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Core strengthening

Back pain

Slipped Disc: What is it and how to fix it

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Slipped discs are very common, right? Well, to tell you the truth… they don’t actually happen! Find out what a slipped disc really is and how YOU can sort it out yourself.

Slipped disc, Herniated disc, disc bulge and sciatica are all interchangeable and often used to explain the same thing. Now I need to say first of all that intervertebral discs cannot actually “slip” as they are firmly attached to the vertebrae above and below vertebrae by very strong ligaments – Slipped disc is just a colloquial term which has bred a lot of fear over the years but really there is nothing to fear!

The two common sites for herniated discs are the lumbar spine (low back) and the Cervical spine (neck). Today we are going to cover the low back as this is the most common, but stay tuned for self-treatment of herniated discs in the neck!

Discs cannot actually “slip” as they are firmly attached to the vertebrae above and below vertebrae by very strong ligaments

Basic anatomy:

lumbar anatomy - slipped discs and herniation

The spine is made up of vertebrae stacked on top of each other, held together by ligament and muscle. in between each vertebra is an intervertebral disc. Now in the lumbar spine, there are 5 vertebrae and the most common level for disc herniations are L5/S1 – this is the Disc between your lowest lumbar vertebrae and your Sacrum. roughly 80% occur here with the second most at L4/5 above it.

The Lumbar discs are made up of a harder outer layer, holding in a gooey middle.

How does a Disc herniation occur?

When too much force is repeatedly put through the front of the disc (such as bending forward, slouching and lifting heavy objects) the gooey center of the disc is forced forward and eventually (after thousands of bends)it forces through the outer layer.

A lot of Discs are injured doing very simple things light, changing a light bulb or picking up a baby but it is not that action that does it, it is a build up over time and it can take any little thing to tip it over the edge!

Now there is different levels of disc damage as you can see in the picture below:

disc bulge levels herniation - how to fix slipped disc

Now, sequestrations are serious and often need surgery but the remaining levels can be and should be treated conservatively (non-surgically) first.

Depending on the level of disc herniation, they can cause symptoms in different places down the leg due to the nerve roots that get annoyed. Keep in mind though that Disc herniations often do not have pain or change on sensation into the legs – there is a very wide range of presentations.

Herniated disc symptoms: You can have some or all of these.

  • Pain worse in the morning and cold/bad weather
  • Sciatica – Common back and leg pain caused by irritation to one of the 5 Lumbar spinal nerves. The nerves are irritated by the disc compressing on it or inflammation from the disc herniation. This usually only occurs down one leg.
  • Back spasm – often people are given this as a diagnosis but muscle spasm DOES NOT HAPPEN FOR NO REASON – there is always something behind it. Muscles around your back tighten up and go into spasm to protect your back and try to stabilize it so that no more damage is done.This is called muscle guarding and is a natural mechanism initially but in the following days, it can lead to a lot of discomfort, pain, and limitation.
  • disc bulge, slipped disc, herniation - self treatment physiotherapyAggravated by sitting, prolonged standing, bending and twisting.

Recovery and healing time

Recovery: Up to 80 percent recover within 6 weeks

Healing time: 12-18 months due to poor blood flow into the discs.

When to go to the hospital or see your Doctor

  • Weakness in your legs
  • Change in bladder or bowel (toileting) function.
  • Constant unremitting pain or pain not improving

If in doubt see your local health professional as this information is not meant to replace the assessment and advice of a health professional.

“Slipped disc” Self-treatment

1. keep active: back in the day bed rest was the first port of call, now it is the opposite. keeping relatively active is the best thing for your back and you need to remember that the chances are your back will get better and that over 80% of the population get back pain just like yours!

2. Exercises: to get the right muscles firing again to stabilize your spine and to loosen off the tight muscles (so that you dont feel hunched over and shuffling!) follow this link: Must know exercises for acute low back pain

3. Stiffness in your upper spine puts a huge amount more stress though your low spine and gets worse when in back pain! Here is a great way to mobilise your own spine

4. The greatest exercise for Disc Herniations: this exercise was developed by a top Physiotherapist Robin McKenzie. Repeated Extensions In Lying (REIL) act to centralise the disc and gradually reduce the disc Herniation.

Prone extensions in lying McKenzie exercise for disc low back pain

Position: Lying on your Front with your hands in front of you like you are going to do a push up.

Action: Keeping your hips and back relaxed, push your shoulders up. Do not push into pain, so stop when and if you feel pain and hold it for 10 seconds then relax down and repeat 10 times.

Initially start on you elbows as shown, then progress to straight arms.

Prone extensions in lying McKenzie exercise for disc low back pain physiotherapy

Reps and sets: 10 x 10 second holds 3 x daily


Remember: if pain worsens with this exercise do not push as far or as hard. If pain continues to worsen then consult a health professional.

These easy steps will help you so much, just remember that you WILL have good days and bad days but if you stick to the above 4 things, your Disc pain will get a lot better. Try and persevere with these exercises for 6 weeks at least!

Let me know how you get on and don’t forget to like, share and follow and remember, a slipped disc doesn’t exist!

For a more thorough rehab plan, download our Complete Low Back Self-Rehab Guide

Also see: progressed exercises for keeping back pain away


Back pain, Core strengthening, Health, physical therapy, physiotherapy

Beating Low Back Pain – Must know Physiotherapy Exercises

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Don’t put up with low back pain and Sciatica. Below are the best and safest exercises to treat your low back pain yourself.

With 80% of the population experiencing low back pain in their lifetimes, and 84% of those having a recurrence within the same year, this is a huge problem, but a problem that can be helped… alot! As with most other pain and injury, treatment and exercises combined lead to optimal results, so below are five exercises for you

As with most other pain and injury, treatment and exercises combined lead to optimal results, so below are five of the best exercises for you to rehabilitate your low back pain at home.

1. Bridge, level one:

Start by lying on your back on the floor or bed with your knees bent. Squeeze your buttocks together and lift buttocks off the floor until your body is aligned. Hold for 5 seconds, then lower down. Repeat 10 times twice.

Brideg - up

Bridge level 2:

For the next level up if the above is too easy, keep one leg straight out in the air and perform with one leg. 10 reps each side, 2 sets.

For the next level up if the above is too easy, keep one leg straight out in the air and perform with one leg. 10 reps each side, 2 sets.

SL bridge 1SL bridge 2

2. Glute sling stretch:

Our favorite stretch!

glut and Lat stretch - Hip flexibilityglut and Lat stretch - Hip flexibilityglut and Lat stretch - Hip flexibility

Start on your hands and knees then bring one knee between your hands. stretch the other leg out behind you and across to the other side. Now slowly walk out over your knee with your hands until you feel a good stretch.

Hold for 1 minute each side.

Tip – If that is too much of a stretch then go down onto your elbows first.

3. Bird-dog: 

Instructions: In four point kneeling slowly raise one arm and leg on opposite sides, making sure to keep your back straight (imagine your dinner is sitting on your hips – it is all about control). Lower down in a controlled manner and repeat, 10 times each side twice.

Beginners: Start by raising one leg only.

birddog 2birddog 1

4: Hip flexor stretch: This is important to unload the Low back and pelvis:

hip flex 1hip flex 2

Tip: to get a good stretch “tuck your bum in” or draw the bones at the front of your pelvis up towards the roof. You should feel it in the front of your hip or top of your thigh.

Hold for 1minute.

5: McGill Curlup

Place your hands down on the floor underneath the natural arch in your lower back (Don’t flatten your back.) Only lift your head and shoulders off the ground – unlike crunches, there should be no movement of your lumbar spine. Your hands are there to make sure your back is not curling off your hands or crushing them.

Once you have good spine control then you can take your hands onto your thighs and slide them to the top of your knees to do the curl-up. It doesn’t feel like you are going far but with repetition, it can get your abs firing well.

Begin with 20 at a time, and build up.

mcgill curl up

The key to all of these exercises is to maintain control and don’t rush them.  Do these exercises twice daily for 6weeks and notice the difference (but don’t stop there!)

Also check out our Lower Back Rehab Guide

And if you want more and harder exercises to strengthen up your low back: Get into some QL strengthening!

Please Share, like and comment to let me know how you go.


Health, running

Running Myths Busted

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From heel landing, stretching to make you faster and shoes for different arch heights, we aim to clear up these murky waters with 5 of the biggest running myths busted.

running myths busted

It is estimated that over 35 million people run in the USA alone for exercise or for sport. Runners are living in a confusing, challenging and ever-changing world. There are so many conflicting opinions out there about what shoe you should wear, how your foot should be landing, whether you should lean forward or not, stretching is bad for you… I could go on but, but I’m sure you get my point!

This conflicting information needs to be cleared up. For you, the runner – whether it be for fitness or competition – and for us health professionals, because we as often as anyone else are always on the look out for the exciting new bit of research, the next quick fix or magic bullet for running injuries. With the incidence of running injuries ranging from 26% upwards, we need to be doing the right things and know what will and will not help us.(2)

So what are the biggest 5 running myths busted?

1. Buying running shoes based on arch height help prevent injury

pronated foot - 5 running myths bustedWhether you have high arches, low arches or neutral feet – Having shoes prescribed for this does not reduce your injury risk. Between us we all have such a great variety of foot shapes,  which obviously can’t be nicely placed into 3 boxes(6).

You can read more here.

2. Stretching helps prevent injury

Even though this is the factor most often thought of as the cause behind running injuries, it is simply not true(3). There is a very common belief around the world that stretching before, during or after exercise decreases the chance of injury and improves recovery, but in actual fact it has been shown that stretching is not protective of running injuries (4). Static stretching could even affect your performance.(12)

It does need to be mentioned though that often stretching is mistaken for warming up. Warming up is defined as a period of prepatory exercise to enhance subsequent training or exercise(5). Warming up does help and has been shown to significantly reduce the risk of injury.

Mo-Farah-core strengthening3. Runners don’t need to strength train

Good, run-specific strength and conditioning can really help your running.

Your joints will be better protected, you will have less injuries and you will run faster! Ideal (7, 8, 9, 10).

Just remember, it isn’t all about the strength, you need to have neuromuscular control. This means making sure that you training is functional and running specific.

4. Minimalist/ Barefoot shoes make you run better

It isn’t about the shoe, it is about HOW you run. Yes, landing on your mid-foot when running reduces the load though your lower limb and reduces risk of injury, but this is altered through your technique (such as increasing your cadence or driving through with your knee) and not through shoes.(11)

First, look at you running technique, then your shoes.

Mo Farah5. One running pattern is right for everyone

As Bryab Heiderscheit writes “There is too much heterogeneity among runners to believe that one running pattern is universally ideal”(13). For example, changing running style to promote forefoot or mid foot strike may unload the knee and shin pain but it would be wrong for someone with  for example a stress reaction or inter-metatarsal bursitis.

Rather, this paper suggests that we may be better off showing people how not to run, giving a couple of things that do lead to poor economy and increased injury risk. These would be things such as not over-striding (foot landing well ahead of the center of mass) and not bouncing up and down too much.

You simply cannot put everyone into the same box – but there are some aspects that do benefit the majority, and these should be promoted.

So there are your 5 running myths BUSTED – what do you think? Surprised?

It is important that we embrace an approach that is not one size fits all, and that is holistic in nature, that takes into account nutrition, goals, ability etc. The other big thing that needs to be looked into further is training error, which has been estimated to account for over 70% of running injuries. This is a huge amount of injuries that are due to training error (running too far, too fast, too long, too soon) – Maybe more needs to be done to place some guidelines around training progression and the best way to go about this. Especially for beginners as they have a 2-3 x higher risk of injury.

I would love to hear your thoughts and feedback on these running myths, see the comments section below or find me on twitter.

Yours in good health,

Shaun


Back pain, Chronic Pain, Health

Low Back Pain – Why it sticks around

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Lower Back Pain can be very limiting, annoying and really hang around. Her is how you can help that with some great info and lower back exercises!

In my previous posts on low back pain I have shown you how to get up and moving when in acute low back pain, what sciatica is and how to treat it and finally I made you a maintenance regime to keep your back strong and mobile.

Today I want to run through one of the reasons back pain can really hang around and affect our lives so much AND run through some effective lower back exercises to address these reasons.

As with a lot of other injuries such as ankle sprains, simple injuries can linger around and even turn chronic because proprioception is lost in that area. This means that you lose kinetic awareness, the ability to know where your body is in space. Our bodies are amazing in the fact that normally you can know where your body parts are with your eyes closed – like holding your arm up in a certain position, closing your eyes and copying it with the other arm – you will be very similar if not spot on. You can do this because you have proprioception.

A recent study compared chronic low back pain patients to pain free patients and looked at the ability to reposition into a good sitting position from being slumped down. they found that the patients with low back pain were undershooting and not getting into good positions – this increases the risk of further back injury and aggravation and you wouldn’t even know it. Also when a sample of the fascia surrounding the back and connecting the legs and arms together (thoraco-lumbar fascia) is taken and analysed – patients with back pain have lost the innervation to that area. This all adds up to you not knowing when your back is in a bad position when you have back pain and this can lead to ongoing problems.

So to re-train your back and get the feeling back there is a couple of things you can do:

  1. bird-dog exercise for glute and spinal strength, stability and balance. physiotherapy exerciseBird-Dog: This lower back exercise is great for retraining the thoraco-lumbar fascia – this connects two of the largest muscles in your body – Latissimus dorsi (Lats) and gluteus maximus. It helps to promote coordinated movement between upper and low limbs while having a stable low back. Action: start on your hands and then extend opposite arm and leg. Do this slowly and KEEP YOUR BACK STRONG (imagine there is your dinner or a fish bowl on your low back!). Do 2 sets of 20, alternating each side (you may need to start off doing less or just using the leg).
  2. Body checks: when at work, at the gym and especially when sitting – stop and check where you are in space , make sure your low back isn’t rounded out and your shoulders aren’t rounded forward. every 20 minutes check your self and right it.
  3. Keep you back strong and mobile with these great lower back exercises

Looking for more? We have compiled all the best info in one, evidence based rehab guide

Please comment, share and follow me for more!


Core strengthening, running, Spine

The importance of Core Stability on injury

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core strength minimizes lower limb injuryHaving a stable core and pelvis has huge benefits through-out the body, including laying a stable base for your legs to work off. This means more bio-mechanical efficiency, less injury AND less pain.

In order to do any lower limb exercise well, including running, squat, weight lifting, tennis etc, you need to be in control of your core. If you don’t have a stable base, everything working off it is going to struggle and compensate. This can lead to tight hip flexors, ITB syndrome, patellofemoral pain, ankle sprains, niggles and more.

Imagine a tennis shot, for example. Your are stepping forward and driving off your back foot while at the same time swinging your raquet forward to strike the ball. If you core isn’t in control then you are losing force between your legs and arms – losing that strength of the drive from your legs.

Core strength makes your body stronger, not just your abs, by conserving and transmitting energy.

Just for clarification, as “core” can mean different things to different people. Core for me is your Lumbo-Pelvic stability. The combined control and strength of your spine and pelvic muscles.

Quick self test: A great way to test and see how good your Lumbo-pelvic stability is yourself is to do the Single Leg Squat Test. If you see your hip dropping or knee tracking inwards, then you are at risk or injury and need to get started strengthening ASAP.

 

Poor core stability can also lead to and contribute to all sorts of injuries and pain, including in your:

  • Low back
  • Shoulder and neck
  • Knee and hip

 

So how do we sort this problem you ask?

Below is an exercise program to get started on that will really make a difference if you stick to it. I also fully recommend finding a good Physio in your area to have your specific deficits assessed to get some manual therapy to speed things up.

Exercises to improve Core stability:


1. Single leg Bridge:Bridge 1 leg - glute activation, leg strength and core stability. the best exercise for hip stabiltiy, great for runners

Position: lying on your back, bend one knee so that your heel is close to your backside and straighten the other leg as above so that your thighs are horizontal. Your arms can be crossed over your chest or down by your side to make it easier.

Action: Pushing through your grounded heel, lift your bum off the ground as above, straighten your back and hold for 30 seconds then lower and repeat on both sides.

 

2. Clam Plus: (Do them right and they are surprisingly hard!)Clam exercise plus - gluteus medius strengthening, pelvic stability, leg strength

Position: Side lying  with top elbow on the ground, knees bent, ankles together and importantly the top knee sticking out 1-2 inches further that the bottom knee.

Action: Making sure not to let your pelvis rotate backwards and keeping your ankles together – lift your top knee up roughly 20cm and lower down in control. Reps: Build up to 50 reps on each side.

If you have found in the past that normal clams don’t do much for you, try it this way with your hip s rolled forward more to isolate Glute Med better and get less Tensor Fasciae latae activation.

 

3. Double or single leg squatSingle leg Squat, Glut Med activation - hip stability and strength:DL squat
Try performing the Single leg squat, but if you are too unstable (cannot stop your knee going inwards) then start with the double leg squats.

Single leg: 2 sets of 12 reps

Double leg: 3 sets of 12 reps

Tips: stick your bottom out like you are going to sit down and keep your knees out!

 

4. Front Plank: 
plank

Hold this for 60  seconds (if you can, otherwise build up to this).

Tip: do not hang on your hip flexors, tuck your bottom in and bring your hip bones up towards your head.

 

 

 

 

5. Side plank: side plank

Again aim for 60 seconds here, keeping your body straight!

 

Too easy? Add in leg raises to this – Raising the top leg straight up and down, building up to 50.

 

 

Do this short program  DAILY and stick to it for at least 6 weeks -Let me know how you go!

 

You may also be interested in:

Iron out your running – What you never got taught

Get your spine moving

Smash your Glutes


Back pain, Core strengthening, Health, running

Glute activation, the missing link

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Glute activation, building a good squat pattern and reaching your Peak.

A strong, healthy back (not to mention your knees!) needs the areas above and below it to work optimally to avoid overload injuries and pain. Whether it is running, lifting up your child or building the perfect squat, good glut activation is essential to all body movement and is one of three aspects essential for a healthy low back and lower limb.

  1. A mobile thoracic spine to unload the low back.
  2. Good muscle length in Gluts, hip Flexors and Lats.
  3. Normal Glut muscle activation.

Today we are going to cover glut muscle activation and the best ways to optimize this as this is the hidden cause behind many injuries such as low back pain, sciatica, patellofemoral pain, meniscal injuries and groin pain.

Here is a quick Test to see how strong your glutes are.

You might ask why bother with increasing your glut activation – your gluts work right? well you could be wrong! The main reasons why glut activation may be missing are:

  • Past back pain or injury. The Lower crossed syndrome is very common in anyone with a history of low back pain of any kind: A syndrome developed by Dr Janda proposed that those with a history of low back pain and troubles all had a characteristic pattern of weak and tight muscles. Weak: Gluteals and abdominals. Tight: Hip flexors and Erector Spinae. It is very common to have people arrive at the clinic with history of low back pain or tightness showing this pattern.
  • Poor technique and lack of body conditioning.

What happens if you have poor gluteal activation:

  • With poor activation in a squat, you cannot protect your back as you use the hamstring and erector spinae (back muscles) to push your body into extension – This leads to Erector spinae increasing the load and compression on the Lumbar spine. So healthy glut function is needed to unload the spine and decrease low back pain.
  • Poor glute activation leading to you hanging on your hamstrings also leads to over extension of the spine – leading to much-increased risk of injuries such as spondylolisthesis (stress fractures) and muscle spasm.
  • Lack of gluteus medius activation causes internal rotation of the legs (knee dropping inwards) leading to increase force on the knee and higher chance of injury.

Now one thing to mention here is that it is impossible to rebuild proper Glute function without a good hip extensor pattern and certainly not with traditional squat exercises utilizing barbells and free-weights (don’t even get me started on leg press machines).

Below is your pathway to achieving optimal glute activation, reaching your goals and decreasing lower limb and back injuries:

Gluteal Muscles - building the best squat pattern.

 Before you get to the exercises, above are the three gluteal muscle and here their function:

  • Gluteus Maximus: External rotation and extension of the hip.
  • Gluteus Minimus and Medius: Abduction of the Hip (pulls your thigh out to the side and stops your hip dropping.)

Must-know exercises for glute function:

1. Clams: This exercise has been shown to be the best for isolating glut Med and Min and really gets the legs shaking if done right!

Clam exercise plus - gluteus medius strengthening, pelvic stability

Position: Side-lying with top elbow on the ground, knees bent, ankles together and importantly the top knee sticking out 1-2 inches further that the bottom knee.

Action: Making sure not to let your pelvis rotate backwards – lift your top knee up roughly 20cm and lower down in control. Reps: Build up to 30 reps on each side.

2. Single leg squats: Now don’t get daunted! these will really get your gluts firing functionally and are far superior to double legs squats.

Single leg Squat, Glut Med activation - hip stability and strengthSingle leg Squat, hip stability and strength

Position: standing on one leg with your arms straight out in front, chest up and looking straight ahead and the other leg directly out to the side.

Action (1st image above): Squat down, like you are going to sit down in a chair(stick your bum out). Only go down as far as your body allow (come back up before you fall over!) and don’t leg your free foot touch the ground. come back up and repeat, no hold needed.

Reps: build up to 2 sets of 12 reps on each leg.

Too hard? – try it with the leg out in front or bent as you can see in the second picture above.

Single leg bridges: The third and final Glut blasting exercise:

Single leg bridge - glut medius activation for hip stabilitysingle leg bridge for hip stability

Position: lying on your back, bend one knee so that your heel is close to your backside and straighten the other leg as above so that your thighs are horizontal. your arms can be crossed over your chest or down by your side to make it easier.

Action: Pushing through your grounded heel, lift your bum off the ground as above, hold for 5 seconds then lower and repeat.

Tip: make sure to keep your pelvis level.

Reps and sets: Build up to 2 sets of 12 reps on each leg with the 5-second holds.

Go hard at these exercises – Twice a day ideally and you will notice a huge difference in everything from running, squatting and weightlifting to low back and knee pain.

You might even like to give The Best Glute Stretch a try as with poor muscle activation, you also often end up with tight muscles!


Back pain, Core strengthening, Health

Sciatica and low back pain – All you need to know to sort it out

• By

You may have heard of Sciatica or Low Back Pain, or been told that you have it. BUT do you really know what the sciatic nerve is or how it gets sore?

In this post I we will go over, common causes, misperceptions and finally, self-treatment techniques.

Sciatica is a buzz word used by a huge amount of back pain sufferers and medical professionals but is really an umbrella term and can be caused by a number of things:

– Tension on the sciatic nerve as it passes through the gluts by your Piriformis muscle.

– Compression on nerve roots as the exit the spinal cord by disc herniation.

– Compression or irritation by rough surfaces and extra bone growth (spondylosis or arthritis of the spine).

The symptoms of sciatica range from radiating pain down the buttock and leg to altered sensation in the leg and foot. Back pain may or may not be present.

Physio exercises and information on low back pain

It is very important that you see a good physiotherapist who can diagnose what is causing your low back pain and/or sciatica as this gives a better picture and leads to a more specific treatment approach.

A large proportion of “sciatica” pain is caused by Lumbar disc herniations which is where the disc bulges backwards into a spinal nerve due repetitive flexion (bending forward or slouching), compressing it and restricting movement and sliding of the nerve.

Self-treatment technique #1: Extensions in lying. In order to know whether it is a disc contributing to your pain, lie on your front with your hands under your shoulders like you are going to do a push-up.

In order to know whether it is a disc contributing to your pain, lie on your front with your hands under your shoulders like you are going to do a push-up. (Now remember not to push into too much pain here)
What I want you to do now is push your shoulders up, keeping your hips relaxed a hanging down. Hold this for 10 seconds 10 times and if this either decreases your pain, or decrease your leg pain and causes pain more centrally in the back then, most likely this is a disc problem which is helped greatly by doing this McKenzie exercise twice daily.

Tip: as in the picture above it is best to slowly progress this exercise, so begin only pushing up into the middle position if you have moderate to severe back pain and then progressing up over the next fortnight.

For more information on how this exercise was developed check out Physiopedia.

Self treatment technique #2: The exercises in this great post lay a great foundation to start rehabilitating your back and is an excellent place to start. They are also fantastic for all common causes of back pain!

Make sure to share, comment and subscribe to future posts for more information on Disc pain.

Looking for more? We have compiled all the best info in one, evidence based rehab guide

Disclaimer: It is important to stop this exercise if it increases back pain and seek medical attention if symptoms worsen or you lose strength in your legs


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