In this article series we’ve been talking about exercises to build lower back strength and endurance. In Part 1 we discussed the limitations of exercises like planks, bridges, and bird-dogs. In Part 2 we introduced the idea of loaded pelvic tilts as a better alternative. The key here is to load the lumbar spine through a full ROM, as opposed to relying on isometic training.
These exercises, as described in Part 2, are more than effective for the majority of patients I see. But sometimes we need to take these exercises to the next level. This may be the case with patients with higher sport or occupational demands. Or these may be patients/clients who want to take their lower back health and fitness to the next level. When this is the case we can incorporate more advanced strength and endurance exercises.
The principles here are the same as we have previously discussed – with the key being to isolate motion to the lumbar spine. So again, we’re going to use pelvic tilt type motions. But here we need to find a way to further increase the load. If we were training the ankle, elbow, or shoulder we could use a heavier weight to create more resistance. But this doesn’t work well for the spine. So instead, we’re going to use the lower body to create more resistance. I refer to these exercises as “Pelvic Curls”.
We can apply this concept to train lumbar flexion (posterior pelvic tilt), lumbar extension (anterior pelvic tilt), and lateral flexion (lateral pelvic tilt). Let’s take a look at each of these in turn.
Supine Pelvic Curl (Lumbar Flexion) – Single Leg
Begin supine with one foot resting on the floor, and the other leg lifted with the hip and knee bent to 90 degrees. Perform an abdominal brace to create muscular tension around the lumbar spine. Now, while holding this brace, perform a posterior pelvic tilt. This is the same motion we have developed with all our previous exercises. But now the raised leg creates more resistance to the motion. It’s the equivalent to using a heavier dumbbell or thicker resistance band.
To be effective, there are a few key things to keep in mind. First, the motion needs to come from the spine and pelvis. So the hip and thigh shouldn’t move. It stays locked in place so it adds resistance, but doesn’t assist in the motion. A common mistake for patients/clients is to flex the thigh towards their trunk to create momentum. This can’t happen.
The other common error is to try to lift and tilt the pelvis by pushing through the foot that’s on the floor. As if this is a glute bridge. This also needs to be avoided. The motion must occur though the abdominals.
Supine Pelvic Curl (Lumbar Flexion) – Bilateral Leg Lift
As a progression, the Supine Pelvic Curl can also be performed with both legs raised. Here we are increasing the resistance by moving against the weight of two legs, not just one.
Prone Pelvic Curl (Lumbar Extension) – Single Leg
Pelvic curls can also be performed from a prone position. Here the focus is on an anterior pelvic tilt, which targets lumbar extension.
From a prone posture perform an anterior pelvic tilt. But to add load, instead of keeping the legs resting on the floor, you will lift one leg up with the anterior tilt. The key here is not to extend the thigh from the hip, but to keep the hip joint locked and lift the leg with the pelvic tilt.
This is the same motion we have developed with all our previous exercises. Which means the motion is driven by the muscles deep in the lumbar spine – the deep erectors and multifidus group. Remember, these deep muscles allow for joint-to-joint segmental control.
The key execution point here is to be able to feel these deep muscles contract. Being a more loaded exercise we will expect some contraction of the superficial erectors as well. But it is imperative that the patient/client can confidently feel and engage the deep muscles in the lumbar spine.
Prone Pelvic Curl (Lumbar Extension) – Bilateral Leg Lift
A progression of the Prone Pelvic Curl is to perform the exercise with a bilateral leg lift. The set-up and execution is the same here, but lifting both legs adds more resistance. Again, as noted above, it is critical to drive the motion with the multifidi and deep erectors. It is not uncommon for form to break down with more challenging exercises. This will greatly decrease the effectiveness of the exercise.
Lateral Pelvic Curls – Single Leg
Finally, we can use lateral pelvic curls to train lateral flexion of the lumbar spine. From a side lying position, perform an abdominal brace to create tension through the lumbar spine. While holding the brace pull, your pelvis (focus here on the iliac crest) up towards your lower ribs. But here we will lift the top leg off the floor.
As we saw with the Prone Pelvic Curl, the key here is not to lift the thigh from the hip. Keep the hip joint locked and lift the leg with the pelvis.
Conscious effort must be focused at creating the motion through the muscles on the lateral trunk. Specifically, the muscles between the iliac crest and lower ribs – the quadratus lumborum and abdominal obliques.
Lateral Pelvic Curls – Bilateral Leg Lift
A progression of the Lateral Pelvic Tilt is to perform the exercise with a bilateral leg lift. The set-up and execution is the same, but now we will lift both legs to create more resistance. As noted above, it is critical to drive the motion with the quadratus lumborum and abdominal obliques.
The conscious effort needs to be directed at creating the motion through the muscles on the lateral trunk. More specifically the muscles between the iliac crest and lower ribs – the quadratus lumborum and abdominal obliques. The key execution point here is to be able to feel these muscles contract and drive the motion.
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Programming
What about programming? As the goal is to build strength and endurance, the key is to perform repetitions to fatigue. There are a few ways to do this. One is to prescribe a specific number to target with the prescribed sets and repetitions (3 x 8-15 reps for example). This can absolutely be effective, especially here as we can modify the load based on each individual. This helps to make sure that we’re not just performing 8-15 mindless reps, but that there is appropriate muscle fatigue at the end of each set.
Alternatively, we can use our REMOM (Rehab Every Minute On The Minute) protocol as described in Part 3 of this article series. The idea here is to perform repetitions based on time (3-5 rounds of 1 minute per exercise, for example). This works well when we are prescribing several exercises (which we almost always are). It creates a focused exercise circuit for the patient/client. I also like this type of programming as it allows the patient/client to keep focused on form and execution. Here the clock does the counting. (FYI, if you are a My Rehab Connection subscriber we have included but types of exercises in our exercise library for you to subscribe).
