Back pain 3: Exercises for low back pain

July 16th, 2008  |  Published in Doh! and ouch  |  18 Comments

Here are just a few tips and ideas for low back pain rehab and prevention exercises. If you are prone to LBP then I recommend including these as part of your regular workout program. Again, other great exercises can be found in Robin McKenzie’s book Treat Your Own Back and Stuart McGill’s Ultimate Back Fitness and Performance. I also recommend bellydancing, yoga, and Pilates. Anything that gets the back moving, strengthens it, and makes you conscious of that area is good. Some folks may find that including stretching of hamstrings and hips, especially the front of the hips, is useful. See my article on squat stretches for ideas.

When training for rehab, aim for endurance rather than heavy resistance and a maximal strength focus. As I mentioned in Part 2, low back pain is correlated with reduced endurance of spinal musculature. This means you want to work on longer sets with lighter weight rather than shorter sets with heavier weight. For example, hold the plank for 1-2 min, or do 20 quadrupeds.

Always, always let pain be your guide. Your aim is to find the pain free range of motion and work within that range, gradually expanding it as you improve. A little discomfort may be felt, and it’s up to you to judge how much is okay. Do not do any exercise, no matter how good it is, if it causes you a great deal of pain. Assume the usual disclaimer: when in doubt consult with your doctor and/or a physiotherapist.

neutral spine

Neutral spine is the position in which the spine is evenly balanced, and the top of the pelvis is neither tipped too far forward (resulting in an exaggerated low back arch and protruding lower belly) nor too far back. It’s not a single position per se, but rather a dynamic state in which the spine is able to respond and correct itself throughout a movement. Neutral spine is the state in which the spine is most able to tolerate loading and mechanical forces acting on it. A happy spine is never entirely straight, but rather looks like a gentle S-curve when viewed from the side. There should not be excessive rounding of the shoulders and upper back, nor excessive arching of the lower back. It shouldn’t look like the letter C or the letter Z. And if it looks like the letter B, you should probably loosen your belt.

One way to find a neutral spine position was taught to me by my Olympic weightlifting coach. While standing, take a deep breath, and push your chest up and out slightly. The position your back gets into with this action is an approximately neutral spine.

To help alleviate and prevent LBP, neutral spine should be maintained as much as possible during loaded movements. Some people incorrectly misinterpret this as saying that the spine should always remain straight up and down. Then they try to squat and fall over backwards. Rather, the spine should form a generally straight line with slight natural curves, but it can retain this line at a variety of angles. This is achieved by bending from the hip, not the waist.

Below are some examples of neutral spine while sitting, squatting, and picking up a laundry basket.

neutral spine while seated

Here’s an example of improper sitting position. Most of us probably do this at our computers without even thinking about it. Upper and midback is rounded, shoulders are hunched forward, and head is also pushed forward. In comparison, this is an example of neutral spine while seated. Head is carried further back, in line with the spine. Shoulders are pushed back and the posture is upright. You should be able to do this without back support, but if a lumbar roll or folded towel helps, then that’s fine.

neutral spine while picking up a load

As I mentioned, one of the most common occurrences of LBP is when doing household chores, but this principle applies in the gym as well. This picture shows the wrong way to pick up something from the floor; in this case, a laundry basket. The back is rounded, which effectively removes the assistance of the supporting spinal musculature. I’m cruisin’ for a bruisin’ here.
Here’s the right way to pick up that load. Squat down (see how useful squats and deadlifts are?), and use the legs to drive the load upwards. Also notice that this picture demonstrates neutral spine while squatting, and you can see that again, it doesn’t mean keeping the spine straight up and down, perpendicular to the floor. Rather, it means keeping the back in a relatively straight line at any angle, using the hips as the “hinge”. Don’t forget to hold your breath and tighten your midsection for a split second through the first part of the lift.

pelvic mobilization

Getting the lower back moving around after an injury will help with healing, strengthening, and pain relief. There are many types of exercises aimed at lower back rehab.

One that I recommend, though not shown here, is the cat-cow sequence from yoga. Get on hands and knees on a mat. Round your back, pressing it towards the ceiling, like an angry cat. Try to curl into a ball without moving your hands and knees. Look down and slightly behind you, so you can see your knees. Hold for a second, then slowly and gently relax, and let your midsection sag downward, pressing your belly towards the floor. Look forward and slightly slightly upward. This is the cow position. Hold that for a second, then smoothly and consciously move back into the angry cat position. Go back and forth between these two positions for several reps per set. Don’t forget to breathe deeply and consciously relax throughout. One of my clients who suffers from chronic back pain as a result of a tennis injury swears that this cat-cow sequence is better than ibuprofen for pain relief.

Below is another one I like: the standing pelvic tilt.

I ripped off this movement from belly dancing. Yes, it looks dorky, so let’s all just get past that and agree to do this when nobody is looking. You should be grateful that I was brave enough to look like such a goof for your benefit. It’s quite simple. While standing, tilt the pelvis back and forth as far as it will go in either direction. Do this slowly, consciously, and gently. Hold each position above for a second or two.

Anterior pelvic tilt (left hand photo) means that the top of the pelvis is tilted forward, and the lower back is arched, as in the photo above.

Posterior pelvic tilt (right hand photo) means that the top of the pelvis is tipped back, and the pelvis is tucked under the body, almost like you’re trying to curl into a ball while still standing, or like a dog tucking its tail between its legs. Do as many sets as you like, and as many reps as you like. Something like a couple of sets of 10 to 15 is a good goal.

Once you get comfortable with this movement, try its equivalent from side to side, slowly alternating raising one hip up and then the other.

torso strengthening

A good lower back rehab program should include some work on strengthening the supporting muscles of the torso. This includes the spinal erectors, obliques, and rectus abdominis, as well as the deeper torso musculature. Here are a few exercise ideas.

This exercise, known as a “Superman”, because it looks like Superman flying, strengthens the low back. Begin by lying face down, as shown in the top picture, with arms overhead. Then, raise arms and legs off the floor. The aim is to hold this “flying” position as long as possible. This exercise should be done for a few sets of at least 30 seconds per set. Don’t forget to breathe! And by the way, I don’t recommend doing them on a hardwood floor, as I did. Owie ow. Do them on a nice cushy carpet or mat. One caveat: McGill is not crazy about this exercise, as he feels it puts undue compressive force on the spine. If you are concerned, skip this exercise.

The exercise in the photo above is known as a plank position. Yoga folks will recognize it. It looks like the top position of a pushup. You simply hold this position as long as possible, while maintaining a good, straight, rigid body position. There should be a straight line from your head to your feet. No sagging in the middle! Like the Superman, do these for a few sets of at least 30 seconds, and don’t forget to breathe. These can also be done resting on forearms instead of hands. To get into this position, begin on hands and knees. Then, straighten out your legs until your body is in position.

This type of exercise is known as a quadruped, as it’s done on all fours. Again, do as I say and not as I do, and do this on a mat if you like your kneecaps. Begin on all fours, with a neutral-ish spine, as shown above. Don’t let your body sag in the middle.

Slowly and consciously, raise your left arm and right leg until they’re both out straight. Hold this position for 10 seconds or so, then slowly lower. Repeat for several reps. You can alternate sides with each rep, or do all the reps on one side first, then the other. I’m sort of looking forward here; find a position in which your head is comfortable. You can look at the floor if you prefer.

Responses

  1. bsmith says:

    March 15th, 2009at 11:25 pm(#)

    Superman puts a huge amount of compressive loads on the spine, as documented in Stewart McGill’s book Ultimate Back Fitness & Performance. You may also like to look into the pelvic tilt when standing.

  2. zheb says:

    April 1st, 2009at 4:32 pm(#)

    I have a lot of lower back pain when doing any ab workouts. The pain is concentrated right above the waist line. The plank position has helped a little, but still after the 20th second it starts hurting really bad. I also do the lower back bench press but that too gets painful pretty soon. I am not sure what to do anymore. I have slight scoliosis and it’s possible that is what is causing the pain. Any suggestions on how to overcome this problem? I would love to work on my abs.

    Love your website and your style, keep it up!

  3. Mistress Krista says:

    April 2nd, 2009at 7:25 pm(#)

    Obviously seeing a sports doc would be a good first step. But here’s a useful source:
    http://www.healthline.com/blogs/exercise_fitness/

  4. Dr. Douglas Yost says:

    May 11th, 2009at 2:55 pm(#)

    The neutral spine position is something everyone should be taught, because it is reduces the stress on your spine tremendously.

    Our mothers were right when they kept telling us to sit upright and stop slouching.

    Shoreview, MN Back Specialist

  5. Dr. David Schwartz says:

    September 28th, 2009at 10:01 pm(#)

    While I am a big fan of making rehabilitative exercises part of my patient’s recovery program, it is just not ok to lump everyone with lower back pain into the same category. If muscle fatigue was the only cause for back pain then athletes would never have any complaints.

    I love McGill’s work but it is only one component of a rather complex problem.

    All the best,
    Dr. David Schwartz

  6. Jacquey says:

    March 1st, 2010at 8:37 am(#)

    This article is wonderful. I have been dealing with back pain for about a week and feel as though I have been unable to exercise. When I don’t excercise I just feel BLAH. This has helped two fold, not only does my back feel better, but some of these moves are work, and I will keep the quadruped in my regular workout!

    Thank You.

  7. Diamond Bar Chiropractor says:

    July 22nd, 2010at 5:51 pm(#)

    Neutral spine positions while picking up a load is the most common trigger of low back pain.

    The sitting position should also take consideration the height of the chair.

  8. Chris Arnett says:

    September 12th, 2010at 6:30 pm(#)

    Several of these exercises are very good tips. I would even consider adding the superman once a clients back grew strong enough.

    Great post and very good photos! Thanks.

    Chris

  9. Jeff says:

    October 17th, 2010at 5:05 am(#)

    I agree with a previous post in saying that there is not 1 specific exercise programme developed for all patients with lbp. You only have to look at the number of different causes of lbp to work out that a different approach to rehab is necessary. For example rehab exercises for an anterior disc bulge will be completely different to posterior disc bulge..

  10. Chris says:

    December 12th, 2010at 5:36 am(#)

    I’ve been suffering from LBP for over two years. Over time, I’ve read a lot, seen the physio and tried out different things. I’ve found Kit Laughlin’s books very useful.

    What works for me now is pretty much what you suggest. Funny about the pelvic tilt and borrowing it from bellydancing. It’s exactly what I do and that’s exactly where I got the idea from as well.

    As long as I take care to exercise my back, stretch and exercise hamstrings, hip flexors and other related areas, I’m good. I do lots of squats, too. As time is passing, I’m regaining some of the flexibility and strength in my lower back, and I’m improving. I’m turning 47 and the dodgy back is not stopping me from undulging in my passion, which is BJJ. I compete and keep up with the young fellas during some pretty hard training sessions :-)

    The photos are good. Thank you for the article, it is helpful.

  11. Jacijl says:

    February 18th, 2011at 12:32 am(#)

    A few years ago, I started weight training, just to see what it was all about, and got hooked for a few months. One of my biggest problems was that I would end up throwing almost every exercise into my lower back, one way or another.

    Shoulder press? My back hurt.
    Sit ups? My back hurt?
    Bench press? Let’s not even go there…

    I’ve now started a training program to receive an associate’s degree in personal training. One of my first questions for my strength training teacher was “How do I keep from hurting my lower back while I exercise?” and the answer I got was crazy simple and insanely effective.

    Stretch my hip flexors. The pelvic tilt and a few other exercises you recommend really focus on that. I really dig Pigeon, or modified versions of Pigeon pose right before an exercise that I know usually ends up being pushed into that area. It surprises me every time how much even a simple, quick stretch can make a difference.

  12. Ashley says:

    February 22nd, 2011at 4:40 pm(#)

    I used to get lower back pain also, but discovered ActiveWrap hot/cold therapy wraps and have had great relief! They only cost around $40 and can be used for ice and heat with the same pack. I also use the back wrap for menstrual cramps. The best part is that I can walk around while wearing it…unlike using a bag of ice and having to sit in one spot. The website is http://www.activewrap.com

  13. Sara says:

    February 24th, 2011at 7:24 pm(#)

    I injured my back in a fall. I did several rounds of physical therapy for two years before hiring a trainer who believed in free weights (my previous trainers loved machines and bouncy balls with 5 pound dumbbells). Two months in, my daily pain went away. By five months in, my back no longer twinged. Granted, I believe that the time I spent on machines and doing bodyweight resistance probably built up my muscles, but the key was free weights. Two years later, I am still pain free and doing Olympic Lifting. I cannot tell you how much I believe exercise is the key!

  14. Jenni says:

    July 23rd, 2011at 2:12 am(#)

    My husband has a recurring lower back problem (muscular) which is randomly triggered – can be as simple as a slight bend. He finally went to a physio who gave him one exercise which has fixed the problem. It is really simple. Sit on a chair/bench with your legs apart as far as they will go. Turn your torso towards one knee, hold the knee with both hands and gently bend forward from the waist toward the knee. Hold 5 sec and repeat each side five times. Do this three times a day.

  15. Mistress Krista says:

    July 23rd, 2011at 5:58 am(#)

    @Jenni: Great tip! Thanks!

  16. Jess says:

    September 7th, 2011at 5:27 pm(#)

    I’ve been diagnosed with a herniated disk at L4/L5. I saw a PT for 3 months and have been doing physical therapy “homework” for 7 months now and the pain has more or less remained the same. I’ve had two cortisone shots but want to avoid a third.

    I’ve been still working out doing modified exercises (with very little weight) with free weights as well as lots of swimming but no real changes. Any suggestions.

  17. Mistress Krista says:

    September 8th, 2011at 3:21 pm(#)

    @Jess: Suggest you look into ART and medical acupuncture, which can be very effective for chronic pain relief. Often, especially with back pain, pain becomes “grooved” neurologically — the mechanical damage is no longer there (or has subsided), but the brain/nervous system still thinks there is damage, and responds accordingly.

    Also investigate the psychological link: http://www.spine-health.com/conditions/depression/stress-related-back-pain
    Typically I find that clients with persistent back pain have other life stress factors such as grief, work stress, relationship stress, etc. that essentially “widen” your “pain receiver” (imagine a satellite dish). Your pain perception and actual inflammation can increase drastically in this case. Consider investigating this angle.

  18. Stella says:

    June 13th, 2012at 5:59 am(#)

    Hey guys!
    I was in a car accident April 26th and suffered back and neck problems. I has bad posture to begin with and the accident brought all the negative effects of bad posture to the surface (thankfully im only 22 and will change this to ensure i have a happy and healthy back) but with that comes a lot of pain.

    Correcting my posture has been somewhat painful as Im adjusting my body into a positioning which its not used to.

    @Jenni suggestion works wonderfully. Im currently at work and started feeling the pains, i have a desk job with not the best ergonomical set up. I went to the lunch room and did her stretches and i feel great ! NO PAIN! I will check with my PT and if its a green (which i dont understand why he wouldnt approve) i will incorporate this into my daily routine.

    Thanks Jenni!

    I would love to create awareness of how important it is to have great posture :)


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