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Planning Retirement Online

Home Exercise and Rehab

November 2012


Gina John Gina John is a Pilates Practitioner and Registered Osteopath who has spent many years offering help and advice, especially to the over 50 age group.

She is founder of The Osprey Clinic in the St. Johns Wood area of London and now specialises in Home Exercise and Rehabilitation Programmes. For further advice on exercising safely, and a selection of exercise films for general fitness and medical conditions, visit the website:



This month: exercises to help with lumbar instability

Q: I’ve been diagnosed with ‘lumbar instability’ and suffer with low back and buttock pain. What causes this problem and what can be done about it? 

A diagnosis of ‘lumbar instability’ is a condition where the spinal joints in the low back region have a tendency to move excessively.

If the condition is due to genetic factors, it is usually apparent in adolescence with the onset of back or joint pain. Symptoms arise as the ligaments and muscles close to the spine are more elastic, allowing spinal or other joints in the body to move beyond what is deemed to be normal joint range.

In later life, lumbar or low back instability is most commonly caused by the degenerative process. The ‘junctional areas’ of the spine are particularly vulnerable. These are the vertebrae which form a transition between the neck (cervical) vertebrae and the upper (thoracic) vertebrae; and between the low back (lumbar) vertebrae and the sacral (pelvic) bone

Forces transmitted through the spine, arrive at these ‘junctional areas’ and over time create excessive movement of the affected vertebrae. This leads to spinal disc or facet joint degeneration, and in more severe cases one vertebra may slip forwards upon the lower vertebrae. This condition is called a Spondylolisthesis or ‘slipped vertebra’.

Instability in the lumbar region commonly causes localised back and buttock pain and symptoms may radiate down the legs. A Spondylolisthesis tends to cause more severe pain of muscle cramps in the legs, as well as numbness or tingling in the legs and feet. If you experience numbness in the buttocks and change in bladder or bowel function, this is deemed a medical emergency.

If you have lumbar instability, due to hypermobility, degenerative changes or you are recovering from a ‘slipped vertebra’ which is in the sub-acute or chronic phase, you can improve the strength and support for your back muscles by exercise. In many cases, patients completely resolve their symptoms.

By strengthening the pelvic floor muscles the pelvic bones are able to transmit ground reaction forces. This is the way our foot and leg muscles react to the surfaces we walk on and propel the body forwards. When the pelvic bones are more stable in walking, they afford protection to the low back by dissipating forces which are transmitted through the limbs to the spine.

Pillow squeeze:
Lie on your back with your feet together and squeeze a pillow between your knees. Hold for 10 seconds and repeat 10 times. While holding the position think of activating your pelvic floor together with your inner thigh muscles, while breathing gently.
Pillow Squeeze
By strengthening the abdominal muscles, you can provide a corset- like support for your low back, thereby helping your deep spinal and postural muscles to work more efficiently while standing or engaged in physical activities.
Knee Folds:
Lie with your feet hip joint width apart. Pull in your abdominal muscles firmly and try to connect the pelvic floor muscles in the background. Exhale as you fold the right knee over the hip joint. Inhale to hold the position. Exhale to lower the foot to the floor. Repeat 20 times, alternating right and left.
Knee Folds
Gentle stretching exercises for your back as well as your buttock, hip and thigh area, will also help to relieve your symptoms.

Hip & Buttoch Stretches:
Lie on your back, with your knees bent and feet on the floor.
Pull up the right leg towards your chest, keeping the right knee angled to the side, so you feel a stretch through the right buttock and hip area. Hold the stretch for 20 seconds, and repeat the stretch to the left buttock and hip.

Hip & Buttock Stretch

It is also important to consider your posture, to help maintain the balance of the back muscles. For example, if you are aware that your shoulders slope forwards, then make a habit of always trying to stand and sit up straight and pull the shoulders down towards the back of your waist. And, if your back aches during or after car journeys or when sitting at the computer, try to support your low back with a pillow. Over time, just by making these adjustments during your daily activities may help to resolve or manage your symptoms.

To help the lumbar spine to cope with ground reaction forces, ensure that your shoes have adequate arch support. This prevents the feet and knees from rolling inwards while walking. If unsure, a podiatrist can advise you on appropriate footwear and if it is necessary to be fitted for orthotics, which are inserted into your shoes to provide arch support.

See all Gina's Home Exercise and Rehab features

Please send your questions for future columns, or feedback, by email to Gina John on

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