Is This A Good Exercise for Lower Back Pain?

Joint Health / Pain
/ By DD Kelsey

I received a question from a reader asking me about her back trouble and an exercise called the “triple threat”. Because the email had several things we could learn from, I’m answering it in a slightly unusual way: you’ll notice that the email text is in red and my thoughts are in black below.

I hope you find this helpful (remember – I answer most emails in the blog in case you email me with a question).

Hi. I hope you are able to receive my email response to your post on the roman chair. I have had pain for over four years in my groin and legs. It especially flares up after doing any kind of leg lifts lying on my back.

Leg lifts while lying on your back create high levels of compression in the lumbar spine as well as high shear forces (this is a force that tries to slide the vertebral bodies one on top of the other). The L4-5 region can refer pain to the hip and groin and can sometimes come from force generated by the exercise.

I have realized that I had to keep my spine neutral and it has helped tremendously.

A spine neutral posture keeps the force distribution balanced through your spine. You should strive for a neutral position during your waking hours.

My question is this – is the exercise that is called the “triple threat” bad for the hips and back? It is done lying with your back on the floor and your legs on top of a big ball. You raise your hips off the floor, holding it in that position and bending the knees bringing the ball in and out. Would that not cause more issues? It is the number two exercise that is given when you have back issues beside the dreaded superman. By the way I have two bulges and tears to my S1/L5 and L5/L4 spine. I have been told that my herniation and bulges are not significantly enough to be causing my groin and leg pain. All my doctors are puzzled by this which has been very disheartening to me as I am a young forty-two year old personal trainer and mother.

The “triple threat” exercise that you described creates slightly more work for your spine muscles than doing the same exercise with your feet on the floor. You can achieve about the same level of muscle demand though by performing a side plank. This eliminates the need to coordinate movement of the hips and lower back. The bridging motion, for some people, is difficult to control and can sometimes increase lower back pain or referred pain.

Some people have disc herniations without any symptoms while others have significant back pain with no obvious tissue damage. Clinicians sometimes make the mistake of associating the degree of tissue damage with the degree of complaint. So, no obvious tissue damage means you should feel fine which is simply not true. There is no correlation. The issue is whether your spinal tissues can withstand the force that they’re exposed to or not.

I do not look like I have issues because I do things everyday to make my day better. I stretch twice a day and do my pelvic tilts along with my plank work.

Stretching is something I prescribe very carefully in people who have disc injuries. Any stretching you do should avoid movement of the spine itself (so no twisting, bending, etc). Plank exercise is a good choice since it has relatively low compression and shear forces.

I have issues with the pool because it causes my knee on my operated side (hip scope in 2004) to burn and causes a chronic cyst to act up. It is so frustrating because I have different issues on both side of my body that I cannot address because it flares up other issues. I found your site when looking for answers and you have been the most helpful along with Dr. Jolie . I tried following her suggestions but I have a lot of issues with doing the split lounges and the full squats. It causes my knees to flare up so bad that it took about three months for me to bend my knees or to sit with my legs extended in front of me like a hamstring stretch. The outside of my knee would burn so much.

Your knee pain may or may not be related to your spine problem. It’s hard for me to tell without seeing you. Split lunges and squats may be more force than what your spine and knees can withstand. Again, this is where email has limits. There is no substitute for an interview and examination but from what you describe, the loads associated with those movements are greater than what your body can tolerate.

I often start people with your type of back pain problem with three things:

Reduce the amount of sitting at one time and in total during the day. Do this by getting a pedometer and shoot for 10,000 steps per day. The more you sit, the worse it is for your spine. If you must sit, use an inflatable beach ball (with just a small bit of air in it) behind your lower back against the back of the chair. This will give your spine support and help reduce the forces on the back side of the spine. Sit less and walk more.
Every two hours, lie down on the floor and place your lower legs on a Swiss Ball. You may need to place your trunk on a couple of pillows. In this position, slowly roll your legs back and forth a very small amount (as soon as you feel your buttock come off the floor, stop the motion and go the other way). The excursion of the legs is usually only a couple of inches. It should be relaxing and easy to do and not painful. Do this for 10 minutes.
Learn how to “brace” and use it everyday. “Bracing” is a phrase we use to describe the process of engaging the spinal stabilizer muscles. Some people call this “drawing in” or “hollowing out” the abdomen but it’s not either of those things. To learn how to get your abdominals and spine muscles to work, lie on your back again with your feet on the Swiss Ball. Place your hand on your lower abdomen. Now, imagine a burning candle a few feet in front of you. Purse your lips and try to blow out the candle. You’ll feel tension in your abdomen. This is the kind of tension you need in your abdomen all day long during your wakeful hours, every day, for the rest of your life. You must learn how to produce it and vary it according to the task. If you’re sitting in your chair, you need a very light amount of tension. If you’re going to lift a heavy box, you need a lot of tension. This is a key step. Without mastering this, all other exercises become very difficult to do.

People have asked me, “That’s it? That’s all I have to do?” To which I respond, “For now.” In most cases, if people follow these instructions, they feel better in a couple of weeks.

Better but not well. Some give up because it seems too simple or because the process is too slow. Rebuilding your spine strength takes time. There are no short cuts when it comes to upgrading your performance .

But, symptom control matters. I’ve been there. For options to reduce symptoms, try my book The Back Pain Toolbox.