
component
 Frontal plane: Side
flexion
Combined
plane
movement

17. Therapist
overpressure
&
Mobilization
Different house of thoughts
Different force, level, angle
of pressure
End range overpressure
Different technique of
mobilization

18. Focus on
RANGE OF
MOTION
Phase 2

19. Push to each ROM
• Rotation
• Side flexion
• Flexion
• Extension
• Combined movement

20. We need Flexion
for ADLs

21. VOMIT
Victim of Medical Imaging
Technology
• 85% nonspecific Pain
• Less than 5% required
scan

22. Myth
Bending
Twisting
Lifting

23. Flexion
appears
before
Extension

24. Muscle
Phase 3

25. Muscle (group
wise)
Core muscle
Glutes
Thigh muscle (all compartment)
Postural muscle

26. CORE MUSCLE
1st to strengthen
• Traverse abdominis
• Internal and external obliques
• Rectus abdominis
• Multifidus and erector spinae

27. Transverse
abdominis
• With other abdominal muscles, TrA helps to
maintain abdominal tension and support
abdominal viscera, increase intraabdominal
pressure that is helpful in forceful expiration,
coughing, defecation.
• It's an important core muscle that supports
lumbopelvic during our movement.
• Unilateral action: ipsilateral trunk rotation

28. Exercise

29. External
oblique
• Bilateral contraction of EO along with rectus
abdominis and internal oblique flexes the trunk
by drawing the pubis towards the xiphoid.
• Unilateral action: ipsilateral side flexion and
contralateral trunk rotation
• External abdominal oblique muscle with other
abdominal muscles helps to maintain abdominal
tension and support abdominal viscera, increase
intraabdominal pressure that is helpful in forceful
expiration, coughing, defecation.

30. Exercise

31. Internal
oblique
• Internal abdominal oblique flexes the trunk when
bilaterally contracted and lateral flexion upon
unilateral contraction, compression causes
increase in the intraabdominal pressure

32. Exercise

33. Rectus
abdominis
• The main action for rectus abdominis is flexion of
the trunk (flexion of thoracic and lumber spine),
while it works by drawing symphysis and
Sternum toward each other.
• Also, it works on posterior pelvic tilt with other
abdominal muscles.

34. Exercise

35. Multifidus
• Bilateral contraction extends the vertebral
column.
• Unilateral contraction contralaterally rotates the
vertebral column to the opposite side.

36. Exercise

37. Exercise

38. 2nd to strengthen
Glutes
Thigh
muscle
Other lower
limb muscle

39. Train glutes

40. Thigh muscle

41. Quadricep exercises

43. Hamstring
exercises

44. 3rd to
educate
Postural muscle

46. Exercise with activities
Phase 4

47. Aerobic
• Aerobic activities make you breathe harder and make your
heart and blood vessels healthier. These include:
• Walking
• Dancing
• Swimming
• Water aerobics
• Jogging and running
• Aerobic exercise classes
• Bicycle riding (stationary or on a path)
• Some gardening activities, such as raking and pushing a lawn
mower
• Tennis
• Golfing (without a cart)

48. Flexibility
• Flexibility-enhancing activities ensure a good
range of motion in the joints. Loss of flexibility can
be a predisposing factor for physical issues, such as
pain syndromes or balance disorders. Gender, age,
and genetics may all influence range of motion.
Flexibility exercises include:
• Stretching
• Yoga
• Tai Chi or Qi Gong
• Pilates

49. Muscle-strengthening
•
• Muscle-strengthening activities
build up your strength. These
activities work all the different parts
of the body—legs, hips, back, chest,
stomach, shoulders, and arms—and
include:
• Heavy gardening (digging,
shoveling)
• Lifting weights
• Push-ups on the floor or against
the wall
• Sit-ups
• Working with resistance bands
(long, wide rubber strips that
stretch)
• Pilates

50. Pain should
decrease &
increase
ROM
If not
Change your
FLAPS
Force
Level
Angle
Pressure
Side
Always remember
Try to Treat in
weight bearing
position as
patient
complaints of
pain in loaded
only
When to treat not
loaded?
Joint is inflamed
or the SIN
(severity,
irritability &
nature of pain)
is high

51. Thank You