Sit-ups are getting bad press lately. A recent article in the Wall Street Journal reported the dangers of sit-ups to lower back injury, with experts recommending alternate, safer ab-strengthening exercises. So, what does this mean for physical therapists in terms of patient treatment recommendations? “No more sit ups” may be a paradigm shift within your facility, and is certainly a new idea within the healthcare/fitness industry in general – however, this shift in thinking even has the backing of the U.S. military.
Not applicable to military work
Many of us may associate the sit-up with traditional high school fitness tests, but they’ve been used for as long as most of us can remember, in fitness tests by the U.S. military, as well. But the U.S. Navy has recently criticized the sit-up and may decide to remove it from military training. This body movement is reported as not applicable, since military personnel would never actually need to perform it during the course of an actual workday. For this reason, it doesn’t make sense to require it as part of a military fitness test. And that’s not all — sit-ups may also do more harm than good.
Dangerous to the lower back
The classic sit-up puts pressure on the spine that can cause discs to bulge with the ultimate result of disc herniation and lower back pain. And as physical therapists are well aware, the lower back is a common culprit for complaints of pain. In fact, according to the American Association of Neurological Surgeons, 75-85 percent of Americans experience lower back pain at some point in their lives. It’s a chronic problem, and PTs are in a perfect position to educate patients and the public about safer ways to work out their abs.
Alternatives to the classic sit-up
Using an exercise ball to protect the back is a safer, modified way to perform a sit-up, but some experts recommend against even modified sit-ups. Enter the plank pose — an effective way to strengthen abdominal muscles without putting the lower back in danger. And depending on the region of the core a patient wants to work, there are plank pose variations:
- Standard plank. A standard plank pose can be completed either on the forearms or with arms extended, facing the floor. It’s important that the back is flat, the head is in line with the spine and the core is tight. Standard planks work the entire abdominal region.
- Side plank. This version of the plank focuses on the oblique muscles. Starting from standard plank pose, you can move into a side plank by shifting weight onto one arm while driving the other arm up and back, turning to face out, with feet staggered. This movement should be repeated on the opposite side to work the obliques evenly.
- Side plank dip. For more oblique work, you can begin in side plank, but dip a hip down toward the floor, then raise it back up. The hips should not rise above shoulder height.
What’s to come for sit-ups?
Although sit ups haven’t been officially proven to cause lower back injury, it makes sense to take a cue from our military personnel and eliminate sit ups from daily exercise routines. With alternatives to sit-ups that are just as effective in strengthening abdominal muscles, perhaps sit-ups — both classic and modified — should become a thing of the past.
What do you think?
Will sit ups become a thing of the past? Have you ever treated patients for whom sit ups may have been a factor in their lower back injury? What exercises do you find to be the most helpful for strengthening abdominal muscles and hip flexors? Please share your input in the comment section below. Thanks!
It is wrong to categorically ban sit ups from your practice. I am using Pilates roll ups with great success, especially for flex ion control in the lumbar spine for patients with spondylolithesis etc.
Planks are totally overrated! Yes they work the core muscles but certainly put a lot of stress on the shoulders, and you could end up with a nice rotator cuff issue!