This month, Northern Virginia Family Practice and MovementX were proud to introduce the first classes of the ‘Age-Proof Your Body’ exercises class series. The series is comprised of 8 classes that cover a variety of topics from strength and mobility to balance and posture. If you would like to attend an upcoming class, please contact Northern Virginia Family Practice at (703) 379-8879.
Below, Dr. Natasha Beauvais of NVFP and Dr. Josh D’Angelo of MovementX discuss some of the benefits of exercises, the problem of lower back pain, and how to optimally perform the exercises presented last class session to improve your core strength, reduce pain, and prevent injury.
Why exercise? Why me?
Exercise benefits people in nearly every aspect of their lives, improving everything from musculoskeletal pain to balance to memory. Strength training improves cardiac health, bone health, and reduces the incidence of many chronic diseases. In this series, we will create a foundation for exercising and demonstrate many fundamental movements to help teach or reinforce strength-building habits. It is our hope that by the end of the series, you will feel stronger, more independent, and more well informed to exercise and reap its many benefits. Today, we will specifically address exercising for the lower back and core.
The Problem: Lower Back Pain
Lower back pain is one of the most common symptoms amongst the general population. In fact, 80% of adults experience lower back pain at some point in their lives. Second, only to diabetes and heart disease, the United States spends more money treating low back and neck pain than any other condition. As the prevalence of lower back pain has increased, it has become the leading cause of disability worldwide.
Treatment and Prevention of Lower Back Pain
While lower back pain is a very common problem, we have a growing body of research that supports the use of exercise and other treatments to help reduce lower back pain and prevent future pain. Both general exercise and specific exercises targeting core musculature are highly beneficial. Below, we discuss a few simple exercises that can help set the foundation for a strong core.
In our class on February 18th, we covered three of our favorite core exercises to help reduce and prevent lower back pain. The core is made up of musculature that covers the front of your abdomen, the lower back, and each side. The below exercises are designed to engage, strengthen, and improve the endurance of your core musculature. Each exercise can be highly beneficial when completed with good quality and control.
Why this is beneficial: ‘Dying Bugs’ are designed to challenge the stability of your core. This exercise should be particularly challenging for the muscles in the front of your abdomen and should not be felt predominantly in the lower back. As you can do more repetitions with good quality form, it is a sign that your core strength and endurance is improving—a helpful protection against lower back pain!
How to do it: Begin with your legs and arms off the ground. Notice that your back naturally assumes a neutral position. Slowly begin extending one leg away from your body and reach the opposite arm above your head. Make sure to keep your back in your neutral position (do not let it pop up further off the ground). Return to your starting position and repeat with the opposite leg and arm. Continue alternating in a slow and controlled fashion.
Where it should be felt: The exertion should be felt in the muscles in the front of your core, near your abdomen. It might be felt around the entire core, but it should not be felt solely in the small of your lower back.
How do I know if I’m doing it correctly? Make sure to keep your lower back flat! The main compensation we see is that someone arches their lower back as they move. If they cannot keep their spine on the ground and instead elevate/arch their back, it is a sign that they do not have sufficient strength, stability, or control to complete the exercise. The goal is to maintain your spine in a neutral position throughout the entire duration of the exercise.
Modifications – a bit less challenging: rather than moving both arm and opposite leg at the same time, just move one leg at a time. By only moving one limb at a time, the exercise is easier to control.
Why this is beneficial: Bridging is a great exercise to engage the posterior core musculature, including the back of your thighs, your hips, and your lower back. It’s also the same sequence of muscles used to get out of a chair and to squat! If you build strength with bridges, it translates to helping with simple activities like bending to get something from the ground and standing up from a low couch.
How to do it: Begin lying on your back with your feet about shoulder width apart and your knees 90 degrees bent. Flatten your back (keep it flat throughout) and lift your bottom off the ground. Hold at the top for 1-2 seconds, then slowly descend and repeat.
Where it should be felt: If done correctly, this is typically felt in the front or back of your thighs and/or buttock musculature. If you are feeling it in the small of your back, reset yourself by flattening your back, make sure it stays flat throughout the lift, and think about pushing your knees a little forward as you lift.
How do I know if I’m doing it correctly? If you’re feeling it in the appropriate place and successfully lifting your pelvis to be in a relatively straight line between your knees and your shoulders, you are doing great!
Modifications – a bit less challenging: Rather than lifting your pelvis high off the ground, try either lifting halfway up or just initiating the push to barely lift off the ground. Even activating the musculature and doing a lower lift is beneficial!
Modifications – a bit more challenging: In your starting position, lift one leg off the ground, bringing the knee towards your chest. With only one leg on the ground, push your pelvis up towards the ceiling in the same motion. Make sure your pelvis stays parallel with the ground! It is much more challenging when only using one leg at a time.
Why this is beneficial: This is a common motion that we make throughout each day. From bending to sit down in a chair to bending to get something from the ground, it teaches us the appropriate mechanics and strengthens the musculature required to complete the activity successfully and pain-free.
How to do it: While standing with feet about shoulder width apart, keeping your spine straight (no rounding or arching of the lower back), slowly bend from the hips. Your knees will bend slightly, but should not bend significantly. Keeping your back straight, return to your starting position and repeat.
Where it should be felt: the back of your thighs and gluteals (buttocks) should be the primary areas engaging in this exercise. It’s okay to feel it a little bit in the lower back, but it shouldn’t be felt primarily there!
How do I know if I’m doing it correctly? If you are feeling work in your legs and are keeping your back in a neutral position, then you are likely doing it well!
Modifications – a bit less challenging: practice this motion in sitting rather than in standing. While sitting at the edge of your chair with your feet flat on the ground and hands on your chest, practice keeping your back straight and leaning forward, then back.
What to do next:
We would love for you to try each of the exercises! If you have specific questions or would like a consultation, the MovementX Doctors of Physical Therapy are happy to set up discounted one-on-one sessions with the Northern Virginia Family Practice members. If you have any medical concerns or have been experiencing lower back pain for more than a week, please contact your primary care provider.
As you improve your strength and these exercises get easier, let us know! We would love to hear your successes and how strength and exercise have improved your life.
In the coming weeks, we look forward to discussing topics like walking and running, posture, and balance, and bone density and leg strength. We hope to see you in a class soon!
Dr. Natasha Lewry Beauvais received her B.A. from Yale University and her M.D. and Master of Public Health degrees from the University of Connecticut School of Medicine. She completed her residency in Family Medicine at SUNY Stony Brook and at the Mount Sinai School of Medicine Jamaica Hospital Family Practice Residency in New York City. She emphasizes caring for the whole family and for the whole person and values patient relationships built through long-term continuity of care. An athlete on the crew team in college, Dr. Beauvais used to be strong and fit. Like many of you, she fell away from fitness when life got busy. But like you, she has recommitted to staying strong, and now can be seen at Gold’s gym in South Arlington nearly every morning before waking up the kiddos. During the day, she will be seeing patients at Northern Virginia Family Practice, a personalized medical practice.
Dr. Joshua D’Angelo received his B.S. from the University of Michigan and his DPT from the George Washington University. He is a Board Certified Orthopedic Specialist by the American Board of Physical Therapy Specialties. He is passionate about personalized healthcare, utilizing the movement system to improve quality of life and the patient-provider relationship. Dr. D’Angelo injured his back when he was 18 years old playing basketball. He didn’t get much relief until he saw his physical therapist, who utilized his hands, hearts, and words to guide Dr. D’Angelo through the healing process. It is now Dr. D’Angelo’s hope to provide the same high-quality care to others in a flexible, convenient, and personalized fashion through MovementX, a mobile physical therapy, and movement health practice. You can reach Dr. D’Angelo via email at firstname.lastname@example.org.