Low back muscle endurance is the most important aspect of long term management of acute and chronic low back pain. The research is very clear: the only factor studied that can reduce your risk of having a future event of low back pain is the ability of the tiny muscles in your back to be able to contract repetitively and effectively throughout the day.
The “Lumbar Bridge” exercise is a common strengthening exercise used by most physical therapists for either strengthening the lumbar spine, hamstrings, or the posterior hip muscles. It’s been around forever, and is also sometimes used in Yoga or Pilates class. I’ve had some clients do this in an “Abs class” in the local gym. If you do a google search, you will find lots of articles stating the lumbar bridge is something you should be doing to “keep your core strong” and “help with low back pain”. An example of this exercise can be found here:
When I was a new physical therapist, I prescribed this exercise for my low back patients as it was, (and to a certain extent) still is, the current standard of care. Interestingly enough, I have had more than a few patients return to the clinic after performing this exercise with increased low back pain. They were upset, and I couldn’t explain the reason why this exercise hurt. After all, this is what was instructed to me in physical therapy school.
One common explanation about why this exercise hurts, is that patients were lifting their hips too high. As a result, the excessive backward bending was hurting their back. But when I reviewed the exercises with my patients, they were not doing any backward bending and performing them “correctly”.
I have no doubt the lumbar bridge is an effective exercise for building muscle strength, but I believe that this exercise (and other exercises common in physical therapy) has excessive sheering or sheer force through the lumbar spine, and this is likely the reason this exercise hurts for a subgroup of people.
What is sheer force? Sheer force is deformation of a material substance in which parallel internal surfaces slide past one another. Great examples of this in everyday life is that sheer force is what allows scissors to cut paper and sandpaper to remove paint and reveal smooth wood. This type of force on the body and joints are extremely powerful and can break tissue much faster than other types of force on the spine.
If you are a 20 year-old athlete with no history of back problems, this is a great exercise to improve athletic performance and core strength. If you a 50 year-old with a disc problem and maybe some lumbar instability, or experience acute disc pain, there is some risk that the lumbar bridge will hurt or make your symptoms worse.
Despite its common use in exercise classes and physical therapy clinics, I made the decision several years ago to stop doing this exercise (along with the pelvic tilt and a few other exercises, but that’s another blog post). The challenge for the physical therapist is to efficiently pick the exercises that have the least risk and have the best chance of having a good outcome. The lumbar bridge is one of those exercises where I believe the perceived benefit of the exercise does not outweigh the risk.
This is what my business tag line, “Innovative solutions for pain”, is trying to convey. The whole idea of my practice is to provide smart and compelling approaches to spine pain and orthopedic injuries. Progressive ideas, based on science, to give you the best outcomes with the least amount of risk. This is the kind of care and attention that my business puts into your physical therapy and to your road to recovery.