Spine Rehabilitation: Roman Chair Hyperextension Bench as Part of a Spine Rehabilitation Program for Back Pain

Published September 6, 2012

To help answer the question of
whether hyper extension exercises on a roman chair are appropriate as part of
your spine rehabilitation program, first let me provide some background information on
the subject. Then, I will describe the muscle control problems that arise
with back pain. Next, we need to establish goals for rehabilitation and
determine the specific training requirements to obtain those goals. And finally, I will describe the inherent problems of traditional roman chairs, followed by a solution.

Muscle Control during
Optimal Health

Research has shown that there are two types of muscles: Superficial
strength muscles, and deep stabilizing muscles. Each has its own
unique characteristics.

Think of the superficial
strength muscles as “sprinter-type” muscles. These muscles contain the same
type of muscle fibers that are highly developed in the legs of Olympic
sprinters. They are great for producing speed during a 100 meter dash but poor
for endurance during a marathon. In contrast, the deep stabilizing muscles
are more like “marathon-type” muscles (superior for endurance but poor for
speed).

In healthy individuals, the
primary role of the superficial strength muscles of the lower back and
abdomen is to move the torso. (Torso is defined as: The human body excluding
the head, neck, and limbs. This part of the body is also known as the trunk.
So, these muscles move the rib cage, lumbar spine, and pelvis.) They are also
responsible for controlling trunk posture during high-level activities. These
activities may include: lifting, pushing, pulling, jumping, running, and other
ballistic (fast) movements of the limbs.

In contrast, the deep
stabilizing muscles of the back and abdomen are used to provide continuous
postural adjustments of the torso throughout the day during low-level
activities. Some examples of low-level activities are: sitting, standing,
moving from a seated to standing position, walking, and slow (non-ballistic)
movements of the limbs.

Muscle Control Problems that Arise with Back Pain

After experiencing back pain, the brain’s strategy for maintaining trunk posture
changes to a simplified, inferior strategy. First, the deep stabilizing
muscles stop working properly. Second, the superficial strength muscles
of the trunk become over-active and their muscle fibers shorten up to restrict
trunk range of motion.

This over-active/shortening-up
response is recognized by experts as the brain’s attempt to “lock up” and
protect the painful segments of the torso during the acute phase of injury.
This compensation pattern typically continues after it is no longer necessary
during the chronic phase of back pain (when the injured soft tissue structures
have healed).

The strategy of using
“sprinter-type” muscles to try to maintain trunk posture throughout the day is
like forcing an Olympic sprinter to compete in a marathon, instead of the 100
meter dash. Obviously, the sprinter’s muscles are built for speed, not
endurance. So to say the least, this strategy would not be very efficient.
But, other problems arise secondary to muscle fatigue and subsequent muscle
spasm which result in disc & joint compression.

Goals for Rehabilitation &
Specific Training Requirements

Just as the goals and specific training requirements for sprinters are different
than for marathon runners, there are also vast differences in the goals and
specific training requirements for a rehabilitation program versus a core
fitness routine.

In rehabilitation, one of our
goals would be to release the superficial strength muscles. (Remember
that they have “locked up” the injured region of the spine.) This is
accomplished through slow, low-load, pain-free movement patterns focused on
lengthening the superficial strength muscles while relaxed. This is
something I describe to my patients as a relaxed muscle release exercise
(not to be mistaken as a muscle-stretch exercise).

Although it is true that we must stretch the fascia and related non-contractile
tissues, it is important to recognize that muscles must be released while
relaxed. This is required in order to reset the muscle spindles that
control the set-point of resting tone and muscle length.

The idea of a relaxed
muscle release exercise is definitely a change in mind-set. What it means
is that typical hyper extension exercises performed on a roman chair bench are
not appropriate for the initial stages of rehabilitation for chronic back pain.

If the superficial strength muscles of the back and abdominal wall
are over-active (contracting too much) and the muscle fibers are shortened up to
restrict trunk range of motion, then “strengthening” exercises would not be the
proper type of exercise for rehabilitation.

Our next goal would be to retrain the deep stabilizing muscles in their
role as the primary trunk stabilizers during low-level activities. This is
difficult to achieve in a person with chronic back pain since the superficial
strength muscles are attempting to perform that role by over-contracting and
shortening up to restrict motion in the previously injured region of the torso.
Therefore, an aggressive exercise utilizing a roman chair that emphasizes the
superficial strength muscles of the torso and hips may neglect to activate
the deep stabilizing muscles appropriately. A more specific training
approach is required.

One important deep
stabilizing muscle of the back is called lumbar multifidus.
This muscle attaches at each segment of the lumbar spine down to the sacrum and
pelvis. The specific training that I recommend on a back exercise machine
is a slow, low-load extension movement occurring at each vertebra, instead of
holding the curve of the lower back in a locked position while moving through
the hips. This exercise should be easy enough to perform 30 repetitions
without fatigue.

The Problem and the
Solution

The specific training requirements for lumbar multifidus rehabilitation are not
likely to be achieved as part of a home exercise program on a traditional roman
chair hyper extension bench. The design of the traditional 90-degree exercise
angle is too difficult and not properly designed to promote the specific
training requirements of spine rehabilitation. This type of roman chair will
emphasize the hamstrings, buttocks and superficial strength muscles of
the lower back. It is also likely that training on the 45-degree exercise
angle will be too difficult and not specific enough.

Fortunately, a solution has
been developed that may be designated as a hybrid of the roman chair hyper
extension bench. It’s called the Back Trainer Medic by Kettler
(made in Germany). The Back Trainer Medic was designed to assure the
correct movement pattern, so the individual segments of lumbar multifidus are
trained appropriately. The torso pad is curved and the height of the pad
is adjustable so it guides the user through the correct motion of the torso for
spinal rehabilitation.

The specific exercises that I
show my patients to perform on the Back Trainer Medic fulfill both goals that I
addressed earlier in this article: First, releasing the superficial strength
muscles of the back (via relaxed muscle release exercises), and second,
retraining the deep stabilizing muscle of the back, called lumbar
multifidus (via a slow, low-load extension movement occurring at each
vertebra). The specific exercises are also demonstrated on a DVD video so my
patients can watch it at home as an additional guide.

The Back Trainer Medic has six levels of difficulty. The easiest level is
easier to perform than the 45-degree exercise angle of a roman chair, so it is
more appropriate for the initial stages of spinal rehabilitation. This
allows the user to progress to higher levels of difficulty while the lumbar
multifidus muscles adapt by improving motor control and increasing in size.
Another advantage is that this machine virtually eliminates the hamstrings from
the exercise so that your efforts are more specifically focused on training the
lumbar multifidus muscles.

Dr. Knudsen is a practicing physical therapist who specializes in rehabilitation of chronic back and neck pain at Back Trainer Institute. For more information on the Back Trainer Medic or for other information on related topics, visit http://www.Back-Exercises.com.

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