BMA BAD BACK BOOK

99B A C K A N D B U T T O C K S

63 KNEELING SUPERMAN and shoulders. It is a key movement for maintaining
a healthy back, and an important rehabilitation exercise
This exercise strengthens the spinal extensor muscles for a number of back conditions.
and deep spinal stabilizers, which support your spine, and
builds strength and stability in your core, lower back,

Keep your back in Align your Keep your core Extend your arm
a neutral position head and spine muscles tight straight out in front

Kneel on all fours, ensuring that your knees are aligned Engaging your core, raise one arm in front of you.
squarely under your hips. Keep your back straight Hold for 10 seconds and return to the start position.
and position your hands directly beneath your shoulders, Repeat with your other arm.
pressing them flat on the ground and pointing forwards.
PROGRESSION – LEVEL 3
PROGRESSION – LEVEL 2
Combining an arm lift and a leg lift requires good strength and
Raising a leg rather than an arm will demand more balance and stability. Contracting your abs, simultaneously lift your right leg
control. Engage your abdominal muscles and lift your right leg behind you to hip height and your left arm forwards to shoulder
behind you to hip height. Balance and hold for 10 seconds, then height. Hold for 10 seconds, then lower your leg and arm to the
return to the start position. Be careful to keep your back straight start position with control. Keep your body straight, and repeat
and to not arch your spine. Repeat with your other leg. with your other leg and arm.

Stretch your Keep your back Align your head Do not twist Extend your arm
leg straight out in a neutral position with your spine your hips straight out in front
and your chest high
behind you

100 M A I N T E N A N C E A N D R E H A B I L I T A T I O N E X E R C I S E S

64 MCKENZIE EXTENSION 65 LEG RAISE

This exercise helps to ease aches in your lower This exercise strengthens your hip flexors and your core,
back, such as those caused by sitting for long periods and is a useful movement to help stabilize your pelvis and
of time. It is sometimes helpful in reducing pain if prevent lower-back problems. Ensure you use the muscles
you have been diagnosed with a herniated disc or of your core and legs, rather than your back.
disc-related sciatica. You may feel some discomfort,
but stop if you feel pain. Aim to perform 10 reps, Keep your
several times a day. head still

Press your Keep your arms Rest your arms, palms-
body flat on close to your down, by your sides
body and your
the floor shoulders relaxed Lie on your back with your head on a folded towel.
Bend your left knee to relax your lower back, with
Lie face down on a mat with your hands flat on the your arms by your sides, hands palms-down, and your
floor and roughly level with your chin. Extend your right foot pointing upwards.
feet, keeping your legs together.
Keep your
core tight

Keep your Relax your
legs straight buttocks

Pressing your hips against the mat and breathing Keeping your knee straight, lift your right leg about
out, lift your torso upwards slowly, using your 40cm (16in) off the floor (or higher as your muscles
arms for support. Raise your head and shoulders up grow stronger) in a slow, fluid movement.
as high as you can, keeping your lower back relaxed.
Pause briefly at the top of the movement and use your Keep your foot
arms to lower your torso back to the start position. at a right angle

Keep your
leg straight

VARIATION Pause at the top of the movement for 3–5 seconds,
then return to the start position, slowly and under
If your injury means that one side of your back is more painful than control. Perform 15 reps, then switch legs.
the other, there is a useful variation of this exercise. While you are
lying face-down on your stomach, as in Step 1, shift your legs towards
your painful side before you extend your upper torso upwards.

101B A C K A N D B U T T O C K S

66 SIDE-LYING LEG RAISE 67 REVERSE LEG RAISE

This exercise strengthens your gluteus medius This exercise strengthens the gluteus maximus muscles in
muscles in your buttocks, which play a key role in your buttocks. It promotes good pelvic stability and helps in
pelvic stability and in the prevention of back problems. the prevention and rehabilitation of lower-back problems.
Use your core and leg muscles rather than your back. If your buttock muscles are weak, you may be tempted to
use your back in the movement. You can prevent this by
Lie with your hips, Extend your arm above placing a pillow under your abdomen and pelvis.
knees, and feet stacked your head for support

Lie with your body Support your head
flat against the mat with your arms

Lie on your left side and stretch your left arm out, Lie on your front with your forehead resting on the
so that your legs, body, and head are aligned. Place back of your hands and your knees straight. Brace
a towel between your head and arm to help keep your your abdomen and squeeze your buttocks tightly together.
upper body relaxed. Use your upper arms to support
you and stop you rolling forwards and backwards.

Turn your Keep your Push your arm Squeeze your
foot inwards hips stacked against the floor buttocks

Keep your Brace your
knees straight abdomen

Keeping your knee straight and your foot turned Keeping your buttocks tight, lift your right leg up
inwards to maximize the benefit of the movement, in a slow, fluid movement about 30cm (12in) off
lift your right leg about 40cm (16in) off the floor. Ensure the floor (or higher as your muscles grow stronger).
you keep your core engaged to prevent lower-back strain.

Keep your leg straight Keep your Keep your
as you lift it hips aligned back straight

Maintain a
tight core

Keep your foot
at a right angle

Pausing at the top of the movement for about Pause for 3–5 seconds when you reach the top of the
3–5 seconds, return to the start position, slowly movement, then return to the start position, slowly
and with control. Perform 15 reps, then switch legs. and with control. Perform 15 reps, then switch legs.

102 M A I N T E N A N C E A N D R E H A B I L I T A T I O N E X E R C I S E S

68 ISOMETRIC ADDUCTOR SQUEEZE 69 ADDUCTOR LIFT

This is a key exercise for the rehabilitation of sacroiliac This is a great exercise for strengthening your adductors.
joint dysfunction, as regaining strength in your adductor Weak adductors can lead to poor hip position and
muscles is essential for the treatment and prevention of sacroiliac joint dysfunction. As your strength increases,
lower-back pain. you can use ankle weights to make it harder.

You should be able to Use your arm to Keep your
squeeze the ball without provide support pelvis neutral
experiencing any pain

Lie on your back with your pelvis in a neutral position, Lie on your right side with your hips stacked and your
knees bent at a right angle, and feet flat on the floor. right arm bent under your head. Shift your weight
Place a medicine ball between your knees. Squeeze as hard forwards, using your left arm for balance. Bend your left
as is comfortable, hold for 10 seconds, then relax to return leg to 90 degrees, with your left knee touching the floor.
to the start position. Repeat the movement as required. Keep your right leg straight. Breathe in.

Place a medicine ball between your ankles. Lie on your Feel the stretch on
back with your pelvis in a neutral position and keep the inside of your
your legs straight. Squeeze the ball between your ankles as right thigh
hard as you can, hold for 10 seconds, and return to the start
position. Repeat as required. This movement should not Keeping your arms and left leg in the same position,
be painful. raise your right leg off the ground as high as you can,
exhaling as you lift, then pause.
Maintain a strong
back and engage
your core

Rest your foot
back on the floor

Lie on your back with your pelvis in a neutral position, Return to the start position, inhaling as you lower
and your hips and knees bent at right angles. Place your leg. Repeat as necessary, before switching sides
a medicine ball between your knees. Squeeze as hard as to work your left leg.
is comfortable, hold for 10 seconds, then relax to the start
position. Perform the necessary number of repetitions. You
should not experience any pain when you squeeze the ball.

103B A C K A N D B U T T O C K S

70 BRIDGE VARIATION

This exercise activates the large gluteal muscles of This exercise can be varied by
your buttocks and your hamstrings. It is an important bending your knees further,
core-stabilizing movement for the rehabilitation of or putting your feet on a Swiss
numerous back problems, including sacroiliac joint pain. ball. This adds a
There is a wide range of potential variations, making it level of instability,
making your
»a very versatile exercise. As your strength increases, you core stabilizers
work harder.
can try the single-leg bridge ( below).

Keep your feet Place your arms
flat on the flat on the floor
floor

Keep your knees Maintain a straight back and
in line with your do not arch your upper back
pelvis and trunk

Lie on your back with your knees bent at right angles Engaging your core, slowly lift your buttocks off the
and your feet flat on the floor, hip-width apart. Keep floor until your body is in a straight line from your
your arms at your sides, with your palms facing down. knees to your shoulders. Pause at the top, then reverse
the movement to return to the starting position.

71 SINGLE-LEG BRIDGE you are performing it on one leg, it forces you to control
the rotation and tilt of your pelvis. It is important to
»A development of the bridge ( above), this exercise ensure that you keep your hips level throughout.

is useful for working the large gluteal muscles of your Keep your hips fixed
buttocks, your hip extensors, and your core. Because and do not twist

Ensure that your hips Engage your
are straight abdominals

Keep your
head and
spine aligned

Lie on your back with your knees bent at 90 degrees, Engaging the muscles of your abdomen and lower
your feet hip-width apart, and your hands palms-down back, lift your buttocks until your hips are fully extended
by your sides. Keeping your right foot flat on the floor, and your body is in a straight line from your lower knee
and your arms by your sides, raise your left knee up to your shoulders. Hold this position, then reverse the
towards your torso until your thighs are at right angles. movement to return to the start position, and switch legs.

104 M A I N T E N A N C E A N D R E H A B I L I T A T I O N E X E R C I S E S

72 LAT STRETCH 73 QUAD STRETCH

Specifically targeting the large muscles of your This stretch works the Keep your head
upper back, this simple stretch is a useful exercise quadriceps muscles at forwards and
for maintenance and rehabilitation for a range of the front of your thigh,
back injuries. your spine neutral

Feel the which enable you to
stretch in your
straighten your knee.
upper back
Because this stretch is

performed in a standing

position, it emphasizes Tilt your pelvis

good posture and balance. back slightly

Keep your Stand with your back to
knees bent a firm table. Place your left
foot on the table and, keeping
Stand facing an upright support that will take your your legs parallel, tilt your pelvis
weight. Grip the support with both hands and lean back slightly so you can feel the
back, bending your knees. Push with your legs and pull stretch in the front of your left
with your arms. thigh. Hold, lower, and repeat
with your right leg.

74 HAMSTRING STRETCH 1 75 HAMSTRING STRETCH 2

This is a simple general-purpose stretch that works all This is another useful stretch for your hamstring muscles to
the muscles in your hamstrings, relieving the tightness help relieve tightness, which can cause pain in your lower
that can stress your lower back. Stretch slowly and back. Perform the stretch in a slow, controlled manner.
avoid “bouncing” at full extension.

Grasp your left leg Keep your Feel the Grasp your
just below your knee right leg stretch left leg with
in your both hands
Feel the straight and hamstrings
stretch in your flat on

hamstrings the floor

Lie on your back with your legs extended. Bend your left Lie on your back with your legs extended. Lift each
knee. Pull gently on your left leg, bringing your knee leg in turn, keeping your knee braced and your toes
towards your chest until you feel the stretch. Keep the back of pulled back towards your body. If you are very flexible, try
your head on the floor. Relax and repeat with your right leg. extending the stretch a little by pulling back on your leg.

105B A C K A N D B U T T O C K S

76 LANCELOT STRETCH Feel the stretch
in your arms
This is a useful stretch if you suffer from stiffness
around your spine, as it stretches your hip flexors and, in
particular, your psoas muscle. Your psoas muscle is directly
attached to your spine and it is important to keep it flexible.

Stand with your feet Look straight Bring your arms together Feel the stretch in
shoulder-width apart ahead above your head, palms your torso as you
and your hands on your touching, your left arm in front reach upwards
hips. Lunge forward with Bend your of your right. Reach upwards
your left leg, bending both knee at a and tilt your pelvis backwards
legs so that your right knee right angle so that your tail bone comes
and the top of your right forwards. Pause and return
foot are touching the floor. to the start position.
Keep your spine neutral Repeat as required Squeeze
and look straight ahead. and switch sides. your gluteals

77 ADDUCTOR STRETCH 1 78 ADDUCTOR STRETCH 2

Stretching your adductor This version of the adductor stretch works more on
or groin muscles is key to the short adductor muscles of your groin. It is easy to
maintaining hip flexibility, perform, can be carried out almost anywhere, and
and can help with lower- forms a useful part of a general stretching routine.
back pain.
Feel the stretch in
Keep your your adductors
body upright

Feel the stretch in Sit on the floor and take a firm hold of the tops of your
your adductors feet. Bring your legs in close to your body, pressing the
soles of your feet together. Push your knees gently down
Keep your body upright and put your hands on your towards the floor as far as you can, and hold.
hips. Bend your left leg so that your left knee is over
your left foot, your right leg is extended, and your right
foot is flat. Rock gently to the side. Relax and switch legs.

106 M A I N T E N A N C E A N D R E H A B I L I T A T I O N E X E R C I S E S

79 PIRIFORMIS STRETCH 80 CALF STRETCH

»This seated stretch is more advanced than the ITB foam Tight calf muscles can cause
a muscular imbalance by
roller stretch ( p.93) because you need greater flexibility making your foot turn outwards
in your hip joint to perform it correctly. It is useful and forcing your hip muscles
for preventing or easing piriformis syndrome, and is to work harder. Your gait may
particularly important for those who exercise regularly. become “flatter”, which can
lead to back pain.
Sit on the floor with your legs extended. Support
yourself with your left hand behind you, and bend Feel the
your left leg, crossing it over your right leg. Keep your stretch in your
left foot flat on the floor. Reach over with your right
hand and gently press on the outside of your left calf muscles
knee until you can feel the stretch
in the outside of your thigh. Push your heel
Hold briefly, then switch sides. into the floor

Feel the From a standing position, press your left hand against
stretch a wall and take a good step backwards with your right
leg, keeping your feet hip-width apart. Bend your left leg
here forwards, ensuring you keep your knee over your foot.
Switch arms and repeat with your other leg.

81 CALF RAISE Keep your
shoulders back
This exercise helps to
strengthen your calf muscles Engage
and improve your gait. your core
It is important to avoid
tight calf muscles, as they Raise yourself
can put stress on the muscles up on one leg
of your lower back, and
cause or aggravate pain
in that area.

Keep your
supporting
leg straight

Stand on your left leg, with the toe of your right leg Raise yourself up as high as you can go on to the ball
wrapped around the back of your left ankle. Support of your left foot, breathing out as you do so. Pause
your body weight with your left leg, and rest your hands briefly, then lower your heel back to the start position,
on the back of a chair. Breathe in. breathing in. Repeat as required, then switch legs.

107B A C K A N D B U T T O C K S

82 SINGLE-LEG STAND VARIATION Maintain a
strong core
This exercise is a good starting point for developing your Once you can confidently perform a
balance in a weight-bearing position. It also improves single-leg stand on a stable surface,
control of your trunk and strengthens your buttock try balancing on an Airex mat, wobble
muscles, helping to improve your pelvic stability. board (shown here), or Bosu ball to
introduce an element of instability
Pick a point on the and make the exercise harder.
wall in front of you
and focus on it. Stand on Keep the knee of
one leg and tighten your your standing leg
buttocks and thighs all at firm but not locked
the same time. Stand in
front of a mirror if you PROGRESSION
need to check your posture
and form are correct. More of a challenge in terms of balance,
coordination, and flexibility, this exercise
Contract the muscles involves you standing on one leg and
in the buttock and thigh
touching the floor with your
of your standing leg opposite hand at points
around an imaginary
clock face. If performed
incorrectly, it can cause
back injuries, so seek
guidance before you try it.

83 WALL-SUPPORTED FOOT LIFT »( p.37), and improves your gait. It can help to prevent

This exercise strengthens the muscles of your feet and problems in your knees, hip, and back in the longer term.
lower legs. It helps prevent flat feet and overpronation

Rest your head, Keep your Slowly and with Keep your
shoulders, back, arms relaxed control, lift your head upright
and arms against a toes and the front
wall. Move your feet of your feet off the Keep your knees
slightly apart and floor. Hold for a few slightly bent
30cm (12in) from seconds, return to
the wall, bending the start position,
your knees slightly. and repeat for the
required number
of reps.

Place both feet
flat on the floor

Raise your
toes

108 M A I N T E N A N C E A N D R E H A B I L I T A T I O N E X E R C I S E S

84 SUPINE PELVIC TILT 85 KNEELING PELVIC TILT

This exercise helps with most types of acute lumbar This movement helps those with poor posture. Some
pain by relieving pressure on the facet joints and gently
stretching the muscles and ligaments of your back, »experts recommend this as an alternative for the supine
strengthening your core and improving your posture.
You should perform this exercise on the floor at first, version of the exercise ( left) after the first trimester of
but as you improve you can try it standing up. pregnancy because that version may interfere with blood
supply to the foetus.
Arch your
back slightly Keep your feet
hip-distance apart

Bend your Kneel on a mat with your hands under your shoulders
elbows slightly and your knees under your hips, keeping your back
in a neutral position, and breathe in deeply.
Lie on your back with your knees bent at a comfortable
angle, your feet flat on the floor, your arms by your sides Draw in
at a slight bend, and your lower back arched but relaxed. your belly

Keep your knees Keep your hands
at a right angle flat on the floor

Gently press the small of your back into the floor and tilt Breathe out, pulling your abdominals in tight, and
your pubic bone upwards by tightening your abdominal suck in your belly button towards your spine. With
and pelvic floor muscles. Hold for at least 6 seconds. one fluid motion, reverse the curve in your lower back
and tilt your hips.

Relax your belly Keep your head in
as you inhale line with your back

Keep your
shoulders
back

Relax and return to the start position, so that the small Release and repeat for the required number of reps.
of your back is slightly arched once more. Repeat as Inhale and exhale as you perform the moves, feeling
required and relax. the pull and push of the movement deep within your core.

109B A C K A N D B U T T O C K S

86 SEATED PELVIC TILT 87 PRONE BACK EXTENSION

It is harder to perform the pelvic tilt in an upright posture, This is a good maintenance exercise for the muscles of
either standing or sitting, but doing this exercise on a your lower back and core, but you should only attempt
Swiss ball provides a helpful guide, as the ball will shift it if your lower back is free of pain. The only sensation
forwards slightly when you do the movement correctly. you should feel while performing it is the muscles
of your lower back tightening as they work.

Keep your
shoulders loose

Keep your back Hold your
straight and your chest up

spine neutral

Sit up straight on a Rest your forearms
Swiss ball, with your on the floor
feet parallel and hip-width
apart. Rest your hands Lie face down on a mat with a folded towel under
on your knees. Keep your forehead to ensure proper alignment of your
your back straight head and neck with your spine. Bend your arms and rest
and your spine neutral. your forearms on the floor, palms down. Breathe in deeply.
Breathe in deeply and
arch your back slightly.

Exhale forcefully, Keep your Keep your head in line with
pulling your thighs parallel your upper back and your
abdominals in tight to the floor
and drawing them in eyeline on the towel
towards your spine.
With one fluid motion, Curve your spine
reverse the curve in
your lower back by Engage your core and reach forwards with the top
tucking your hips under of your head to lengthen your spine, keeping your
your torso and rolling shoulders apart. Then, facing downwards, lift your head
the ball forwards very and shoulders off the floor, exhaling as you do so. Make
slightly as you do so. sure that you do not use any strength from your arms.

Hold the position Keep your
for a few seconds, legs straight
then release to return
to the arched position
in Step 1. Repeat as
required and relax.

Pause at the top of the movement, then inhale and
slowly return to the start position without resting.
Repeat as required.

110 M A I N T E N A N C E A N D R E H A B I L I T A T I O N E X E R C I S E S

88 STANDING BACK EXTENSION 89 KNEES-TO-CHEST STRETCH

This exercise gently arches your lower back, and it is useful This exercise helps if you have strained a facet joint, and
for lumbar disc problems. You should perform it every the surrounding muscles are tight and aching. However,
couple of hours through the day. If it increases your pain, you should proceed with caution if you know your pain
is caused by a disc protrusion.
»try the prone back extension exercise ( p.109) instead.

Pull your Raise your
elbows back knees towards
your chest
Stand up straight with your
feet pointing directly forwards, Rest your arms
about shoulder-width apart. by your sides
Place your hands on the small of
your back and breathe in deeply. »Lie down and do a basic pelvic tilt ( p.108). Then

Relax your draw your knees up towards your chest, keeping
shoulders your lower back flat.
and back
Grasp your legs
behind your knees
with both hands

Breathe out slowly. Use your hands to help draw your knees closer to
As you do so, your chest. Keep your head on the floor.
bend backwards,
supporting your back Keep your calves
with your hands, so parallel to the floor
that your lower back
is arched. If you have Let go of your thighs and return to the start position.
neck pain you should Repeat for the required number of reps.
look ahead and avoid
extending your neck.

Return to the start position and
repeat for the required number
of reps, but do not exceed 10 reps
at any one time.

Keep your feet
shoulder-width apart

90 SWISS BALL BACK EXTENSION 111B A C K A N D B U T T O C K S

This advanced exercise requires you to stabilize the 91 BACK ROTATION
full length of your body while increasing resistance
(by placing your hands behind your head) and This exercise improves general mobility and is particularly
range of motion (the ball adds height to the lift). useful for relaxing the muscles of your back and pelvis.
It also relieves facet joint pain by stretching the capsules
Keep your feet and ligaments around the facet joints in your lower
hip-width apart back: those on your left will be stretched as you drop
your knees to the right, and vice versa.

Press your lower
back into the floor

Position your torso on a Swiss ball with your legs Lie on your back with your knees bent, your feet flat
extended, and dig your toes into the mat. Alternatively,
plant your feet against a wall. Rest your fingertips lightly at »on the floor and your arms by your sides, as for the
the back of your head and lengthen your spine. Breathe in.
pelvic tilt ( p.108). Press your lower back into the floor.

Raise your Keep your
upper body calves

parallel to Extend your arms
the floor out to the sides

Keep your
legs straight

Exhale as you squeeze your buttocks and slowly lift Keeping your knees together, lift them until they
your torso to 45 degrees. Press your hips into the are above the middle of your abdominal region,
ball. Pause at the top, then inhale. and bring your arms straight out to your sides.

Keep your arms out to the
sides and your head still

Slowly return to the start position without resting. Let your legs flop over to the right as far as they will
Gradually build up the number of reps. go. Breathe slowly and deeply, allowing your legs to
drop a little further with each breath. Hold for as long as
you can, then bring your legs back up and lower them
to the other side. Repeat the movement as required.

112 M A I N T E N A N C E A N D R E H A B I L I T A T I O N E X E R C I S E S

92 FOUR-POINT SUPINE KNEE LIFT a useful exercise for preventing pain in your lumbar
region. To get the best results from the movement,
This is a moderate-impact core-stabilizing exercise. keep the muscles of your core engaged throughout.
It can be helpful for strengthening the deep muscles
of your abdomen and your lower back, and can be Lift and bend your
knee to 90 degrees
Brace your Align
abdomen your knees Use your arms
for stability

Lie on your back and bend your knees, with your feet flat Keeping your abdomen braced, lift your left leg

on the floor. Relax your shoulders and upper back, brace so that your hip and knee are at right angles.

your abdomen, and keep your spine in a neutral position. Keep your right foot firmly on the floor.

Raise your right leg Keep your
to the same level core engaged

Engage your core

Still keeping your abdomen braced, lift your right Keeping your core engaged, slowly lower your left
leg until it is level with your left. Hold this position leg until your foot is flat on the floor.
for a few seconds and use your arms to stabilize yourself.
VARIATION
Align your knees
centrally Once you can perform the basic four-point supine knee lift with
confidence and you have improved the strength and stability in
Relax your your abdomen and lumbar region, you can make the exercise
shoulders harder by placing an air cushion (shown here) or Bosu board
in the small of your back. Focus on maintaining
Now lower your right leg, returning to the start stability in your torso and keeping the muscles
position. Repeat the exercise 5 times and then of your core engaged. Try not
repeat the sequence beginning with your right leg. to use your arms to
keep you balanced.

Position the air
cushion beneath

your pelvis

113B A C K A N D B U T T O C K S

93 ISOMETRIC HIP FLEXION 94 SINGLE-LEG ELONGATION

This exercise strengthens your deep abdominal muscles This exercise is used in the rehabilitation of facet
and hip flexors, and stabilizes your lower back. It can joint and sacroiliac joint dysfunction; it also stretches
be used to treat sacroiliac joint dysfunction and the muscles of your lower back, and can help with
lumbar hypermobility. three-curve scoliosis. Perform this exercise only
on the affected side.
Bend your knees
at a right angle Relax your Align your
abdomen legs and hips
and trunk

Lie on your back and bend your knees. Relax your
shoulders and upper back, brace your abdomen,
and keep your spine in a neutral position.

Lie on your back with your feet hip-width apart and
your arms by your sides, palms down.

Push with your
right hand and resist

with your left knee

Keep your foot Relax your trunk Pull your leg
at a right angle up at the hip

Place your right hand on your left knee. Push your Keeping your arms by your sides, pull your unaffected
knee and flex your hip simultaneously: the force of leg up at the hip to shorten it.
the push and flexion of the hip should be equal, so no
movement will occur. Hold for 10 seconds. Elongate your leg You should feel
by stretching your the stretch here
Keep your
core engaged lumbar region

Maintaining the resistance between your left knee Now elongate the leg on your affected side by
and right hand, raise your right foot off the mat. stretching the side of your lower back and your
Hold for 5 seconds, then relax and return to the start hip joint. Hold the position for 5 seconds, then relax.
position. Perform the move 5 times, then change legs. Repeat for 3 sets of 5 reps, only on this affected side.

114 M A I N T E N A N C E A N D R E H A B I L I T A T I O N E X E R C I S E S

95 PRONE KNEE BEND 96 SIDE GLIDE

This exercise is used to mobilize your femoral nerve This exercise was developed by physiotherapist Robin
and stretch tight muscles at the front of your hip and McKenzie to help acute lower-back pain due to disc
thigh. It can be useful for increasing the range of problems that have shifted the pelvis to one side. Look in
motion in damaged knee joints, and helps to a mirror: if your right hip is more prominent, this exercise
prevent lower-back pain. should help you pull your pelvis to the left and your trunk
to the right. If your left hip is more prominent, do the
Relax your legs Rest your head exercise the other way round.
and feet on your hands
Stand with your feet shoulder-width
Lie face down on a mat. Bend your arms in front apart, knees straight, and arms
of you and rest your forehead on your hands. hanging loosely beside you.
Relax your trunk and legs.
Relax
Use your resting Keep your Keep your your arms
foot for stability pelvis on head still
the mat Feel the
stretch here
Keeping your left leg flat on the mat, bend your
right leg up as far as you can in a slow, relaxed Slowly bring your hips across to
motion. Ensure that you keep your hips still as you the left and move your shoulders
perform the movement. to the right, keeping them horizontal.
This may cause twinges and the muscles
Keep your Keep your pelvis will tighten up in resistance. Stop if the
knees in line pressed into the mat pain increases in your back or legs.

Relax and return to the start
position. Repeat the sequence
until you return to a neutral position
with no lateral shift. Repeat 10 times
every 2 hours. Once your tilt is
corrected you can start prone ( p.109)

» »or standing back extensions ( p.110).

Lower your right leg down and bend your left leg up Keep your legs
simultaneously. Continue alternating legs, repeating straight and
10 times for each leg, slowly and under control, then
return to the start position. shoulder-width
apart

115B A C K A N D B U T T O C K S

97 STATIONARY LUNGE you will feel the front of your thigh working first, the
lunge is also strengthening your buttocks and the backs
Lunges are fantastic for the muscles of your buttocks and of your thighs, and helping to improve your hip mobility.
thighs, and can help to prevent lower-back problems, as
these muscles all provide support to your back. Although

Keep your back Look straight
straight and lower ahead

your body

Place your Engage Rest one hand
hand on your core on the back
your hips of the chair
Stretch your
hamstrings

Place your feet
close together

Stand with your feet slightly apart, Holding onto the chair, bring your Inhale and lower your right knee,
your right hand on your hip, and left leg back, heel lifted, keeping with your left knee over your ankle.
your left hand resting on a chair back. your legs parallel. Keep your hips facing Exhale as you straighten your legs.
Align your shoulders, hips, and feet. forwards and your weight centred evenly. Repeat as required, then switch sides.

98 FORWARD LUNGE of the exercise. This version of the lunge requires more
balance as you do not have a chair to hold onto.
»Once you are comfortable with the stationary lunge

( above), you can progress to this unsupported version

Stand with Step forwards Look straight Pause, then
your feet hip- with your right ahead spring back to
width apart and leg and come up the start position.
your hands on your on the toes of your Complete the
hips. Keep your left foot. Bend both required number
shoulders, hips, knees so that your of reps, then
and feet in line. right knee is bent switch legs.
above your ankle
and your left knee
is close to the floor.

Keep your feet Lunge forwards Bring your feet
directly below your together again

shoulders

116 M A I N T E N A N C E A N D R E H A B I L I T A T I O N E X E R C I S E S

99 REVERSE LUNGE WITH KNEE LIFT most of the exercise, while moving your other leg through
a full range of movement. To make the exercise more
This exercise works the muscles in your thighs, buttocks,
and shoulders, while also increasing your core stability. It »difficult, try starting the movement from the raised
helps with your flexibility and balance too, as the exercise
requires you to centre your body weight on one leg for knee position ( Step 6) without pausing in the middle.

Look straight Keep your
ahead head up
and level

Place your Engage Keep your
hands on your core torso upright
your hips
Align your Drop your leg
Start with hips with your until it almost
your feet shoulders touches the floor
hip-width and ankles

apart

Stand with your feet hip-width Breathe in and lunge backwards Continue the movement until you
apart, your legs and back straight, with your left leg, taking your are in a full lunge position with your
and your hands on your hips. weight on your right leg as you do so, left knee almost touching the floor,
and bending your right knee slightly. or as far as you can comfortably go.

Keep your Keep your Keep your Bring your knee
shoulders back straight shoulders up until it makes
a right angle
in line relaxed

Keep your
abs tight

Raise your
knee

Push down on Push down
your right foot through your
as you stand supporting leg

Start raising yourself up by Straighten your right leg fully and Push forwards and up with your left
straightening your right leg and continue the forward movement knee until it is at hip height and bent
pushing down on your right foot. Bring with your left leg, pushing through at a right angle. Pause and return to the
your left leg forwards at the same time. your left knee. start position. Repeat for the required
number of reps, then switch legs.

117B A C K A N D B U T T O C K S

100 HIP FLEXOR STRETCH 101 PSOAS LUNGE

Your psoas muscles work as hip flexors and can shorten This exercise is an adaptation of a standard lunge
with prolonged sitting, creating a muscle imbalance. that focuses the stretch on your psoas muscle.
Stretching them reduces strain on your lower back. The key to performing it is to keep your pelvis
tucked underneath your torso.
Let both legs hang off
the edge of the table

Feel the stretch here

Extend your
knee only as far
as your toes

Lunge your right leg forwards, and place your hands

Start by sitting on the edge of a firm padded table, with on either side of your right foot. Straighten your back
your legs hanging over the side. Then lie back and rest
your head on a pillow or folded towel. leg, and press your left hip

Bring your towards the floor. Look straight
right leg ahead

towards you Lean back Lift your chest
Keep your left slightly

leg hanging Engage
over the table your core

Engage Feel the
your core stretch here

Raise your right leg and bend it at the knee. Grip your Tuck your hips underneath you and place both hands
thigh and bring your knee close to your chest. on your right thigh. Exhale, lift your chest, and look
straight ahead of you.

Look back

Point Hold your knee Feel the
your toes in position stretch here

Raise your left leg to the horizontal and hold briefly, Slowly reach your right arm behind you and twist
then relax it, allowing it to drop to achieve a full stretch. your torso around, while reaching your left arm out in
Hold for 15 seconds, then return to the start position and front of you, so that both arms are extended. Look back
switch legs. in the direction of the twist and hold briefly, then return
to the start position. Repeat as required, and switch legs.

118 M A I N T E N A N C E A N D R E H A B I L I T A T I O N E X E R C I S E S

102 KNEELING HIP FLEXOR 103 PRONE ARM AND LEG LIFT

This exercise will stretch your hip flexor muscles, which This exercise strengthens the muscles around your
may be particularly tight if you spend a lot of time sitting shoulders and along your spine, along with your buttocks
down. Tight hip flexors can cause imbalances around and hamstrings. It is especially useful for people who can’t
your pelvis and lower back, leading to back pain. If you
find your knees hurt during the movement, you can rest »kneel properly or have wrist problems and can’t perform
them on a cushion or soft pad.
the kneeling superman exercise ( p.99).
Keep your
neck straight Keep your Place your palms
feet together flat on the floor

Brace Lie face down with your forehead resting on the mat.
yourself with Align your neck and head. Extend your arms in front
of you with your palms facing down. Lengthen your torso
your foot by stretching your neck away from your body, and contract
your abdominals.

Kneel on your right knee, with your hands resting
on your left knee for balance, so that your right knee
is below your shoulders and your head is in line with
your back. Keep your back straight.

Keep your Keeping your head in line with your upper back, raise
head upright your left arm and your right leg 8–15cm (3–6in) off
the floor. Hold the movement briefly.

Push your Return your
pelvis forwards feet to the
start position

Bring your left knee forward and feel the stretch Lower your limbs slowly and with control, and return
in the thigh of your right leg, but don’t extend your to the start position. Switch sides and continue to
left knee over the front of your left foot. Hold the stretch alternate sides until you have completed the required
for 15 seconds, relax, and switch sides. number of reps.

119B A C K A N D B U T T O C K S

104 OBLIQUE CRUNCH 105 SIDE CRUNCH

This exercise requires flexibility, stamina, and mobility. Side crunches target the oblique muscles responsible
It can potentially aggravate some types of back pain, for core strength and trunk stability. They can potentially
so seek guidance to ensure that it is right for you aggravate some types of back pain, so consult your
and that you are performing it with good technique. physiotherapist for guidance first.

Engage Engage Keep your
your core your core foot flat on
the floor

Keep your
calves parallel

to the floor

Lie on your back with your pelvis in a neutral position, Lie on your back with your pelvis in a neutral position,
your knees and hips bent at 90 degrees, and your your left leg bent to 90 degrees, and your left foot
arms outstretched at right angles to your body. firmly on the floor. Rest your right leg across your left
knee, and place both hands at the base of your head.
Support your head
with your hands Keep your
elbows aligned

Use your hands to
support your head

With your hands held lightly to the sides of your Keeping your lower back pressed into the mat, lift your
head, simultaneously bring your left knee and right shoulder blades off the floor. Leading with your left
elbow together, planting your right foot firmly on the floor. elbow, curl your upper body towards your right knee.

Lift your right Cradle your
leg towards head in

your left elbow your hands,
but avoid
pulling

Alternate the movement at a steady pace, ensuring Pause briefly, then return to the start position slowly
that you curl up and rotate your trunk, and avoid and with control. Repeat until you have completed
pulling your head or neck. Complete the required the required number of reps, then switch sides.
number of reps before returning to the start position.

120 M A I N T E N A N C E A N D R E H A B I L I T A T I O N E X E R C I S E S

106 CHILD’S POSE 107 SWISS BALL ROLL-OUT

This yoga position gently stretches your spine, hips, This advanced exercise builds stability and strength in your
core muscles, as it makes your abdominals and lower
thighs, and ankles. If you find the exercise uncomfortable, back work together. It also strengthens your shoulders.

you can place a rolled-up towel between the back of your Straighten
your back and
thighs and calves. Relax your engage your core
shoulders
Position your
hips over your knees

Keep your
feet hip-

width apart

Place your
hands under
your shoulders

Kneel on all fours with your hands in line with Kneel down, resting your hands and lower arms on
your shoulders, your fingers pointing forwards, the top of the ball. Ensure that your back is flat.
and your knees directly below your hips. Keep your
back straight and your head in line with it. Keep your Extend your
pelvis neutral arms forwards
Feel the stretch in your hips and
thighs, and the middle of your back

Extend your
arms out in
front of you

Keeping your hands in position, slowly lower yourself Roll the ball forwards by extending your arms, and
down onto your heels until your forehead touches the follow it with your upper body as far as you can
mat. Breathe in and out, and feel the stretch in your body. without arching your back. Use your abdominals to
pull the ball back to the start position.

VARIATION VARIATION

This exercise can also be performed with a slight variation to stretch Using a barbell instead of a stability ball is a high-level variation of
the side muscles of your back. Instead of stretching your arms out this exercise, but should only be attempted once you have very good
directly in front of you, stretch them out diagonally, keeping them abdominal and spinal control. Kneel with your hands on the bar,
parallel as you do so. Hold the position for a few seconds, then shoulder-width apart. Keep your back flat as you roll the bar forward
and use your abdominals to pull it back to the starting position.
repeat on the other side to fully benefit
from the stretch.

121B A C K A N D B U T T O C K S

108 SIT-TO-STAND CHAIR SQUAT good confidence-builder, as the chair or box provides a base
and you do not have to squat too low.
Practising squats helps you develop the habit of using your
hips and leg muscles instead of your back. This version is a Keep your
head level

Look forward

Position your Engage Lower
knees over your core yourself
your ankles using your
Use your leg and
leg muscles buttock
to push muscles
yourself up

Sit on the edge of a sturdy box Lean forwards from the hips, Straighten your knees – without
or chair with your knees bent keeping your back straight. locking them – until you are in
at a right angle over your ankles and Breathing out, press down through a standing position. Pause briefly,
your feet hip-width apart. Place your your feet to stand up, and squeeze your then return to the start position
hands on your waist. Breathe in. buttocks together as you begin to stand. slowly and with control.

109 STAND-TO-SIT CHAIR SQUAT

»This exercise is almost the reverse of the sit-to-stand differs slightly, in that your arms are outstretched in front
of you, giving you a little more balance.
version of the chair squat ( above). The arm movement

Look straight Keep
ahead your arms
extended
Stand with Touch the box
your back with your

straight buttocks but
do not sit
Engage
Don’t lock your core Keep your
your knees knees over
Use your leg your feet
muscles

Stand in front of a sturdy box or Pressing down through your heels, Continue to bend at the knees
chair with your feet hip-width apart, breathe in and bend at the knees, until your buttocks touch the
gently pressing your body weight down reaching back with your buttocks and edge of the box, but do not sit down.
through your heels. Raise your arms in lowering yourself towards the box. Keep Breathe out as you squeeze your
front of you and look straight ahead. your shoulders over your ankles. buttocks and return to the start position.

122 G L O S S A R Y

GLOSSARY

Abductor A muscle that functions to pull Cool-down A period after completion Form The correct posture or stance used
a limb away from your body. See Adductor. of a training session designed to help return when performing exercises.
your body to its pre-exercise state.
Active range of motion During Fracture A break in a bone, ranging from
rehabilitation, the movements you are able Core The central part of your body, mainly minor cracks to serious breaks.
to make yourself using muscle strength, as the stomach and lower-back muscles, but also
opposed to your passive range of motion. including the pelvis, chest, and upper back. Free weight A weight – usually a barbell or
dumbbell – not tethered to a cable or machine.
Acute (pain) Pain that comes on suddenly Core stabilizers Deep trunk, abdomen,
but lasts only a short while and can be paraspinal, and pelvic floor muscles. Gluteus medius dysfunction Strain in the
treated successfully. See Chronic. These muscles provide support to your buttock muscles that hold the pelvis stable.
lower back.
Adductor A muscle that functions to pull Head (of a muscle) The point of origin
a limb towards your body. See Abductor. Corticosteroids Hormones administered of a muscle.
by injection, cream, or tablets, for example
Aerobic A process that requires oxygen. to reduce inflammation. Herniated disc When a portion of a spinal
Aerobic metabolism occurs during long- disc ruptures and bulges outside its normal
duration, low-intensity exercises, such CT (Computerized Tomography) scan position, and may press on the nerve roots
as long-distance running and swimming. A type of scan that builds a three-dimensional of the spine.
It is the opposite of anaerobic. picture of the body.
Hypermobile joint A joint that is loosely
Analgesic A drug used to reduce pain. Diaphragm The muscle that separates held together because the ligaments are
your chest cavity from your abdomen. either naturally lax or have been overstrained
Anaerobic A process that does not require (which can lead to instability).
oxygen. Anaerobic metabolism occurs during Disc A cushion-like pad that sits between
short-duration, high-intensity exercises, each vertebra and acts as a shock absorber. Hypomobile joint A joint that moves
such as in some forms of intensive strength Discs allow your spine to bend. less than it should, sometimes caused
training. It is the opposite of aerobic. by shortening of the muscles attached
Discogenic pain Pain caused by deterioration to the joint.
Ankylosing spondylitis (AS) A form of of discs.
spinal arthritis that leads to inflammation Inflammation Swelling, pain, and redness
and calcification of the ligaments in the Discography A procedure that uses dye of an area of the body as a response to a
sacroiliac and invertebral joints. and X-rays to look at your spine and confirm harmful stimulus.
if the disc(s) is/are the source of pain.
Antagonistic muscles Muscles that are Instability Slackening of the ligaments
arranged in pairs to carry out flexion and Disc prolapse/protrusion See herniated disc. caused by narrowing and tears in a disc.
extension of a joint. See flexor and extensor.
Dumbbell A type of free weight made up of Isometric A form of training in which
Anterior The front part or surface, as a short bar with a weight at each end. It can you contract your muscles without
opposed to posterior. be lifted with one hand. moving your body or any limbs.

Barbell A free weight made up of a bar Dynamic exercise Any activity in which Isotonic A form of training in which your
with weights at both ends, long enough to your joints and muscles are moving. muscles work against a constant resistance.
hold with at least a shoulder-width grip.
Erector A muscle that raises a body part. ITB (Iliotibial Band) A tough group of
Bone density The amount of bone fibres running along the outside of your
mineral in a given volume of bone. Ergonomics The design of devices that thigh that primarily works as a stabilizer of
work with the body to help prevent repetitive the hip in standing, walking, and running.
Brachialgia Nerve pain in the arm. strain injuries.
Lactic acid A waste product of
Cervical Relating to the neck area. Extensor A muscle that works to increase anaerobic respiration. It accumulates in
the angle at a joint, such as straightening your muscles during intense exercise and
Chronic (pain) Pain that persists for your elbow. It usually works in tandem is involved in the chemical processes that
a long time and is often resistant to with a flexor. cause muscular cramp.
treatment. See Acute.
Facet joint A small joint that connects each Lateral Positioned towards the outside of
Coccydynia Pain around the coccyx. vertebra with the vertebra directly above and your body. Movement in the lateral plane
below it, providing stability to the spine. refers to a side-to-side movement.
Coccyx Bone at the base of the spine.
Facet joint strain Pain that occurs when Ligament A tough and fibrous connective
Cognitive Behavioural Therapy (CBT) a facet joint is suddenly twisted or jerked. tissue that connects your bones together
A psychological approach that is used to at the joints.
explore and modify how your thoughts Flexor A muscle that works to decrease the
influence your perception of pain and angle at a joint, such as bending your elbow. Lumbar Relating to the lower-back area.
your situation. It usually works in tandem with an extensor.

123G L O S S A R Y

Metabolism The sum of all your body’s Proprioception The term used to Spinal stenosis Narrowing of the spinal canal
chemical processes (anabolism and catabolism). describe the information originating due to bony spurs developing on the vertebrae
from joints, tendons, ligaments, and which protrude into the spinal canal.
Mineral Inorganic elements that are essential muscles that is sent to the brain to provide
for normal body function and must be information about joint position, direction, Spondylolysis Occurs when a defect
included in your diet. and pressure. in a vertebra develops into a fracture.
The vertebra is then at risk of slipping out
Mobility exercise An exercise that helps you Range of motion (ROM) A term used of line with the vertebrae adjacent to it,
to maximize the movement of your joints. in physiotherapy, this is the movement leading to spondylolisthesis.
a joint is capable of in every direction.
MRI (Magnetic Resonance Imaging) A type Sprain An injury sustained by a ligament
of scan that reads the molecular structure of Regimen A regulated course of exercise that is overstretched or torn.
your body to form an image to aid diagnosis. and diet designed to produce a pre-
determined result. Stabilizers Small muscles close to the spine
Muscular tension Tensing your muscles, a which hold the vertebrae or spinal region in
normal response to stress; a major cause of Rehabilitation The process of recovering alignment for static posture or while dynamic
back pain. fully from an injury, often with the assistance movements are being performed.
of professionals.
Musculoskeletal Affecting both the muscles Static exercise An exercise in which you
and bones. Repetition (rep) One complete movement hold one position.
of a particular exercise, from start to finish
Neuropathic Relating to pain caused by and back. Strain An injury to muscle fibres caused
abnormal processing of nerve signals due by overstretching.
to damage or dysfunction. Resistance training Any type of training in
which your muscles work against resistance, Swiss ball A large, inflatable rubber ball
Neutral spine position The most provided by a weight, an elastic or rubber used to promote stability during exercise.
efficient posture in standing or sitting, or band, or your own body weight. Also known as an exercise ball.
the mid-range position of a joint or region
of the spine. Rest interval The pause between sets of Tear A rip in, for example, a muscle.
an exercise that allows muscle recovery.
Osteoarthritis A degenerative disease in Tendinopathy Painful tendons, often
which the body suffers a loss of cartilage, Rupture A major tear in a muscle, tendon, resulting from overuse while doing
leading to stiff joints. or ligament. repetitive actions.

Osteoporosis Weakening of the bones Sacroiliac joints The two joints located Tendon A type of connective tissue that
caused by loss of minerals, especially common at the base of the back on either side of joins your muscles to your bones.
in women after menopause. your spine between the sacrum and the ilia
(hip bones). Thoracic Relating to the chest and back
Pain-relief medication Different between the neck and lumbar regions.
medications have different functions, such Sacroiliac strain Damage to the ligaments
as reducing pain by reducing inflammation, supporting the sacroiliac joint, usually caused Torticollis An acute stiff and painful neck
but all produce the result of limiting your by a heavy fall or a blow to the bottom of which makes turning your head sideways
experience of pain in the body. the back. difficult and painful. It is often triggered
by lying or falling asleep in an awkward
Passive range of motion The movements Sciatica Nerve pain in the leg. position. Also known as “wry neck”.
a physiotherapist or helper is able to make
with parts of your body while supporting Scoliosis Curvature of the spine that causes Traction A technique used to straighten
their weight. See Range of motion. it to twist to one side. or realign bone fractures into a permanent
position, or to relieve pressure on the spine
Pelvic floor The area of muscle located in Sensorimotor Relating to processes and skeletal system.
the lower part of the abdomen and attached involving the communication between brain
to the pelvis. and muscles via the nerves. Warm-up A series of low-intensity exercises
that prepares your body for a workout by
Piriformis syndrome Irritation of the sciatic Set A specific number of repetitions. moderately stimulating your heart, lungs,
nerve by tightening of the piriformis muscles and muscles.
that rotate the hip. Skeletal muscle Also called striated muscle,
this type of muscle is attached to your skeleton Whiplash An injury in the neck area
Plyometrics Exercises that aim to improve and is under voluntary control. Contracting following an acceleration-deceleration force,
the speed and power of movements by your skeletal muscles allows you to move your usually as the result of an indirect impact.
training muscles to contract more quickly body under control.
and powerfully. Wobble board Circular in shape with a flat
Smooth muscle A type of muscle found top and hemispherical underside, this piece
Posterior The back part or surface, as in the walls of all the hollow organs of your of equipment is used to promote good
opposed to anterior. body which is not under voluntary control. balance, and to improve your core stability.

124 I N D E X

INDEX

A bone scans 27 lying waist twist 43 ergonomics, sedentary
bowel disorder, lower back and oblique crunch 119 occupations 46–47, 122
abdominal muscles 14 plank from knees 96
curl-up 94 leg pain as symptom 25 prone back extension 109 exercise and sport 40–41
four-point supine knee lift 112 brachialgia 122 prone plank 96 cool-down exercises 41
isometric hip flexion 113 brain haemorrhage, neck reverse lunge with knee lift 116 gear choice 40
plank from knees 96 seated pelvic tilt (Swiss ball) injury avoidance 40–41
Swiss ball roll-out 120 pain as symptom 20 injury, exercising after 41
Swiss ball twist 95 bridge 103 109 warm-up exercises see
broken rib, mid-back pain 22 side crunch 119 warm-up exercises
abdominal pain 26 bronchitis, back and neck side plank 97
abscess, mid-back pain 22 single arm and leg raise 90 extension
acupuncture 32 pain as symptom 22 single-leg bridge 103 McKenzie extension 43,
adductor muscle 122 burning sensation, possible squat 87 100
supine pelvic tilt 108 neck extension and flexion
isometric adductor causes of 25 Swiss ball back extension 111 69
squeeze 102 buttocks Swiss ball roll-out 120 neck extension with
Swiss ball side crunch 98 overpressure 77
lift 102 bridge 103 Swiss ball side crunch with prone back extension 109
stretch 105 clam 89 seated back extension
aerobic exercise 122 forward lunge 115 twist 98 43, 78
Alexander Technique 33, 39 gluteal/piriformis foam Swiss ball twist 95 standing back extension
alligator 92 corner chest stretch 43, 84 43, 110
analgesics 27, 122 roller 93 corticosteroids 122 Swiss ball back extension
ankles prone arm and leg lift 118 coughing 21, 22 111
child’s pose 43, 120 reverse leg raise 101 crunch towel neck extension 82
see also feet reverse lunge with knee oblique crunch 119 upper back 78
ankylosing spondylitis 122 side crunch 119 see also flexion
lower back and leg pain 25 lift 116 Swiss ball side crunch 98
arms side-lying leg raise 101 CT scans 27, 122 F
doorway chest stretch 76 single-leg bridge 103 curl-up 94
hand and forearm pain, single-leg stand 107 curvature of the spine see facet joints 122
stationary lunge 115 scoliosis back rotation 111
seated shoulder squeeze 75 see also hips; pelvic stability compressed, lower back and
prone arm and leg lift 118 D leg pain 25
single arm and leg raise 90 and strength degeneration, lower back
see also shoulders dead bug 90 and leg pain 25
aromatherapy 33 C depression, lower back and leg hip-hitcher 88
arthritis, lower back and leg knees-to-chest stretch
calf raise and stretch 106 pain as symptom 25 43, 110
pain as symptom 25 see also legs diet 44–45 passive neck retraction
autogenic training 33 discs 11, 16, 122 43, 80
cardio work, low-impact 41 single-leg elongation 113
B cat and camel 43, 95 cat and camel 43, 95 sleeping position 58
cat stretch 73 discography 27, 122 strain, lower back and leg pain
back extension central canal stenosis, lower herniated, McKenzie extension 24, 122
prone 109 strain, neck pain 20, 122
seated 43, 78 back and leg pain 24 43, 100 supine pelvic tilt 108
standing 43, 110 cervical spine see neck problems, standing back vertebrae 10–11
Swiss ball 111 chair, getting in and out of
upper-back 78 extension 43, 110 feet
see also extension 64–65 protrusion, lower back and fallen arches 37
chest pronation 37
back rotation 111 leg pain 24, 122 reflexology 33
supine 81 corner chest stretch 43, 84 protrusion, neck pain 20, wall-supported foot lift 107
see also rotation doorway chest stretch 76 see also ankles; walking
knees-to-chest stretch 43, 110 21, 122
balance lying trunk rotation 72 tear, lower back and leg pain flexion
forward lunge 115 childbirth see pregnancy isometric hip flexion 113
reverse lunge with knee child’s pose 43, 120 24 neck extension and flexion
lift 116 chiropractor consultation 31 doctor consultation see medical 69
sensorimotor training 30 circulatory problems, lower back neck flexion 77
single-leg stand 107 and leg pain as symptom 24 consultation neck side flexion 68
Swiss ball side crunch 98 clam 89 doorway chest stretch 76 supine neck flexion 77
Swiss ball twist 95 coccyx 9, 12, 122 double-jointed see hypermobility towel neck flexion 82
walking lunge 87 complementary (alternative) dressing and washing 62–63 see also extension
see also posture treatments 32–33 driving 56–57
computer use 46–47 drug treatment 27, 122 flossing (neural glide) 70
barbell 123 headaches 49 foam roller 93
roll-out 120 cool-down exercises 41, 122 E forward lunge 115
see also warm-up exercises
bed, getting in and out of 61 core stability and strength 122 electromyography 27
blood tests 27 bridge 103 energy levels, Basic Energy
BMI (body mass index) 45 clam 89
four-point supine knee lift 112 Requirement (BER) 45
kneeling superman 99
leg raise 100

I N D E X 125

four-point supine knee lift shopping 51 prone arm and leg lift 118 stationary 115
112 see also gardening; lifting reverse leg raise 101 walking 87
side-lying leg raise 101 lying down see sleeping and
Fowler position, sleeping and and carrying single arm and leg raise 90 lying down
lying down 58 hydrotherapy 30 single-leg elongation 113 lying trunk rotation 72
hypermobility 122 single-leg stand 107 lying waist twist 43, 92
functional training 30 see also hamstrings; knees;
isometric hip flexion 113 M
G lower back and leg pain 25 thighs
prone breaststroke 74 levator scapulae stretch 76 McKenzie
gardening 54–55 hypnotherapy 33 lifting and carrying 50–51 extension 43, 100
moving around 64–65 method 28–29
see also housework; lifting I long loads 51 night roll 58
and carrying shopping 51 side glide 114
injury weight assessment 50, 51
gluteus muscles 14, 122 avoidance 40–41 weight distribution 51 see also physiotherapy
dysfunction, lower back and exercising after 41 see also gardening; housework manual isometrics 71
leg pain 24 ligaments 122 massage 32
gluteal/piriformis foam intercostal muscles 14 strain, lower back and leg
roller 93 intertransverse muscles 14 osteopathic 31
isometric exercises pain 25 self-massage, sacral circle
groin pain 23, 24 lower back
see also hips adductor squeeze 102 91
hip flexion 113 adductor stretch 105 medical consultation
H manual 71 alligator 92
ITB (iliotibial band) 122 calf raise 106 diagnosis and treatment
hamstrings foam roller 93 cat and camel 43, 95 26–27
bridge 103 cat stretch 73
prone arm and leg lift 118 J child’s pose 43, 120 see also physiotherapy
stretch 104 dead bug 90 meditation 33
see also legs joint mobilization see facet forward lunge 115 meningitis, neck pain as
joints; hips; sacroiliac joints four-point supine knee lift
hand and forearm pain symptom 20
seated shoulder squeeze 75 K 112 mid-back pain, symptoms and
see also arms hamstring stretch 104
kidney infection and stones, isometric adductor squeeze causes 22–23
headaches back pain as symptom 23 mobility
phone and laptop use 49 102
roll-down stretch 43, 84 knees kneeling hip flexor 120 aids 65
sedentary occupations 38, 46 four-point supine knee lift kneeling superman 99 and moving around 64–65
supine neck flexion 77 112 knees-to-chest stretch Moiré fringe analysis 27
kneeling hip flexor 120 MRI scans 27, 123
healthy eating 44–45 kneeling pelvic tilt 108 43, 110 muscles 14–15
herniated disc 122 kneeling superman 99 lat foam roller 93 massage and muscular
knees-to-chest stretch leg raise 100
McKenzie extension 43, 100 43, 110 lying waist twist 43, 92 tension 32
see also discs plank from 96 McKenzie extension 43, meditation and muscular
hips prone knee bend 114
adductor lift 102 reverse lunge with knee 100 tension 33
adductor stretch 105 lift 116 press-up, seated 88 muscle-energy technique
child’s pose 43, 120 see also legs prone back extension 109
clam 89 prone knee bend 114 29, 30
groin pain 23, 24 L prone plank 96 muscular tension, neck pain
hip flexor stretch 117 reverse leg raise 101
hip-hitcher 88 Lancelot stretch 105 seated hip tilt 86 21
isometric hip flexion 113 laptop use seated hip walk 86 nerve stimulation 13
joint problem, lower back seated twist stretch 43, 85 proprioceptive neuromuscular
headaches 49 side glide (McKenzie) 114
and leg pain 25 see also computer use single-leg elongation 113 facilitation 30
kneeling hip flexor 120 lat squat 87 Schroth method and muscle
Lancelot stretch 105 band row 79 standing back extension
leg raise 100 foam roller 93 control 29
piriformis stretch 106 muscles 14 43, 110 spasm 15, 28, 30
prone knee bend 114 stretch 104 stationary lunge 115 myofascial trigger-point therapy
psoas lunge 117 legs supine back rotation 81 29
seated hip tilt 86 calf raise 106 Swiss ball back stretch 78 see also physiotherapy
seated hip walk 86 calf stretch 106 Swiss ball roll-out 120
side glide (McKenzie) 114 leg length difference, Moiré walking lunge 87 N
single-leg bridge 103 see also mid-back pain;
sit-to-stand chair squat 121 fringe analysis 27 neck
squat 87 leg raise 100 upper back cervical spine, movement
stand-to-sit chair squat 121 one-leg circle 91 lower back and leg pain of 17
walking lunge 87 pain 24–25 cervical vertebrae 8–9, 12
see also buttocks; pelvic acupuncture 325 see also shoulders
symptoms and causes 24–25
stability and strength lumbar spine, movement of 17 neck exercises
housework 52–53 lunge active neck retraction 80
forward 115 head and neck alignment
moving around 64–65 psoas lunge 117 while sitting 38, 46–47
reverse lunge with knee levator scapulae stretch 76
manual isometrics 71
lift 116 neck extension and flexion
69

126 I N D E X

neck extension with seated pelvic tilt (Swiss ball) upper-back band row 79 single-leg elongation 113
overpressure 77 109 upper-back extension 78 strain, lower back and leg
see also balance
neck rotation 68 side glide (McKenzie) 114 pregnancy pain 24
neck side flexion 68 side-lying leg raise 101 kneeling pelvic tilt 108 Schroth method 29
passive neck retraction single arm and leg raise 90 prolapsed womb, back and leg sciatica 123
supine pelvic tilt 108
43, 80 see also buttocks; hips pain as symptom 25 acupuncture 32
roll-down stretch 43, 84 phone use, sedentary and stretching 42 lower back and leg pain 24
seated back extension 78 occupations 49 press-up McKenzie extension 43, 100
seated hip tilt 86 physiotherapy 28–30 seated 88 neurodynamics 30
seated hip walk 86 assessment 28–29 see also wall sit press one-leg circle 91
shoulder rotation 43, 69 hydrotherapy 30 prolapsed womb, back and leg scoliosis 123
shoulder shrug 74 McKenzie method 28–29 pain as symptom 25 lat band row 79
supine neck flexion 77 neuro-stimulation 30 prone position prone breaststroke 74
thoracic foam roller 93 sensorimotor training 30 arm and leg lift 118 single-leg elongation 113
towel neck extension 82 spinal mobilization and back extension 109 upper-back band row 79
towel neck flexion 82 breaststroke 74 seated
towel rock 81 manipulation 28 knee bend 114 back extension 43, 78
neck pain 20–21 therapeutic ultrasound 30 plank 96 hip tilt 86
phone and laptop use 49 see also medical consultation shoulder squeeze 75 hip walk 86
posture sitting at desk 38 piriformis syndrome 123 see also supine position pelvic tilt (Swiss ball) 109
sedentary occupations 47 ITB foam roller 93 proprioceptive neuromuscular posture, good and bad 38
sleeping and pillow support lower back and leg pain 24 facilitation 30 press-up 88
piriformis stretch 106 psoas muscles shoulder squeeze 75
59 plank hip flexor stretch 117 twist stretch 43, 85
torticollis (twisted neck) from knees 96 Lancelot stretch 105 waist stretch 85
prone 96 lunge 117 wall sit press 89
20, 123 side plank 97 sedentary occupations 46–49
neural glide (flossing) 70 pleurisy, back and neck pain as Q desk top computers 46–47
neuro-stimulation 30 symptom 21, 22 ergonomics 46–47, 122
neurodynamics 30 pneumonia, back and neck pain quad stretch 104 head and neck alignment
as symptom 21, 22
O posture R 38, 46–47
active neck retraction 80 headaches 38, 46
oblique muscles Alexander Technique 33, 39 reflexology 33 hip flexor stretch 117
lying waist twist 43 calf stretch 106 relaxation techniques 33 kneeling hip flexor 120
oblique crunch 119 corner chest stretch 43, 84 repetitive strain injury (RSI), laptops 48–49
side crunch 119 correcting bad 36–37 levator scapulae stretch 76
and exercise 40 seated shoulder squeeze 75 McKenzie extension 43, 100
osteoarthritis 123 fallen arches 37 reverse leg raise 101 phone use 49
acupuncture 32 feet pronation 37 reverse lunge with knee lift posture 46–47
lower back and leg pain as head and neck alignment press-up, seated 88
symptom 25 116 prone shoulder squeeze 75
neck pain as symptom 21 while sitting 38 rib injury, back pain as seated back extension
improvement 36–37
osteopath consultation 31 kneeling pelvic tilt 108 symptom 22 43, 78
overpronation, wall-supported lat band row 79 roll-down stretch 43, 84 upper-back extension 78
leg length difference 27 roll-out, Swiss ball 120 self-massage, sacral circle 91
foot lift 107 lower back and leg pain 25 rotation self-traction, press-up, seated
Moiré fringe analysis 27
P neck side flexion 68 back rotation 111 88
orthotics 37 lying trunk rotation 72 sensorimotor training 30
pain pelvic angle, correct 36 neck rotation 68 sex and back pain 59
acupuncture 32 plank from knees 96 seated twist stretch 43, 85 shopping 51
description 26, 122 pressurre on spine 39 shoulders 43, 69 shoulders
hypnotherapy 33 relaxed seated 38 supine back rotation 81
neuro-stimulation 30 rigid 37 Swiss ball twist 95 cat stretch 73
relief and analgesics 27, 122 roll-down stretch 43, 84 trunk 71 corner chest stretch 43, 84
seated back extension 78 dead bug 90
pancreatitis, back pain as seated hip tilt 86 S doorway chest stretch 76
symptom 23 seated hip walk 86 and driving 56
seated pelvic tilt (Swiss ball) sacroiliac joints 123 kneeling superman 99
passive neck retraction 43, 80 adductor lift 102 lat band row 79
pec stretch 70 109 bridge 103 levator scapulae stretch 76
pelvic infection, lower back and sedentary occupations 46–47 hip-hitcher 88 oval shoulder stretch 83
sensorimotor training 30 inflammation, lower back pec stretch 70
leg pain as symptom 25 sitting at desk 38 and leg pain 24, 25 phone use 49
pelvic stability and strength sitting at desk, neck pain 38 isometric adductor squeeze prone arm and leg lift 118
sitting, good and bad 38, 39 102 prone shoulder squeeze 75
clam 89 standing, good and bad isometric hip flexion 113 reverse lunge with knee lift
curl-up 94 sacral circle 91
dead bug 90 36, 39 116
kneeling hip flexor 120 supine pelvic tilt 108 rotation 43, 69
kneeling pelvic tilt 108 sway back 37 scapula 8
leg raise 100 seated shoulder squeeze 75
pelvic angle, correct 36 shoulder rotation 43, 69
pelvic floor muscles 123
reverse leg raise 101

I N D E X 127

shoulder shrug 74 single-leg stand 107 forward lunge 115 prone breaststroke 74
shrug 74 stationary lunge 115 ITB foam roller 93 prone shoulder squeeze
Swiss ball roll-out 120 stomach problems, back pain as prone knee bend 114
upper back stretch 70 quad stretch 104 75
upper-back band row 79 symptom 23 reverse lunge with knee lift roll-down stretch 43, 84
upper-back extension 78 strength seated back extension 43
wall sit press 89 116 seated hip tilt 86
see also arms; neck and core stability see core stationary lunge 115 seated hip walk 86
side crunch 119 stability and strength walking lunge 87 seated shoulder squeeze
Swiss ball 98 see also legs
side glide (McKenzie) 114 and pelvic stability see pelvic thoracic spine 75
side plank 97 stability and strength foam roller 93 seated twist stretch 43, 85
side-lying leg raise 101 lying trunk rotation 72 seated waist stretch 85
single arm and leg raise 90 and spinal mobility see spinal movement of 17 shoulder rotation 43, 69
single-leg mobility and strength vertebrae 8–9, 10, 12 stretch 70
bridge 103 wall sit press 89 supine back rotation 81
elongation 113 stress-related mid-back pain torticollis (twisted neck) Swiss ball back stretch 78
stand 107 23 20, 123 thoracic foam roller 93
sit-to-stand chair squat 121 towel trunk rotation 71
sleeping and lying down 58–61 stretches neck extension and flexion upper-back band row 79
Fowler position 58 adductor muscle 105 upper-back extension 78
getting in and out of bed 61 benefits of 42–43 82 wall sit press 89
insomnia 60 calf stretch 106 rock 81 see also lower back;
McKenzie night roll 58 cat stretch 73 traction, self-traction, press-up,
mattress choice 58 corner chest stretch 43, 84 seated 88 mid-back pain
neck side flexion exercise 68 doorway chest stretch 76 trapezius muscles 14
pillow support 59 dynamic 41 shoulder rotation 43 V
positions 58–59 hamstrings 104 trigger-point therapy, myofacial
sex and back pain 59 hip flexor stretch 117 29 vertebrae, anatomy of
turning in bed 60 knees-to-chest stretch trunk 8–12
slipped disc, McKenzie 43, 110 dead bug 90
extension 43, 100 Lancelot stretch 105 lying trunk rotation 72 W
soft-tissue mobilization 29 lat 104 rotation 71
see also physiotherapy levator scapulae stretch side crunch 119 waist
spinal mobility and strength 76 single-leg stand 107 lying waist twist 43
alligator 92 oval shoulder stretch 83 tumour, mid-back pain as stretch 85
child’s pose 43, 120 pec stretch 70 symptom 22
kneeling superman 99 piriformis stretch 106 twist walking
seated hip tilt 86 and pregnancy 42 lying waist twist 43, 92 calf raise 106
seated hip walk 86 programme 43 seated twist stretch 43, 85 calf stretch 106
tension, neural glide quad stretch 104 Swiss ball 95 lunge 87
roll-down stretch 43, 84 Swiss ball side crunch with wall-supported foot lift 107
(flossing) 70 seated twist stretch 43, 85 see also feet
spinal mobilization and seated waist stretch 85 twist 98
manipulation 28 static 41 wall sit press 89
Swiss ball back stretch 78 U see also press-up
see also physiotherapy twist stretch 43, 85
spinal stenosis 123 upper back stretch 70 ultrasound, therapeutic wall-supported foot lift
waist stretch 85 30 107
back and leg pain as
symptom 24 superman, kneeling 99 upper back warm-up exercises 40,
supine position alligator 92 41, 123
spine band row 79
anatomy of 8–9 back rotation 81 cat stretch 73 cat and camel 43, 95
cervical, movement of 17 neck flexion 77 corner chest stretch upper back stretch 70
dural sheath 12–13 pelvic tilt 108 43, 84 see also cool-down
ligaments 15, 16 see also prone position extension 78
lumbar, movement of 17 surgery 25, 27 lat band row 79 exercises
muscles see muscles sway back 37 lat foam roller 93 washing and dressing 62–63
spinal cord 12–13 see also posture lat stretch 104 whiplash 123
spinal nerves 12–13, 15 swimming 40, 122 lying trunk rotation 72
thoracic, movement of 17 Swiss ball 123 lying waist twist 43, 92 neck pain 20
vertebrae see vertebrae back extension 111 neck extension and supine neck flexion 77
workings of 16–17 back stretch 78 flexion 69 wobble board 123
curl-up 94 neck side flexion 68 curl-up 94
spondylolisthesis 123 roll-out 120 oval shoulder stretch 83 single-leg stand 107
lower back and leg pain as seated pelvic tilt 109 pain and sedentary wry neck, torticollis 20, 123
symptom 24 side crunch 98 occupations 47
twist 95 passive neck retraction X
squat 87 43, 80
chair squat 121 T pec stretch 70 X-rays 27
phone and laptop use 49
stamina, oblique crunch 119 therapeutic ultrasound press-up, seated 88 Y
standing 30
yoga 40, 42
back extension 43, 110 thighs child’s pose 43, 120
chair squat 121 chair squat 121
posture, good and bad 36, 39 child’s pose 43, 120

128 A C K N O W L E D G M E N T S

ACKNOWLEDGMENTS

AUTHORS’ AND PUBLISHER’S SAFETY INFORMATION
ACKNOWLEDGMENTS
Users of this book should not consider the
The authors would like to acknowledge the valuable contributions information, advice, and guidelines it contains
of learned colleagues of The British Institute of Musculoskeletal as a substitute for the advice of medical
Medicine and the International Spine Intervention Society for professionals, accredited physiotherapists,
their collective years of experience and study in diagnosis and and other registered practitioners.
management of spinal pain. The authors would also like to
extend their grateful thanks to their patients. Do not attempt self-diagnosis or self-treatment for
serious or long-term problems without consulting
The authors and publishers would like to thank the following a medical professional or qualified practitioner.
people and organizations for their generous help in producing Do not undertake any self-treatment while you
this book. are undergoing a prescribed course of medical
treatment without first seeking professional advice.
For modelling: Always seek medical advice if symptoms persist,
Emily Hayden; Eva Hajidemetri; John Tanner; Annie Hajidemetri; and do not exceed any recommended dosages
Gareth Jones; Scott Tindall; Mary Paternoster; Sam Bias Ferrar; of medication without professional guidance.
Anne Browne; Chris Chea; Louise Cole; Sarah Cookson;
David Doma; Amanda Grant; Michelle Grey; Anouska Hipperson; All physical activity involves some risk of injury.
Elizabeth Howells; Christopher James; Gunilla Johansson; Participants must therefore take all reasonable care
Megan Lolls; Zoe Moore; Sean Newton; Caroline Pearce; during their rehabilitation and maintenance training.
Yasmin Phillips; JamieRaggs; Lucy Shakespeare; Rufus Shosman; Any treatment or rehabilitation programme should
William Smith; Kirsty Spence; Sheri Staplehurst; and Sally Way. always be carried out under the guidance of the
appropriate professionals.
For use of facilities:
Dr Eric Ansell at 999 Medical and Diagnostic Centre. The publishers of this book and its contributors
are confident that the exercises described herein,
For equipment: when performed correctly, with gradual increases in
Paul Margolis of Margolis Office Interiors Ltd resistance and proper supervision, are safe. However,
(www.margolisfurniture.co.uk) for supplying the readers of this book must ensure that the equipment
ergonomic chair. and facilities they use are fit for purpose, and they
should adhere to safety guidelines at all times. They
For reference photography: should also ensure that supervisors have adequate
Nigel Wright, XAB Design; Gillian Andrews; Keith Davis; insurance and relevant, up-to-date accreditations
Phil Gamble; Eva Hajidemetri; Cobalt ID; Russell Sadur; and qualifications, including emergency first aid.
and Graham Atkins-Hughes.
The publishers, the members and representatives
For illustrations: of the British Medical Association (BMA), the
Philip Wilson; Debbie Maizels; Phil Gamble; consultant editors, and the contributing authors
Mark Walker; Debajyoti Dutta; Mike Garland; of this book take no responsibility for injury to
Darren R. Awuah; and Jon Rogers. persons or property consequent on embarking
upon the advice and guidelines included herein.
For additional material and assistance:
Dr. Sue Davidson; Margaret McCormack (indexer);
Scott Tindall; Derek Groves; Glen Thurgood; Len Williams;
the British Weightlifting Association (BWLA); Scarlett O’Hara,
Nicky Munro, Hugo Wilkinson, Georgina Palffy, Kingshuk Ghosal,
and Suneha Dutta (editorial); Joanne Clark, Katie Cavanagh,
Govind Mittal, and Deep Shikha Walia (design); Ben Marcus and
Balwant Singh (pre-production); Mandy Inness (production);
and Shanker Prasad (CTS).