Have you ever been told to exercise to help with your low back pain, but are unsure of where to start?
Or have you tried exercises before and found it just made your low back pain worse?
Well, keep reading as we may be able to provide you with some answers on how to effectively train your back.
Before we even start talking about exercise, let’s discuss low back pain.
The thought of exercising may sound a bit absurd if you are in a situation where you can barely move due to pain.
When you’re in pain, you don’t want to be doing anything to make things worse or cause more damage. However, the opposite is actually true.
It is extremely important to move and exercise as much as you can, especially if you are experiencing pain. This is because pain does not always mean that something is damaged, nor does it necessarily mean you are making things worse1,2.
Personally, I used to believe that pain was just a sign of injury. Based on my experience with cuts, scrapes, and broken bones, this makes sense because I only had pain after I got hurt. But after gaining knowledge and experience in the physiotherapy field, I learned that the concept of pain is not that simple, especially when it comes to the lower back.
Back pain is extremely complicated and there are many factors that influence it besides the injury. There are behavioral and lifestyle factors such as low physical activity, poor sleep, and diet which can increase pain. There are also contextual factors such as not appropriately addressing the issue, social factors such as work status, psychological factors such as stress, and so much more. Really, pain is more of a perception based on the contextual environment, rather than just the injury itself3.
If it’s still hard to wrap your mind around the idea that our environment influences how we feel and interpret pain, think about watching a scary movie. A scary movie will always be scary, but imagine watching it outside in the sun with a group of friends versus watching it alone in a dark room in the dead of night. For me at least, the latter is much more terrifying.
The key take home message here is that although there might be pain with movement and exercise, be reassured that you are not damaging your back and you are not making it worse.
If back pain is so complex, how is exercise going to help?
The reason exercise is so key is that it directly addresses many of the contextual factors that influence back pain. Movement and exercise guide the body’s healing process and promote recovery of tissues. Exercise releases our body’s natural painkillers and has anti-inflammatory effects, which reduce our perception of pain. Exercise increases our confidence with activity and makes movements less scary. It is also shown to make you feel good and has positive effects on mental health and well-being.
With exercise ticking off many good boxes, it’s almost a given that we should do it for low back pain. But what exercises are best?
The best exercises for low back pain
With so much information out there, you can find many different exercise regimens for low back pain. You will find some people focus on core training, some promote different types of exercises such as yoga, and others will take a more cardiovascular approach and recommend walking or swimming. But thankfully, exercise is simple.
Any form of exercise that strengthens the muscles of the back is effective for treating low back pain, so do what you enjoy the most4,5.
Where can I start?
When first deciding what exercises to do for your back pain, it is best to start by finding what positions are bothersome for your back. For example, if your back pain is aggravated by standing and better when you are sitting or bending down in a “flexed” position, it might be best to start exercising in a position where your spine is straight, or in an “extended” position. Vice versa, if your back pain is aggravated by standing upright and relieved by sitting or slouching, it will be best to start working through spinal “flexion”. We will write another low back exercise piece based on the McKenzie approach to low back pain that takes this concept further.
This is not to say that we should permanently avoid certain positions, because we do need to eventually be able to move our spine in all different directions for our usual daily activities. This is to say that we should start in positions that are comfortable, slowly build our tolerance, and then work towards positions that are more aggravating.
Back Strengthening Exercise Examples
This may seem like an overwhelming list of exercises, but you don’t have to spend a lot of time on them or do them all. It was shown that even 15 minutes of exercise a day can have a significant effect on low back pain. So pick a few exercises that you can do and try your best to be consistent with them as that is how you will get the best results2.
Here, we will first describe exercises you can use to move through “extension”. Second, we will provide exercises that will strengthen the muscles that extend the spine while the spine is neutral, or “anti-flexion” exercises. Finally, we will list exercises that work the muscles of “extension” through range.
Extension Movements – These are simple movements that can be done early on, even if your back is very sensitive. They may help in reducing pain, especially if it is caused by bending forward. These movements can be done throughout the day as needed, or even as a warm up to the strengthening exercises.
1. Stomach Lying – This is the easiest way to start as there is not much work involved. Simply by lying on your stomach, your spine is put into a bit of extension, which can be relieving.
2. Prone Press – Basic stomach lying can then be progressed by propping yourself on to your elbows, and then even your hands. Some protocols encourage us to “relax the back” once we are in the slightly arched position
3. Standing Extension – If lying on your stomach is not for you, simply leaning backwards while standing can have the same effect. And if you are worried about your balance, an option could be to lean back into a wall so you have some support.
Anti-Flexion Exercises – These are great exercises to start strengthening the muscles of the spine, as there is minimal movement involved and you are in full control of how much you squeeze and work the muscle.
4. 4-point Finger Prop – By pushing yourself on to your hands, you are forcing the muscles in your back to work and stabilize your spine. The closer your hands are to your knees, the easier it will be, so work at a level that is comfortable for you.
5. Standing Bicep Curls – This may not seem like a back exercise, but when we hold a weight in front of us, we are forcing our back muscles to work to keep us standing.
6. Romanian Deadlift – This simple hinge movement can be used to introduce bending in a way that uses the hips more so than our back. This can first be done unweighted, but to progress, weight should be added. The key here is that the exerciset is more through the hips NOT through the low back. If there are any questions around this one please ask one of our therapists to help coach you through the correct movement.
Extension Through Range – These exercises will build resiliency and strength for your back. Work in whatever range is comfortable starting with body weight, and then slowly add load to progress. You do not necessarily need a weight to add load, options could be to use a bag and gradually add items such as books or cans as weight.
7. Jefferson Curl – While keeping your legs straight, slowly bend to touch the floor, and then slowly stand tall.
8. Hip Thrust – Prop your shoulders on to an elevated surface and with your feet firmly on the floor, push your hips up into the air to form a bridge.
9. Side Planks – You can start by doing side planks from a wall and progress by doing them from the floor.
10. Standing Side Flexion – While standing, alternately drag your hand down the side of your leg.
These are simple movements that can be done even if your back is very sensitive. They may help in reducing pain, especially if it is caused by bending or standing/extending. These movements can be done throughout the day as needed, or even as a warm up to the strengthening exercises.
11. Knee to Chest – Start by lying on your back and slowly bring your knee to your chest, one at a time. This is an easy way to introduce some flexion in your spine. This can also be progressed by bringing both knees to your chest at the same time.
12. Seated Forward Reaches – Start by sitting down and slowly reaching forward. You can even use a counter top or a yoga ball for support while reaching.
13. Seated Bend – This is similar to the forward reaches except with this exercise, you are reaching down towards your heels.
It’s important to keep in mind that anti-extension means that extension is poor form – not that you’re using extensors.
Again, these are an easy way to introduce strengthening as there is minimal movement involved and you are in full control of how much you squeeze and work the muscle.
14. Plank – I’m sure most of you reading have seen this exercise in some shape or form. You can initially start by doing this exercise on a table or a wall, and progress to doing it on the floor
15. Bird-Dog – With this one be as flat as a countertop and try not to let your body rotate
Flexion Through Range
These exercises will build resiliency and strength in your back through range.
16. Sit-ups – When doing these really try to curl your spine moving each bone one at a time
17. Bicycle Crunch – These are like sit-ups, just with a slight twist
18. Reverse Crunch – Similar to the sit-ups, curl your spine but just in the opposite direction
Again, these are just some examples of exercises you can do at home to begin your rehabilitation journey, and are not the end all be all. So, if you prefer other forms of exercise such as walking, running, cycling and so on, do what you enjoy. Just remember to have a schedule and be consistent with it.
Rotation Exercises – As the name suggests, we want to introduce some easy rotation into the low back because, well life typically demands that from us so we had better train it.
19. Knee Flops – Laying on your back with knees bent, allow both knees to slowly fall to one side while keeping your shoulders more or less on the floor. Repeat with your knees going the other direction, pausing for a few seconds with each knee flop. Please note that sometimes during an episode of low back pain, one direction of rotation can be more limited than the other and if this is the case then it’s okay to exercise, just allow yourself to move more fully into the range of motion that is comfortable and less fully into the sticky or sore range of motion.
20. Seated Twists – Sometimes we see people do these with a stick across their upper back and shoulders. While that is fine to do, the point is to hold a nice straight posture and then slowly turn your upper body to the left and right. Similar to the knee flops mentioned above, this exercise is much more about joint lubrication and motion rather than strength or stability so go ahead and allow yourself the ability to perform more repetitions (within comfort levels).As a progression, you may try holding a weighted bar across your shoulders and then slowly turning the torso left and right again. This is now more of a strength exercise
21. Wood Choppers – There are many variations of these movement patterns so we will simplify them down to three series of basic movements and you can take it from there.
22. Pure rotation – the resistance is anchored in a middle position give or take around belly button height. Keep your hips square during this exercise to allow low back rotation to occur. Once you perform a set moving from left to right, turn around and allow yourself the same exercises going from right to left
23. High anchor – This exercise combines rotation with some forward bend and side bending so please begin slowly and with light resistance to ensure your back is happy with this progression. Unlike almost every other variation of this exercise, you can kind of see why they were called wood choppers
24. Low anchor – Quite simply the opposite of the above.
But what if you experience pain with exercise?
Unfortunately, pain might occur when performing your exercises but that is okay and expected as we are working an area that has been injured.
It is even shown that people who do exercises that cause a bit of pain actually do better in the long term compared to people exercising pain free.
A good rule of thumb to follow is to rate your pain out of 10 before you start exercising and to not let it increase by 2 points. For example, if your pain is at a 5/10 to start and with the exercises, it jumps to an 8/10, take a break. Let things settle back down and resume when your back is feeling a bit better.
Another side effect of exercise will be soreness for a couple of days. This is normal too, as the body is responding and adapting to the load and work that was done. The more we exercise, the faster our body will adapt and recover, which will then reduce soreness. So don’t feel let down if things feel a bit worse after exercising. Stick with it, work hard, and your back pain will improve.
If you are still unsure about what to do or have any questions feel free to call us at the clinic location that best serves you.
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- Kent P, Laird R, Haines T. The effect of changing movement and posture using motion-sensor biofeedback, versus guidelines-based care, on the clinical outcomes of people with sub-acute or chronic low back pain-a multicentre, cluster-randomised, placebo-controlled, pilot trial. BMC musculoskeletal disorders. 2015 Dec;16(1):1-9.
- Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC musculoskeletal disorders. 2014 Dec;15(1):1-21.