Back extension exercises - conflicting advice

[caz]

Every physio I've seen in the past has told me to do back extension exercises for my lower back pain. But my present physio has told me not to do them because she thinks its causing me further problems. I have very little movement in my lower lumbar spine but a lot of flexibility in my thoracic spine -she says that by doing the extension exercises, I'm putting additional stress on the joint that is just above the 'fixed' ones. Apologies for the layman's terms - I'm sure there is a more accurate medical description!

My instinct is to follow the instructions of my current physio because I've always found the exercises to be painful. And the fact that I've been doing them for years but it hasn't helped would indicate its not doing me much good! But I'm just wondering why this was recommended to me in the first place?

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[sherille]

Before you undergo any exercises to your lower back I suggest that you need to have an X ray examination for this. In order for a physiotherapist to rule out that the pain causing you is only a simple back pain so can advise you to have a back pain exercises.

low back pain exercises has a two types. One specifically for pain when you bend forward and the other type is for pain when you over extend your back.

[MarklandK]

Hi Caz

Listen to your symptoms. Think about what makes you better and what makes you worse in normally daily activity is there a consistant pattern is it always one movement direction that helps and another that aggravates or is it really variable?

Now take a baseline just stand and observe you symptoms what can you feel right now? How far forward can you reach right now? How far back can you reach right now? And how far can you bend side to side? Make sure you have these baselines locked in your mind. Next try doing the repeated arching back - you may need to do a lot. observe what happens. Try thinking about when it hurts and what happens with repetition. Does it just hurt at the very end of the movement? Or does it through the movement? As you do the repetitions does the pain get better and better or worse and worse or stay the same?

Now stand up and recheck your baselines - what is your pain and movement like now? Better, worse or the same?

Clearly if your pain gets worse and worse and is worse afterwards the movement is not right for you.

If its better after (even if painful during) it is probably good for you.

Caz - there are many different philosophies in the medical world which is why at times there can be contradictions - frustrating for all. It is great you are trying to help yourself and problem solve.

[vam44]

I would suggest that if you have always done extension exercises and they no longer work then its time to change tack and try something else. Try the advice from MarklandK and let us know what happens. It may be time for you to do a comprehensive abdominal stability exercise programme instead.

[caz]

Thanks very much for your replies.

I can reach forwards and touch my toes without any problem at all, and my side flexion is reasonably good too. The movement I always have problems with is arching backwards - my thoracic spine moves but my lumbar spine just doesn't - what I tend to do is push my hips forwards and arch that way. I hadn't realised I was doing this until my physio held my hips still and I found I just COULDN'T arch backwards!

So it does look like I need to get some movement in my lumbar spine, but I'm just not sure that the extension exercise I've been doing is the way to do it because it doesn't seem to get to the problematic joints....