Irene Wicki from Physioart Klinik St. Anna in Lucerne tells us what to note
What are the causes of a hollow back?
Excess weight is one of the causes, as is a pregnancy belly or insufficient muscle strength, as seen in people with sedentary occupations who take little exercise. Those who have to stand a lot in their profession can also develop a hollow back. In addition, when hip mobility is restricted – at the start of osteoarthritis, for example – the pelvis adopts an incorrect position which we then perceive as a hollow back.
Can a hollow back also be the result of incorrect training?
Yes. Weightlifters, for example, who excessively train their back extensors. With other athletes it's sometimes their very pronounced buttock muscles that simply give the impression of a hollow back.
Is a hollow back automatically pathological?
No. Deviations from the norm – either to a flat back or a hollow back with increased curvature of the thoracic spine – are common and not, as such, pathological. Not everyone’s spinal column has the physiological form seen in anatomy books, i.e. one that corresponds to a gently curved, double S-shape when viewed from the side.
What kinds of pain are typical?
The pain is typically linked to the person’s posture or movements. If symptoms worsen when standing, walking or reaching up, and improve when sitting or bending over, a hollow back can be a relevant factor. However, not every hollow back causes discomfort. Incorrect posture can remain painless well into old age.
Is it true that a hollow back leads to attrition of the spinal column?
Again, this isn't necessarily the case, but is possible if joints and nerve roots in the lower back are subjected to too much pressure. This is particularly true if the hollow back isn't evenly distributed across the whole spine but is more apparent in one or two segments. This sometimes creates points of excessive pressure, causing these segments to degenerate even more, which can be painful.
Which exercises can correct a hollow back?
A hollow back is the result of muscular imbalances in the lower back and hip region. This means that one muscle group works excessively while its counterpart on the opposite side of the body is weakened. It's therefore important to activate and strengthen the abdominal muscles.
What do I do if this is painful?
If the exercises are painful, it’s worth having the causes of your hollow back addressed by a medical specialist. You will then be given an exercise programme that is controlled at regular intervals and optimally adapted to your needs.
What else is important when training?
There's no getting around it: it takes initiative, diligence and discipline to change a posture that has been acquired over a long period of time. After all, the body will always tend to fall back into its automatic pattern. This is why it's important to do the exercises daily, if possible, and to continually correct your posture throughout the day.
Exercise 1: Towel exercise for lumbar spine
This exercise will give you a feeling for the position of the spine, strengthen your abdominal muscles and mobilise the lumbar spine.
- Place a towel around the lower spine and grasp with both hands.
- Pull the towel forward, tilting the pelvis. This will create a hollow lower back.
- Then release the pull and tilt the pelvis back again. The lower back becomes round.
- Repeat the exercise several times.
This exercise will help relax the lower back and relieve pain. It also enables you to identify the neutral position, i.e. the position achieved in the middle of the exercise.
Strengthening the abdominal muscles
This is where the abdominal muscles come into play
- Pull the towel forward more forcefully with your hands.
- The abdominal muscles will tense up in reaction and create resistance.
Exercise 2: Basic core training
In order to train the abdominal muscles correctly, you should be able to stabilise your core.
- Lie on your back with legs hip-width apart. Look up at the ceiling, neck and shoulders relaxed. Place the pelvis in a neutral position, i.e. not completely on the floor. Observe your breaths.
- On an exhale, activate the core muscles, draw the navel gently towards the spine and tense the pelvic floor muscles. This will feel as though you want to hold back urine. Release the tension on the next inhale.
- Then learn to hold this position, also known as «powerhouse» in Pilates, for several breaths.
- Increase the difficulty by raising your legs. Raise one leg first, and maintain the core tension. Ensure that the position of the spine doesn't change even when you put your leg down. As soon as that works, try with both legs.
- Build the tension in the core muscles and lift both legs one after the other. Hold at a 90 degrees angle and slightly lower one leg after the other, without changing the position of your back. The more you lower your leg, the more difficult it is to maintain the back’s position.