Spine Conditioning Program - OrthoInfo - AAOS 01/04/2024 05:27

RECOVERY

Spine Conditioning Program

To ensure that this program is safe and effective for you, it should be performed under your
doctor's supervision. Talk to your doctor or physical therapist about which exercises will best
help you meet your rehabilitation goals.

After an injury or surgery, an exercise conditioning program can help you return to daily
activities and enjoy a more active, healthy lifestyle. Following a well-structured conditioning
program can also help you return to sports and other recreational activities.

Strength: Strengthening the muscles that support your spine will help keep your back and
upper body stable. Keeping these muscles strong can relieve back pain and prevent further
injury.

Flexibility: Stretching the muscles that you strengthen is important for restoring range of
motion and preventing injury. Gently stretching after strengthening exercises can help
reduce muscle soreness and keep your muscles long and flexible.

Target Muscles: The muscle groups targeted in this conditioning program include:

Cervical spine (neck)

External oblique rotators (side and lower back)
Trapezius (neck and upper back)
Internal oblique rotators (side and lower back)
Latissimus dorsi (side and middle back)
Piriformis (buttocks)
Back extensors and erector spinae
Gluteus maximus (buttocks) (middle and lower back)
Gluteus medias (buttocks)
Quadratus lumborum (lower back)
Hamstrings (back of thigh)
Abdominals

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Length of program: This spine conditioning program should be continued for 4 to 6 weeks,
unless otherwise specified by your doctor or physical therapist. After your recovery, these
exercises can be continued as a maintenance program for lifelong protection and health of
your spine. Performing the exercises 2 to 3 days a week will maintain strength and range of
motion in your back.

Getting Started
Warm up: Before doing the following exercises, warm up with 5 to 10 minutes of low impact
activity, like walking or riding a stationary bicycle.

Stretch: After the warm-up, do the stretching exercises shown on Page 1 before moving on to
the strengthening exercises. When you have completed the strengthening exercises, repeat
the stretching exercises to end the program.

Do not ignore pain: You should not feel pain during an exercise. Talk to your doctor or
physical therapist if you have any pain while exercising.

Ask questions: If you are not sure how to do an exercise, or how often to do it, contact your
doctor or physical therapist.

1. Head Rolls
Repetitions 3 sets of 3
Days per week Daily

Main muscles worked: Cervical spine muscles, trapezius

You should feel this stretch all around your neck and into your upper back

Equipment needed: None

Step-by-step directions

Sit in a chair or stand with your weight evenly distributed on both feet.
Gently bring your chin toward your chest.
Roll your head to the right and turn so that your ear is over your shoulder (1). Hold for 5
seconds.

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Gently roll your head back toward your chest and to the left. Turn your head so that
your ear is over your left shoulder (2). Hold for 5 seconds.
Slowly roll your head back and in a clockwise circle 3 times (3).
Reverse directions and slowly roll your head in a counterclockwise circle 3 times (4).

Tip Do not shrug your shoulders up during this exercise.

Head rolls

2. Kneeling Back Extension

Repetitions 10
Days per week Daily

Main muscles worked: Quadratus lumborum, erector spinae

You should feel this stretch in your lower back and your abdominals

Equipment needed: None

Step-by-step directions

Begin on your hands and knees with your shoulders positioned over your hands.
Rock forward onto your arms, round your shoulders and allow your lower back to drop
toward the floor. Hold for 5 seconds.
Rock backward and sit your buttocks as close to your heels as possible. Extend your
arms and hold for 5 seconds.

Tip Look down on the floor to keep your neck in alignment with your spine.

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Kneeling back extension

3. Sitting Rotation Stretch

Repetitions 2 sets of 4
Days per week Daily

Main muscles worked: Piriformis, external oblique rotators, internal oblique rotators
You should feel this stretch in your buttocks, as well as at your sides

Equipment needed: None

Step-by-step directions

Sit on the floor with both legs straight out in front of you. Cross one leg over the other.
Slowly twist toward your bent leg, putting your hand behind you for support.
Place your opposite arm on the side of your bent thigh and use it to help you twist
further.
Look over your shoulder and hold the stretch for 30 seconds. Slowly come back to
center.
Repeat on the other side. Repeat the entire sequence 4 times.

Tip Sit up tall and keep your sit bones pressed into the floor throughout the stretch.

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Sitting rotation stretch

4. Modified Seat Side Straddle

Repetitions 10 each side
Days per week Daily

Main muscles worked: Hamstrings, extensor muscles, erector spinae

You should feel this stretch in the back of your thighs and into your lower and middle back

Equipment needed: None

Step-by-step directions

Sit on the floor with one leg extended to the side and the other leg bent.
Keep your back straight and bend from your hips toward the foot of your straight leg.
Reach your hands toward your toes and hold for 5 seconds.
Slowly round your spine and bring your hands to your shin or ankle. Bring your head
down as close to your knee as possible.
Hold for 30 seconds and then relax for 30 seconds.
Repeat on the other side. Repeat the sequence 10 times.

Tip Keep your extended leg straight as you bring your head down.

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Modified seat side straddle

5. Knee to Chest
Repetitions 3 sets of 10
Days per week Daily

Main muscles worked: Quadratus lumborum

You should feel this stretch in your lower back, as well as in the front of your hip and inner thigh

Equipment needed: None

Step-by-step directions

Lie on your back on the floor.

Lift one leg and bring your knee toward your chest. Grasp your knee or shin and pull
your leg in as far as it will go.
Tighten your abdominals and press your spine to the floor. Hold for 5 seconds.
Repeat on the other side, then pull both legs in together. Repeat the sequence 10 times.

Tip Keep your spine aligned to the floor throughout the sequence.

Knee to chest

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6. Bird Dog
Repetitions 5
Days per week Daily

Main muscles worked: Back extensors, erector spinae, gluteal muscles

You should feel this exercise in your lower back and into your buttocks

Equipment needed: None

Step-by-step directions

Begin on your hands and knees with your shoulders positioned over your hands and
your hips directly over your knees.
Tighten your abdominal muscles and raise one arm straight out to shoulder-height and
level with your body. Hold until you feel balanced.
Slowly lift and extend the opposite leg straight out from your hip.
Tighten the muscles in your buttocks and thigh, and hold this position for 15 seconds.
Slowly return to the start position and repeat with the opposite arm and leg.

Tip Keep your stomach muscles tight and your back flat to stay balanced.

Bird dog

7. Plank
Repetitions 5
Days per week Daily

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Main muscles worked: Back extensors, erector spinae, quadratus lumborum, abdominals
You should feel this exercise in your middle to lower back, abdominals, and gluteal muscles

Equipment needed: None

Step-by-step directions

Lie on your stomach with your forearms on the floor and your elbows directly below
your shoulders.
Tighten your abdominal muscles and lift your hips off of the floor.
Squeeze your gluteal muscles and lift your knees off of the floor.
Keep your body straight and hold for 30 seconds. If you cannot hold this position, bring
your knees back to the floor and hold with just your hips lifted.
Slowly return to the start position and rest 30 seconds. Repeat.

Tip Do not let your pelvis sag toward the floor. Keep your stomach muscles tight.

Plank

8. Modified Side Plank

Repetitions 5
Days per week Daily

Main muscles worked: Quadratus lumborum, external oblique rotators, internal oblique
rotators You should feel this exercise in your lower back, waist, and abdominals

Equipment needed: None

Step-by-step directions

Lie on your side on the floor with your bottom leg slightly bent and top leg straight.
Your elbow should be directly under your shoulder with your forearm extended on the
floor in front of you.
Tighten your abdominal muscles and raise your hip off of the floor.

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If you can, straighten your bottom leg and lift your knee off of the floor as shown.
Keep your body straight and hold this position for 15 seconds.
Slowly return to the start position and repeat on the other side.

Tip Keep neck in alignment with your spine and do not shrug your shoulder up to your ear.
Do not let your elbow fall behind your body; keep it directly under your shoulder.

Modified side plank

9. Hip Bridge
Repetitions 5
Days per week Daily

Main muscles worked: Lower back extensor, erector spinae, gluteal muscles, hamstrings
You should feel this exercise in your lower back, buttocks, and back of your thigh

Equipment needed: None

Step-by-step directions

Lie on your back on the floor with your arms at your sides, your knees bent, and your
feet flat on the floor.
Tighten your abdominal and gluteal muscles and lift your pelvis so that your body is in
a straight line from your shoulders to your knees.
Hold this position for 15 seconds.
Slowly return to the start position and repeat.

Tip Center your weight over your shoulder blades. Do not tense up in your neck.

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Hip bridge

10. Abdominal Bracing

Repetitions 5
Days per week Daily

Main muscles worked: Abdominals

You should feel this exercise in your stomach muscles

Equipment needed: None

Step-by-step directions

Lie on your back on the floor with your knees bent and arms at your sides.
Tighten your abdominal muscles so that your stomach pulls away from your waistband
(toward the floor).
Hold this position for 15 seconds. Repeat.

Tip Flatten your lower back into the floor.

Abdominal bracing

11. Abdominal Crunch

Repetitions 2 sets of 10
Days per week Daily

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Main muscles worked: Abdominals

You should feel this exercise in your stomach muscles

Equipment needed: None

Step-by-step directions

Lie on your back on the floor with your knees bent and hands at the back of your head
with your elbows open wide.
Tighten your abdominal muscles and lift your head and shoulder blades off of the floor.
Keep your back flat to the floor and hold for 2 seconds.
Slowly lower and repeat.

Tip Relax your neck and do not pull on your head with your hands.

Abdominal crunch

Last Reviewed
February 2022

Contributed and/or Updated by

Daniel K. Park, MD, FAAOS

Peer-Reviewed by
Thomas Ward Throckmorton, MD, FAAOS

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AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This
information is provided as an educational service and is not intended to serve as medical advice.
Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon,
or locate one in your area through the AAOS Find an Orthopaedist program on this website.

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