Conditioning: Phase 3

The following is the third 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 you have rare instances of pain (e.g. no issues sleeping, waking up without pain; prolonged sitting/standing causes minimal discomfort; and there is no pain with bending forward or backward).

Duration: 2 Weeks
Goal: Increase core strength and endurance with more movement to challenge spinal stability.
Frequency of Exercises: 3 x per week.

Mountain Climbers: 2 x 1 minutes. Start on your hands and feet, with your hands directly above the shoulder. While maintaining a level pelvis, bring one knee under you toward your other arm and then alternate with the other side. You should feel the muscles of your core and shoulders working to keep you stable. Purpose: Increase core demand and stability.
Side Plank: 3 x 30 seconds (each side, or until fatigue). With your elbow aligned with your shoulders, come up on your side. Keep your body straight throughout. Purpose: improve hip strength and core stability to reduce risk of knee caving in.
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. Maintain a parallel position to the ground, bring one hand 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.
Captain Morgans: 3 x 30 seconds (each side) or 3 x 8-10 reps. Near a wall, stand straight and bring your “wall side” knee up; you can use a ball, but if you don’t have one just use the wall. Keeping your torso straight with hands in front, begin to squat down by bringing hips back then bending knee. On one leg, without that knee caving in, push your knee hard against a ball/wall. If it’s too easy, it can go up and down slowly. Should primarily feel hip and thigh muscles working. Purpose: Increase hip strength to reduce knee from caving in.
Side Steps (With Band): 3 x 12 steps (each direction); some pain okay. Place the Band around your foot/ankles, step side to side in a slight squatting position while keeping your body aligned and your feet facing forward. You should feel muscles working on the side of your hips. Purpose: Increase glute strength to reduce knee caving in.

Up and Backs: 3 x 30 seconds. Go up and back at a running pace. This will increase load capacity on the tissue and guide you back toward sprinting-type activities. Add time as endurance improves. Purpose: increase pressure on joints to improve resilience.
Foundational Squat: 3 x 6 repetitions. Standing in a squat position with your back neutral, hold the squat while you bring your arms overhead. Bringing your arms overhead will stimulate your back muscles to engage. Hold your arms up for 3 seconds and then lower them while maintaing the squat position. You should feel your back, quads, and shoulder muscles engaging. Purpose: IIncrease endrance and strength in back muscles in more functional positions.

Walk/Run Program: Begin if guidelines are met (see link).
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 4

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)
Required: Successful implementation of the walk/run program with at least 3 consecutive run/walks without any pain.
Ideal: Hold a full plank for 60 seconds
Ideal: Hold a side plank for 60 seconds
Ideal: Perform back holds on ball for 60 seconds
Ideal: Hold a single leg bridge for 45 seconds (each side)
Ideal: Hip flexor mobility is improving toward extension

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.