As discussed in my last column published in the July/August 2009 issue of the Journal, many clients, especially those who are overweight or obese, may be limited in their ability to move themselves down to and up from the floor. Knee and back conditions are common problems in this group of clients. My colleague, Cathy Maloney-Hills, RPT, at Courage Center, Minneapolis, MN, and I collaborated on creating some ideas for seated and standing exercises that may be helpful modifications for people who are faced with obesity coupled with orthopedic conditions. This column focuses on back health conditioning exercises that keep clients off the floor as they take charge of their own exercises at home or as part of your class. If your clients have chronic conditions, be sure they are cleared by health care providers for independent exercise.
Group exercise instructors might find these exercises helpful for participants who need to modify exercises during class. Personal trainers or clinical practitioners may find these ideas useful home workout assignments for clients who are learning how to take charge of their own activity.
This "Off the Floor" handout is designed so exercise practitioners can copy and distribute to clients with permission from ACSM. Check off the recommended exercises for your client and add individualized notes for a tailored program.
HEALTHY LOW-BACK HOME WORKOUT
Core function and core stability focus on strengthening crucial trunk muscles that surround and support the spine. Dr. Stuart McGill, University of Waterloo, Waterloo, Ontario, Canada, one of the world's leading researchers on low-back stability offered these specific guidelines for training (1):
- Injuries occur when the spine "buckles." By training the trunk muscles that surround the spine to maintain "stiffness," the back is protected from tissue injury or irritation. Well-trained trunk core muscles help maintain a healthy neutral posture (ears, shoulders, and hips aligned) and minimize the chances for the spine to buckle.
- A stiff or more stable spine can be developed during posture exercises that focus on contracting the gluteals, abdominals, and spinal muscles that are used to brace the spine.
- Functional standing or neutral posture exercises that focus on muscular contractions of the abdominal, gluteal muscles, and spinal muscles brace the spine in good alignment so the abdominals, spinal muscles, and gluteals create a stiff or more stable spine.
Perform checked exercises three days per week, with at least one rest day between and gradually add more days as you get stronger.
Symbol Objective: Mobility of the spine to reduce present stresses on the spine.
- Place your hands on a countertop or table, hands and feet about shoulder-width apart. Keep your knees bent slightly.
- Move in a fluid motion as you slowly start curling the spine (low back) upward and then downward. Avoid pushing as far as possible to stay within a comfortable range. Dr. McGill calls this mobility exercise "flossing the spine." If this movement causes any back discomfort, keep abdominals and/or buttock muscles tight to make the arching movement smaller.
- Breathe rhythmically as you complete about 5 to 6 cycles.
STANDING PLANK AND SURRENDER
Symbol Objective: To strengthen the deep core muscles on both sides of the body.
- Face the wall, standing about an arm's distance away.
- Lean against the wall on your elbows and lower arms, keeping feet and hands about shoulder-width apart.
- Create a stiff "plank" with your body (look straight ahead, keeping head and neck in a straight line, and avoid dropping your hips forward).
- Hold and pull your abdominals into the spine and squeeze buttocks to create a ridged position.
- Hold the plank for about 6 seconds and then stand up to recover.
- Repeat several times until you feel your muscles tremble a bit or when you're unable to hold the plank position. This is termed muscle fatigue. Over time, your muscles will adapt to the challenge and get stronger.
To add more challenge: Plank with feet and hands together and stand sideways.
STANDING BIRD DOG
Symbol Objective: This exercise is a safe alternative to the back extension machine in the gym.
- Stand with back against the wall, shoulders touching. A soft ball can be used for comfort.
- Walk your feet away from the wall as you slide your body into a mini squat, toes forward.
- Hold the squat position by squeezing your gluteals (buttocks) and by tightening your abdominal muscles.
- Lift one arm up over your head without changing your body position or arching your back. Keep looking straight ahead.
- Hold 6 seconds. Breathe normally. Repeat with the other arm.
- Continue to alternate arm lifts until leg muscles fatigue.
EXERCISES TO AVOID
- Leg raises performed while lying on the back and sit-ups with straight or bent legs. These exercises create high compressive loads on the back.
- Exercises that push the spine into extreme positions (end range of motion) such as the cobra position in yoga or a full extension (pushing backward) on the back machine in the gym.
- Using hand and/or leg/ankle weights during walking, jogging, or running.
- Bending forward with legs locked (pulling weeds in the garden, sorting through stuff, or picking up a golf ball). Instead, keep your back stiff, bend your knees, squeeze your gluteals, and use your legs for support. You also can lift the opposite leg up as you reach and pick up the object with one hand. If you have both back and knee problems, Cathy Maloney-Hills, RPT, suggests buying an extended reacher from a local discount store instead of bending down.
Special thanks to Cathy Maloney-Hills, RPT, for her contribution to this column and for teaching me how to be a more effective practitioner, especially with clients who have special needs. Thanks also to our model Hsiu-Hui Tai (Daphne) from Taiwan. Daphne recently earned her ACSM Certified Health Fitness Specialist® certification and is a graduate student working on her Master's degree in Public Health at the University of Nevada, Reno.
© 2009 American College of Sports Medicine
1. McGill S. Low Back Disorders, Evidence-Based Prevention and Rehabilitation
. Champaign (IL): Human Kinetics; 2002.