The three exercises you must do to prevent and rehabilitate an episode of low back pain.

Do you want to know the secret of successful Low Back Rehabilitation? These are the three most important exercises that, almost universally, should be included in the successful rehabilitation protocols of any low back problem.

I’ve been involved in Low Back Pain rehabilitation for almost 20 years. I’ve been involved in resistance training and sport, at an international level, for even longer. The industry, both Physiotherapy and Health and Fitness, have gone through huge changes in that time - most of them for the worse. The idea that Pilates is a form of reasonable exercise, and could also be used to rehabilitate Low Back Pain is one of them. Lying on your back in tights, while pulling in your belly button and waving your arms and legs about like a dying beetle is only to be considered an exercise on April 1st. Looks like someone forgot to stop the joke. It’s now time for an Iron Punchline. Pilates is NOT functional stability. It is not functional and it is not stability.

Now for a surprise! I’m here to tell you it is O.K. to lie on your back for Low Back Rehabilitation. It’s O.K. as long as the exercise involves getting you off your back and onto your feet!

This article cannot tell you everything about the treatment and assessment of Low Back Pain. I run courses on Functional Strength Rehabilitation for both Personal Trainers and other Health Professionals and they usually take a full weekend, so this short article is aimed at the trainer who has some good understanding of the problem. If you want to know everything from beginning rehabilitation to full sport return then just sign up to my Facebook page and I’ll have the course dates and locations.

What are the 3 BEST exercises for Low Back Rehabilitation?

• • The Get Up
  • The Kettlebell Deadlift
  • The Kettlebell Swing

Not necessarily in that order, but for some it is, and here is why. Strap yourselves in.

Two problems dominate the Low Back Rehabilitation landscape; both of them are rarely addressed by Medical, Paramedical, or Rehab Trainers. They are:

• • • Atrophy of the multifidus muscle
    • Poor movement patterning into flexion

Where current treatment regimes fail is that they do not understand what YOU as a trainer do; that to make a muscle grow, you must impose overload upon it so it has to adapt and grow. We know that the stabilising muscle Multifidus atrophies after low back pain. The ‘Get Up’, ‘Deadlift’ and ‘Swing’ are some of the key components of the exercise program I use.

Now to tell you WHY! Most professionals astound me that they do not understand the role of the multifidus muscle; people assume it is primarily a lumbar extensor. Not quite. The multifidus contracts to OPPOSE the lumbar flexion that would be produced by the abdominals when they contract. Let us see, so if you lay on the ground and had a weight at arms length and tried to stand up from there I guess your abdominals are going to be pretty damn important, aren’t they? What muscle do you use to stabilise the spine against the flexion of the abdominals? THE MULTIFIDUS!

How damn good is the “Get Up” for Low Back Rehab? Beyond your wildest expectations. Considering that your starting posture is on your back, you have to use your abs to get up, to hold a 3-point balance bridge that moves dynamically to a 2 point kneel while holding a weight overhead and THEN you have to STAND UP on 2 feet! You are not finished yet, however. Now you have to get back down through the same positions but in reverse, slowly, with control!

You want spinal STABILITY? That, my dears, is stability, not some stupid Bosu/Fitball BALANCE exercise that has NO FUNCTIONAL relationship to human performance outside of surfing. Now for the BIG NEWS - BALANCE IS NOT STABILITY! They are two separate concepts entirely; do not confuse them as being the same. This is where so many trainers fail their clients.

We want Functional Stability for Low Back Rehabilitation; this means the ability to move in natural world daily postures and tasks that would be encountered by human beings, in a natural setting or sporting endeavour. There are NO Fitballs in nature; there are none in the jungle, the great plains of Africa or on any mountainside. Fitball training is unnatural and stupid. Game over. Now get some Kettlebells, barbells, chin-up bars, climbing ropes, Club Bells, Bulgarian Bags and Sledgehammers and train functionally!

I know you want to run and grab your kettlebell now and start doing your ‘Get Ups’, but hold on and first let me tell you about The ‘kettlebell dead lift’ and ‘swing’. We need these movements early in rehab. The kettlebell dead lift is better for your rehab client than a barbell dead lift due to its centre of gravity, ability to perform the ‘face the wall’ dead lift which encourages correct neutral spine, and transfer of skill to the kettlebell swing.

Remember I said it is better for rehab, not that it is an overall better exercise than the barbell dead lift, but it has an earlier position in the Low Back Rehab plan. The kettlebell deadlift is wonderful and I encourage you all to go and buy an 80kg ‘Bomb’ for your clients - set the bar high!

Remember, we are on the cutting edge as professionals and consequently need the best tools and skills on how to apply them. Keep reading with a passion and if you have any questions, feel free to contact me via my new Facebook group ‘Functional Strength Rehabilitation’. To avoid an further confusion, the rumours are true – I am now officially back working as a physiotherapist and consultant full time and will be running the full series of ‘Functional Strength Rehabilitation Certification Courses’.

Train Hard, Stay Big!