Clinical Support

Spinal Exercises Services –

Physiotherapy
Information for patients

Exercise has been shown to help with low back pain however it often
takes time to take effect. It is important to be patient and persevere with
the exercises. They have been selected to help to improve your core stability, spinal control
and flexibility. This will also help to manage your symptoms in the longer term and therefore
you should always continue with them even when your physiotherapy is completed.

These exercises have been selected for you by your physiotherapist. Only perform the
exercises that have been ticked as they have been selected specifically for you.

You may find that your exercises will be changed as you progress. If this happens your old
exercise will be crossed out and a new one will be ticked.

When starting any new exercise it is not unusual to experience some discomfort. This is
normal, however the exercises should not be very painful or cause your symptoms to worsen.
If this happens, firstly perform the exercises more gently. Secondly reduce the number of
exercises. If the pain continues to worsen, stop and let your physiotherapist know at your next
appointment.

You should also attempt to perform some cardiovascular exercise 2 – 3 times per week. This
could be as simple as walking or gentle swimming. Some people will also benefit from more
advanced exercise such as attending the gym, cycling, keep fit or pilates classes. Your therapist
will advise you which are the most suitable activities to try.

You may find that your symptoms increase from time to time. If this happens you should
reduce or rest from your exercises for 1 – 2 days then restart the exercises gently at first then
gradually increase them as you start to feel better.

If you are struggling with any of the exercises, forget how to perform them or are having
difficulty finding time or a location to do the exercises please speak to your therapist. This is
one of the most important aspects of your treatment and we are here to help you.
The basics
Neutral Spine
Neutral spine position is the natural inward
curve of the lower spine.
This should be a gentle shallow curve. You
should attempt to maintain this position
during some of your exercises and during
activities such as sitting and lifting. Your
physiotherapist should have taught you how
to find your neutral spine position.

Transversus abdominis (Trans abs)

Trans abs is one of your stomach muscles
which helps to provide core stability. Core
stability is the action of certain muscles which
helps to provide support for your spine.
Core stability is important to help you move
around but it is also very important for your
posture and when you are static.
Trans abs muscle is located in the lower part
of your stomach.

Trans abs exercise

Lie on your back with your knees
bent. Press your fingers into the
lower part of your stomach (on the
right and left side) Gently draw in
the lower stomach wall (think of
pulling our stomach down off your
fingers or alternatively pulling
your stomach backwards towards
your spine) You should feel the
muscle gently push up against your
fingers.
Hold for 10 seconds. Ensure that
you continue to breathe normally.
Repeat 10 times.
 Pelvic Tilt in Crook Lying
Lie on your back with your knees
bent. Tilt your pelvis backwards so
that your back flattens onto the
floor. Then tilt your pelvis forwards
by pushing your tail bone into the
floor to arch your back. Repeat 10
times.

Sitting
Start in sitting with your back
straight. Roll your pelvis backwards
to flatten your lower back. Then
tilt your pelvis forwards to hollow
the lower back. Repeat 10 times.

Four point kneeling

Kneeling with your hands on
the floor. Tilt your pelvis slowly
backwards to flatten your back.
Then tilt your pelvis forwards to
hollow your lower back. Try to
prevent your chest from moving
throughout the exercise. Repeat 10
times.
Pelvic tilts
Exercise 1 1
Lie on your back with your knees bent.
Tilt your pelvis backwards so that your
back flattens onto the floor. Then tilt your
pelvis forwards by pushing your tail bone
into the floor to arch your back.
Then allow your lower back to flatten
slightly so that you are in the Neutral
Spine position.
Repeat 10 times.
2
Exercise 2
Lie on your back with your knees bent.
Tilt your pelvis backwards so that your
back flattens onto the floor. Then tilt your
pelvis forwards by pushing your tail bone
into the floor to arch your back. Then
allow your lower back to flatten slightly so
that you are in the Neutral Spine position.
Now activate your trans abs muscle by
drawing in your lower stomach. Hold for
10 seconds. Ensure that you continue to 3
breathe normally.
Repeat 10 times.

Exercise 3
Perform the pelvic tilt with neutral spine.
Now activate trans abs. Push through your
knees and lift your pelvis off the floor.
Ensure you maintain neutral spine and
trans abs contraction throughout. Hold
5-10secs, repeat 10 times.
4

Exercise 4
Perform the pelvic tilt with neutral spine.
Now activate trans abs. Push through your
knees and lift your pelvis off the floor.
Ensure you maintain neutral spine and
trans abs contraction throughout. Now
raise your right leg without allowing your
body to twist.
Hold for 5-10 seconds.
Repeat 5 times each leg.
Rotation dissociation
Exercise 1 1
Lie on your back with your hands on
your pelvis. Bend your right knee. Your
hip should dip down on the right side.
Now try to level your pelvis by rotating
it. Hold for 5-10 secs. Repeat 10 times
on each leg.

Exercise 2
Lie on your back with your hands on
your pelvis. Bend your right knee. Allow 2
the bent knee to roll out to the side.
Try to keep your pelvis level.
Hold for 10 seconds. Ensure that you
continue to breathe normally.
Repeat 10 times on each leg.

Exercise 3
Lie on your side with both knees bent.
Your back should be in neutral spine
position. Now activate your trans 3
abs muscle by drawing in your lower
stomach. Keep your feet together and
slowly raise your knee. Ensure that your
hip does not roll backwards.
Hold for 10 seconds.
Repeat 10 times on each leg.

Exercise 4
Lie on your back with your knees bent.
4
Tilt your pelvis slowly backwards and
forwards then stop in neutral spine
position. Now activate your trans
abs muscle by drawing in your lower
stomach. Push through your legs to
raise your bottom and back off the
floor.
Now raise your right leg without
allowing your body to twist.
Hold for 10 seconds.
Repeat 5 times each leg.
Dead Bug
Exercise 1 1
Lie on your back with both knees bent,
neutral spine position. Now activate
your trans abs muscle.
Slowly raise one knee whilst
maintaining trans abs and neutral spine
position (try not to allow your pelvis to
rotate).
Hold for 10 seconds.
Repeat with the opposite leg.
Perform 10 times with each leg.

Exercise 2 2
Perform exercise 1 then raise your
opposite leg (with knee bent) so that
both legs are off the floor.
Hold for 10 seconds.
Then replace one leg on the floor
followed by the other.
Perform 10 times.

Exercise 3
Perform exercise 2 then
3
slowly straighten one leg then
return the leg to exercise 2
position.
Repeat with the opposite leg.
Repeat this 5 times each leg.
Prone
Exercise 1 1
Lie on your stomach with
your back in neutral spine
position. Now activate
your trans abs muscle by
drawing in your lower
stomach.
Hold for 10 seconds. Ensure
that you continue to
breathe normally.
Repeat 10 times.

Exercise 2
Perform exercise 1 then
raise one arm forwards
and hold for 5 seconds.
Maintain trans abs and
neutral spine.
Repeat 10 times each arm.

Exercise 3 3
Perform exercise 1 then
raise one leg keeping the
knee straight. Maintain
neutral spine position and
trans abs.
Hold for 5 seconds.
Repeat 10 times each leg.

Exercise 4
Combine exercise 2 and 3 4
together, ensuring opposite
arm and leg are raised.
Maintain neutral spine
position and trans abs.
Hold for 5 seconds.
Repeat 10 times each leg.
4 Point Kneeling
Exercise 1 1
Kneeling with your hands
on the floor. Tilt your pelvis
slowly backwards and
forwards. Find neutral spine
position and activate your
trans abs muscle.
Hold for 10 seconds.
Ensure that you continue to
breathe normally.
Repeat 10 times.
2

Exercise 2
Perform exercise 1 then slowly
straighten one leg behind
you. Try to prevent your spine
from twisting.
Hold for 10 seconds.
Repeat 10 times on each leg.

3
Exercise 3
Perform exercise 1 then slowly
raise one arm and hold for 10
seconds. Try to prevent your
spine from twisting.
Repeat with the opposite
arm.
Repeat 10 times each arm.

4
Exercise 4
Combine exercise 2 and 3
ensuring you raise opposite
arm and leg. Try to prevent
the spine from twisting. Hold
for 10 seconds.
Repeat 10 times.
Miscellaneous
Prone Lying
Lie face down on a firm flat
surface. Ensure that your back and
leg muscles are completely relaxed.
Hold for 1 minute.
Repeat ………times per day

Prone on Elbows
Lie face down on a firm flat
surface. Rest on your forearms,
allowing your back to arch. Ensure
your back and leg muscles are
relaxed.
Hold for 5 seconds
Repeat 10 times
Perform ……. times per day

Extension in Lying
Lie face down on a firm flat
surface. Place your hands under
your shoulders and slowly
straighten your elbows allowing
your back to arch. Keep your back
and leg muscles relaxed.
Hold for 5 seconds
Repeat 10 times
Perform ……. times per day

Flexion in Lying
Lie on your back on a firm flat
surface. Take hold of your right
knee and gently pull it towards
your chest. Then do the same with
your left leg until you feel a slight
stretch in your lower back. Slowly
lower your legs one at a time.
Repeat 10 times
Perform ……. times per day
Slide Glides
Stand side on about 1 foot away from a wall. Place your ………… shoulder and arm against the
wall. Then slowly glide your hips towards the wall, pause, and then slowly move your hips back
to the start position.
Repeat 10 times
Perform …….. times per day

Mini Sit Ups

Lie on your back with your knees
bent. Place your hands on your
thighs and slowly slide your hands
towards your knees so that your
shoulders lift slightly off the floor/
bed.
Repeat 10 times
Perform…………times daily
Stretches
Calf Stretch
Stand with your hands against a table
or wall. Step your right foot behind
you with the heel on the floor and
the toes pointing forwards. Lunge
forwards bending your left knee.
Keep your right heel on the floor.
Hold for 30 seconds
Repeat with the left leg
Perform 5 times per leg, 2 times daily

Hamstring Stretch
Lie flat on your back. Bend you
right hip to a right angle. Place a
towel behind the thigh then try to
straighten your right knee keeping
your foot relaxed.
Hold for 30 seconds.
Repeat with the left leg
Perform 5 times per leg, 2 times daily

Quads Stretch (standing)

Stand with your hands against a table or wall.
Bend you right knee behind you, take hold of
your right ankle with your right hand (use a towel
if you are unable to reach). Pull your heel towards
the back of your thigh. Try to maintain neutral
spine position.
Hold for 30 seconds
Repeat with the left leg
Perform 5 times per leg, 2 times daily
 Quads Stretch (prone)
Lie face down. Bend your right
knee and take hold of your right
ankle with your right hand (use
a towel if you are unable to
reach). Pull your heel towards
the back of your thigh. Try to
maintain neutral spine position.
Hold for 30 seconds.
Repeat on the left leg.
Perform 2 times daily.

Sciatic Nerve Sliders

Lie on your back with your hip bent to a right
angle. Start with your knee bent and your ankle Stop before you feel any pain or stretching.
pulled up towards you. Slowly straighten your
knee. At the same time slowly point your foot Repeat ……times each leg
away from you. Perform …….times daily

Sciatic Nerve Stretches

Lie flat on your back. Bend your hip to a right
angle. Hold the back of your thigh (use a towel Hold for ……..seconds
if you cannot reach). Pull your ankle and toes
up and slowly attempt to straighten your knee. Repeat ……times each leg
Stop when you feel a gentle stretch. Perform …….times per day
MICB4088

Author: Rehabilitation, Physiotherapy Department

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW. Tel: 01642 850850
Version 1, Issue Date: July 2014, Revision Date: July 2016