Back Basics: Exercises to Keep Your Back Scuba-Ready

Low back pain is a very common medical problem, estimated to occur in about two-thirds of adults. Because divers must move around a great deal, climb ladders, lift tanks, and be capable of self-rescue and assisting other divers in the water, back pain can be more than a nuisance for a diver. In some cases it can keep you out of the water.

Back pain can result from a variety of injuries or illnesses. The purpose of this article is not to help you diagnose the cause of your back pain. That task is best left to your physician. What I hope to accomplish here is to recommend exercises intended to minimize problems with back pain associated with the most common musculoskeletal causes. Before you begin any of these exercises, consult your physician or physical therapist.

Flexibility Training

The fundamental underlying principle is that it helps strengthen and improve the flexibility in your back, stomach, hips and thighs. It is important to balance strength and flexibility. For instance, if you exercise the hamstring muscles in your legs in such a way that they become tight (inflexible), the mere act of bending over may cause you to suffer a back injury. A back exercise program should be maintained on a regular schedule — at least every other day for starters and working up to twice each day. If you don’t keep up the program, and allow your muscles to become deconditioned and less flexible, then you will lose all the advantage you have obtained by stretching and exercising.

Begin each exercise routine slowly, with gradual stretching and lighter loads leading to more vigorous stretching and heavier loads. When you lift a load or exert, you should exhale. Inhale during the rest period between exertions. If you find yourself holding your breath while straining to perform an exercise, your breathing pattern is backwards.

The following are exercises and stretches to relieve back pain. Dress in loose-fitting, comfortable clothing. Equipment you’ll need: an exercise mat or beach towel, a chair. Repeat each exercise from five to 10 times:

Single knee-to-chest stretch – Lie on the floor faceup. Keeping one leg straight and your head against the floor, bend the knee of the opposite leg and pull the knee to your chest, using both hands locked behind the knee. You should feel your hamstring and hip stretch. Hold the stretch for 60 seconds, then pull your leg (still bent at the knee) out from the midline of the body, so that you feel a stretching sensation on the inside of your thigh. Hold this position for 30 seconds. Return your leg slowly to the floor and repeat this exercise using the other leg.

Double knee-to-chest stretch – Lie on the floor faceup. Bend both knees at the same time and pull both knees to the chest, using both hands locked behind the knees. Hold the stretch for 60 seconds, then pull your legs apart out from the midline of the body, so that you feel a stretching sensation on the inside of your thighs. Hold this position for 30 seconds.

Prone back extension stretch – Lie on the floor facedown with hands held against the sides of the body or on the forehead. Gently raise the head and shoulders from the floor and hold for a few seconds. If this is too difficult, place your hands on the floor near your head so that you can push up by straightening your arms. Keep your hips on the floor.

Standing back extension – Stand with the feet slightly wider than shoulder-width apart to maintain balance. Place your hands on your hips or against your lower back and gently bend backward at the waist. Hold this position for a few seconds.

Kneeling back arch (“cat” arch) – Kneel on hands and knees with arms forward of the head, palms on the floor. Tuck down the chin and arch your back upwards, while slowly leaning back on your heels and dropping your shoulders toward the floor. Hold for 60 seconds.

Standing hamstring stretch – Stand in front of a chair. Place one straightened leg on the seat of the chair. Gently stretch the hamstring of the straightened leg by slowly bending the other (balancing) leg at the knee. Try to hold the stretch for 30 seconds. Repeat using the other leg.

Standing calf stretch – Lean forward against a wall with both palms on the wall, heels flat against the floor. Place one foot forward to isolate the back leg, then lean until you feel a stretch in your calf muscles. Hold for 30 seconds. Repeat using the other leg.

Side-bend stretch – Stand straight, then bend at the waist to the side sliding the arm down the leg. Release the stretch and repeat to the opposite side.

Targeting Muscle Groups

The following exercises help strengthen different muscle groups related to back health:

Wall slide (back, hips and legs) – Stand with your back against a flat, smooth wall surface with your feet shoulder-width apart. Keeping your back against the wall, bend your knees toward a squatting position until your knees are bent to a right angle (90 degrees). Don’t squat beyond this position. Hold this position for a few seconds, and then slide back up to a standing position. The arms can be held at the sides or straight out in front for balance.

Prone leg raises (back and hips) – Lie on the floor facedown with your arms at your sides. Keeping one leg pressed against the floor, tighten the muscles in the other leg and raise it up a few inches for a count of 10, then lower it back to the floor. Keep your hips against the floor. Repeat this exercise for the other leg. A variation of this exercise is to place your arms extended in front of your head and raise the arm opposite the raised leg (e.g., left leg and right arm) at the same time.

Standing back leg swing (back and hips) – Stand behind a chair with your hands on the back of the chair. Keep one leg straight with foot planted on the floor while you raise the other leg backwards. Lower the leg slowly and then repeat the exercise with the other leg.

Supine leg raises (stomach and hips) – Lie on the floor faceup with your arms at your sides. Keeping one leg pressed against the floor, tighten the muscles in the other leg and lift it straight up 6-12 inches (15-30 cm) for a count of 10, then lower it back to the floor. Repeat this exercise using the other leg. You should feel a pulling sensation in the hamstring muscles of the lifted leg.

Sitting leg lift (stomach and hips) – Sit upright in a chair and lift one leg straight up to a position where you have a 90-degree angle at the waist, while keeping the other leg straight and lifted just a few inches off the floor. Repeat this exercise for the other leg.

Kneeling leg lifts (hamstrings, lower back and buttocks) – Kneel on the floor with your arms at shoulder-height for balance. Pull in one knee to your chest, then extend that leg straight behind you and lift it up slightly. Hold for 10 seconds. Repeat with the other leg.

Semi sit-ups (stomach “crunch”) – Lie on the floor faceup with knees bent and feet flat on the floor. Raise your head and shoulders slowly off the floor and reach toward your knees with your hands. Tighten the abdominal muscles. Hold the “up” position for two seconds, then release and slowly lie back down.

Back pain may be a symptom of a potentially serious situation. Inform your physician if your pain is accompanied by fevers, chills, unintended weight loss, difficulty with urination or bowel movement, pain or a tingling sensation in the legs or feet, or loss of circulation in the legs or feet.

To prevent low back pain, avoid risks such as heavy lifting (particularly while bending forward at the waist), sudden or forceful twisting of the torso, extreme body blows or vibration, jumps from heights, obesity and poor physical condition.

When Not to Exercise

Most therapists agree that it is not useful to begin exercises during the acute period when you have just suffered a back injury or have begun to experience pain. It is best to wait until the pain (and perhaps inflammation) has begun to subside, usually from seven to 10 days from the time that the pain has significantly improved. If you are controlling your back pain with pain medication, you must be particularly careful to wait to begin exercises until instructed by your physician or therapist.

Back-Saving Tips for Divers

Specific prevention measures for divers include:

When lifting any heavy objects, bend at the knees, not forward at the waist. This is particularly relevant when handling tanks and heavy luggage.

When donning a tank, let someone help you. Some persons like to lift a tank up over the head to slide it down their back so that they can slip their arms into the attached buoyancy compensator (BC). This puts extra strain on the back and neck, risks dropping the tank, and is much less stable than sitting or standing and having the tank carried into position by another person.

When wearing a tank, move very carefully when walking, particularly on a boat. It’s easy to lose your balance and fall or wrench your back. Try not to bend forward more than is necessary to maintain balance. Always hold on to something to maintain stability.

Be very careful ascending and descending ladders, particularly when wearing a tank.

Do a few stretching exercises before donning dive equipment before each dive.

Avoid sitting for prolonged periods. This is the anatomical position that is least favorable for low back strain, especially for those with chronic back problems.

By Paul M. Auerbach, M.D.