Conditioning: Phase 2

The following is the second of four phases that will guide you from lower back pain toward healthy running. Progress from each phase as instructed, applying rehabilitation modalities such as taping where needed.

Start here if your pain is at a level <2/10 (e.g. sleeping is no longer an issue, comfortable with sitting or standing for prolonged periods of time, and bending forward and backward bring minimal or no pain.

Duration: 2 Weeks
Goal: Gradually reload and stabilize the spine and improve strength in the surrounding muscles.
Frequency of Exercises: 3 x per week.

Pelvic Tilt: Every lower back has a certain tolerance to pain, with some being more sensitive than others. To progress, we need to find a position that decreases the pain in your low back. Start by lying on your back with your knees bent (hooklying position). Rotate your pelvis posteriorly or anteriorly (or within that range) to find a position that is most comfortable. Many people find comfort with a posterior tilt (i.e. when the low back is flat). You can place your hands under your lower back to determine when it is flat against the ground. It may be a little sore, but continue with the posterior tilts a few times to see if the pain subsides and the motion gets easier. If it is too painful or gets worse then being in the middle range may be ideal. Though rare, an anterior tilt can help some people (i.e. extend/arch the back). Before you begin your exercises, it is important that you get comfortable with this concept, as this will be used as you progress in your training.

Supine “Dying Bug” (Alternating Legs): 3 x 12 reps. Lie on your back with your knees bent. Find the position most comfortable for your back (see Pelvic Tilt). Engage your abdominals to stabilize your spine. It may be helpful to place your hands underneath your low back to feel the posterior tilt of the lumbar spine. Next, bring one leg up to the “90/90 Position” while maintaining the posterior tilt. It is important to stabilize your spine here. Next, if strong enough, bring the other leg up without arching your low back off of your hands, and then bring your leg up to meet the other in the “90/90 Position”. Then bring one leg away from you while keeping your core stable. Finally, bring the leg back and alternate with the other side. Purpose: Activate abdominal muscles.
Side Plank (On Knees, Leg Up): 3 x 12-16 reps or until fatigue (each leg). On your side with your elbow directly under your shoulder, come up on your elbow and knee, keeping your top leg bent (for a challenge, keep the top leg straight). Next, as you maintain a side plank, bring your top leg up and down slowly. Perform this without rotating. Purpose: Activate muscles on the side of your core and hip.
Back Planks (On Ball, Arms Up): 3 x 45 seconds. With your feet against the wall and in a high kneeling position, come down on the ball (55 cm ball preferred), and then straighten your legs so that your knees are off the ground and your hands are supporting you. The ball should be positioned under your abdominals. Maintaining a relatively parallel position to the ground, bring one arm up and then the other while maintaining form. You should feel muscle activation in the glutes, hamstrings, and lower back. (No Ball): 3 x 10 repetitions. On your hands and knees in quadruped position, bring one leg back while maintaining a level and stable core. Hold your leg out for 3 seconds then come back and alternate with the other leg. If that is too easy, you can alternate the hand/leg sequence to increase demand on the core and back musculature. Purpose: Activate hamstring, glute and lower back musculature.

Kneeling Hip Flexor Stretch: 1 minute (each side). In a kneeling position with your hands on the wall for support, perform a posterior tilt by engaging your abdominals and glutes. Keeping your spine in a neutral position (do not extend your low back), lean forward until you feel a decent pull at the front of your hip. For a challenge, bring one arm up overhead and lean away. Purpose: Stretch the hip flexor muscles while also decreasing anterior tilt to reduce strain on the lower back.
Single Leg Glute Bridge: 3 x 12 repetitions (or until fatigue). On your back with knees bent in a hooklying position, perform a posterior tilt first and then bring one leg up in the air with the knee bent. Next, engage your glutes and coming up in the air, maintaining a posterior tilt. If you feel some achiness in your back, do not go up as high, but assess if you are maintaining your posterior tilt. Purpose: Activate in glutes, hamstrings, quads, and low back.
Squats: 3 x 10 repetitions. Standing with your feet apart – slightly wider than shoulder width – come down by bringing your hips back first, and then bend your knees. Keep your back in a neutral position the whole time. Come down to about 90 degrees at the knees, and then come back up using your glutes. Do this slowly, as proper form is essential with appropriate muscle activation. Look in a mirror to see how you initiate the squat. You should feel muscles work in your quadriceps, glutes, and back. Purpose: Begin functional movements incorporating your core muscles.

Figure-4 Stretch: 1 minute hold (each side). On your back with one foot on a wall and your knee bent to 90 degrees, place the other shin on your thigh that is on the wall. With one hand, push down and hold your knee towards the wall so that you feel an increase stretch in your glutes. Purpose: Increase hip mobility to reduce excessive shearing forces in the lumbar spine.
Calf Stretch: 1 minute per side. Standing with one foot back, place your toes on a half roll or rolled-up towel to increase stretch. Lean forward while keeping your knee straight. Purpose: Address calf restrictions.

TO GRADUATE TO PHASE 3

Required: Able to bend forward and backward without pain
Required: No pain with sleeping
Required: Minimal discomfort with sitting/standing for a prolonged period of time (>30 min)
Ideal: Hold a full plank for 45 seconds
Ideal: Hold a side plank for 45 seconds
Ideal: Perform back holds (on ball) for 45 seconds
Ideal: Hold a single leg glute bridge for 30 seconds (each side)

Principles of Lower Back Pain: A Review

CAUSE – Tensile, compression or shear overload of the disc, joint, muscles, or surrounding lumbar ligaments.
NEED – Unload the lumbar spine to decrease symptoms with isometric contractions to restore muscle function and decrease inflammation.
PLAN – Once pain decreases, gradually increase load to improve tissue resiliance and structural integrity.

Still Need Help?

You are welcome to meet virtually with our PT for additional feedback and assessment. Otherwise, continue to the next step to learn how best to manage the pain from your injury.