part of a rehabilitation program for the patient with low back pain. It can be very confusing for the chiropractor because there are many different opinions and strategies involving spinal rehabilitation. Additionally, these exercise programs differ depending on a patient’s severity of the condition, ability to perform the exercises, and even stage of care. This guide has two sections: flexibility and strengthening. These exercises should be performed daily or every other day for best outcomes. Although flexibility may seem bor-ing to the patient – even the doctor – there needs to be muscular inhibition through post isometric relaxation (PIR), post facilitation stretch (PFS) or even static stretch-ing to increase mobility. Ideally a more passive approach is best suited. However, since this program is to be done on a near daily basis, it’s best to just provide the patient with static stretching. A lack of flexibility through the hips (hamstring, hip flexors, gluteus muscles) can contribute to low back pain, therefore it is important to work on this if the patient is experiencing back pain. Please make sure all stretches are pain-free. If the patient feels discomfort, he or she may not be ready to do that specific stretch. 1. Quadriceps stretch. Have patient lie on stomach. Using a towel or band, pull the heel of the affected foot toward the buttock. Hold this stretch for one minute. Repeat three times each leg. 2. Hip flexor stretch. Kneel with affected knee on the ground, same side arm goes back causing pelvis (hips) to shift forward, and back to extend. Hold for 20 to 30 seconds. Repeat three times each leg. 3. Adductor stretch. Prop the inside of the ankle up on a table. Lean into the side being stretched. Hold for 20 to 30 seconds. Repeat three times each leg. 4. Hamstring stretch. Prop the back of the heel up on a table, keep back straight, and lean forward at the hips. Hold for 20 to 30 seconds. Repeat three times each leg. 5. Sidelying ITB/TFL Stretch. Lie on one side, use a towel or band and pull foot back as if stretching quadriceps. Use opposite foot to push down on distal part of leg. Hold this stretch for one minute. Repeat as needed. Exercises for lumbar spine stability Flexibility Strengthening 1. Supine abdominal draw in. Lie on your back on a table or mat, knees up with feet flat on table/mat. Pull the abs in and push your low back to the table/mat. Repeat 20 times. 2. Abdominal draw in with knee to chest. Lie on your back on table or mat. Draw one knee to the chest while maintaining the abdominal draw in. Do not grab the knee with your hand. Repeat 10 to 20 times each leg. 3. Abdominal draw in with double knee to chest . Lie on your back on table or mat. Bring both knees to your www.canadianchiropractor.ca Canadian Memorial Chiropractic College May 2015 Canadian Chiropractor 21
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