Conditioning: Phase 4

The following is the last 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 no back pain, but want to improve your low back endurance and loading capacity.

Duration: 2 Weeks
Goal: Increase core strength and endurance with more plyometric demand to increase loading tolerance.
Frequency of Exercises: 3 x per week.

Mountain Climbers (With Rotation): 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 (Running Arm): 3 x 30 seconds (each side). On your side, come up on your feet and elbow. Your elbow should be positioned directly below your shoulder. Maintain a level body without rotating or dipping your torso and hips, and bring your top knee to your top elbow, come back, and repeat. Purpose: Activate muscles in your lateral core and hips.
Back Planks (On Ball, Arms Extended): 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 arm up and then the other, finishing with full arm extension 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.

Jump Squats: (On box first, then on ground) 3 x 8-10 reps. Legs shoulder width apart, bend down by bringing hips back and knees bent, and then come back up. As you land, try to make the landing quiet indicating shock absorption. If too loud, then you are not landing with enough knee bend/hip bending. Do this one at a time at first, then do intervals over time (sets of 3, 4, etc.). Purpose: Increase loading capacity to core and legs.
Side Running in Place: 3 x 30 seconds. Side to side, keeping your core stable. Purpose: Increase loading capacity to core and legs.
Jump Roping: 3 x 30 seconds. Purpose: Increase loading capacity to core and legs.
Bulgarian Split Squats: 3 x 10 reps (slowly, 3 second down, 3 second up). In a split squat stance with your back leg supported on a chair, come straight down then back up. You can use a pole or chair to support your balance. Add weight if it is too easy. Purpose: Increase demand on hamstrings.

Single Leg Balance (Running Man): 3 x 30 seconds. Stand with both hands on your hips with your feet directly under you. Keeping your pelvis as stable as possible, bring one leg up without causing your pelvis to tilt or rotate. Bend the standing leg slightly, and go through a running motion with the other side by bringing the leg backward and forward. Purpose: Improve balance and stability.
Hip Flexor Stretch (Active): 3 x 30 seconds (each side). Standing upright with your feet shoulder-width apart, step forward into a mini lunge, keeping your back leg straight. As you go forward, keep your torso upright while maintaining a posterior pelvic tilt (see video below). For added stretch, bring your hands overhead. Hold for a few seconds then switch to the other side. You should feel a stretch in the front part of your thigh on the trailing limb. Purpose: Decrease compression/shear forces on the lumbar spine by improving hip flexibility into extension.
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 FROM PHASE 4

Required: No pain in back
Required: Able to hold a front and side plank for 90 seconds
Required: Perform back holds for 90 seconds
Required: Hold a single leg glute bridge for 60 seconds (each side)
Ideal: Improved hip flexibility to 10-20 degrees of hip extension, such as with a hip flexor stretch

Principles of Lower Back Pain: A Review

CAUSE – Tensile, compression or shear overload of the disc 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.

Need help with a running plan?

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.