Physical Therapy Goals - Basic Exercises and your Back's Health

Examples of Basic Exercises
As noted previously, specific exercises for the neck and back are chosen by the PT based on the individual's specific problem and areas of deficit noted on exam. The exercises are also carefully monitored to ensure proper form and technique to facilitate the desired outcome before they are issued for the home program. In short, not every exercise is right for every back or neck pain.

PT exercises for the back tend to focus on improving the flexibility and strength of the trunk. For example, lower abdominal strengthening is often a goal to facilitate better support to the lower back.

1.) Strengthening is usually started lying on the back with the knees bent.

2.) Tighten and pull in the lower abdominals. Think about drawing the belly button and the muscles below it toward your spine.

3.) The breath should not be held with this exercise. Counting out loud to 10, tightening the lower abs when you say 3, can facilitate normal breathing.

This abdominal "bracing" is the foundation for other exercises to help stabilize the lumbar spine. Once bracing is mastered, the exercise can be appropriately progressed by the PT to include adding resistance with various arm and/or leg lifts while maintaining the taut abdominals and neutral spine in various positions.

Back strengthening exercises might include lying on the stomach, with or without a pillow under the pelvis. Depending on the person's ability, he or she might be instructed to place both arms overhead like superman flying and alternate lifting one arm at a time without shrugging. This might be progressed to lifting on leg (thigh and all) at a time and finally progress to lifting the opposite arm and leg at the same time.

Stretching exercises might include lying on the stomach and performing a press-up, keeping the hips on the floor (Figure B). Or, depending on the specific pain pattern, the person might be instructed to lie on the back and pull the knees up toward the chest.

Exercises for the neck often focus not only on basic range of motion, but also on specific neck stretches and strengthening exercises, especially of the supporting postural muscles.

An example of a neck exercise is called cervical retraction (Figure C).

Sitting up straight, keeping the chin LEVEL, gently pull the chin straight in as if you are hiding against a wall or sideways behind a tree. Your head should not bob up or down. The back of your neck should feel long. The highest point of your body should be the top back or your head. This is a good postural correcting exercise to perform during the day, for example while doing computer work. It counters the tendency most people have in sitting to slip into a forward head posture.

Another neck exercise is called upper cervical nodding which stretches the muscles at the base of your skull called the suboccipital muscles. Sitting up straight (the top, back portion of your head is the highest point), nod your head up and down about ½ inch. With the down motion, you should feel stretching at the base of your skull.

Finally, a really good postural exercise is called the breastbone lift. In sitting, practice lifting your breastbone a couple of inches. As you lift, gently squeeze your shoulder blades DOWN and together. Sometimes it is helpful to picture a string tied to the top 2nd or 3rd button on a shirt, pulling straight up to the ceiling. Doing this breastbone lift/shoulder blade depression repeatedly helps to correct your posture and strengthen the lower trapezius muscles, which "anchor" you in a good sitting position.

In Conclusion
The role of physical therapy in improving the health of your neck and back is first and foremost to educate you on what is going on that might be contributing to your pain and what you can do about it. Understanding and recognizing the contributing factors to your pain are the first steps to controlling it. Follow-through with postural awareness and the appropriate exercises is the key to recovery and prevention of future problems.