Low back pain is a debilitating condition that will affect most of us at some point in our lives. Experts all agree that exercise therapy is the best type of treatment for chronic low back pain, but how do we know what sort of exercise is going to be best?
Should we do gentle aerobic exercise or strengthening exercise? While there is still a lot of research to be done to confirm some specific types of exercise there is data to show that strengthening exercises are important to help support your spine.
Strengthening your core muscles is about a lot more than just getting an enviable six-pack. When you strengthen your abdominal muscles you can actually help to prevent low back pain by reducing your risk of injury. Many cases of lower back pain are partly due to weak abdominal muscles.
Your core is located in the very center of your body in order to provide your body with the foundation that it needs for all types of movement. Your abdominal muscles are the supporting framework that helps to stabilize your spine. If you have weak abdominal muscles you may find that your back muscles have to work harder to make up for it, and this can be a major cause of lower back pain. By improving your core strength you are less likely to put unnecessary strain on the wrong muscles, less prone to injury and less likely to need medication for lower back pain.
When you add core strengthening to your daily routine you can help your body properly support both your spine and your neck. A good core workout should include all of your abdominal muscles which includes your internal and external obliques as well as your transverse abdominal muscles.
Studies Supporting The Use Of Core Strengthening For Chronic Low Back Pain
The European and American Guidelines for the Management of Chronic Non-Specific Low Back Pain recommend supervised exercise therapy as a first-line treatment before patients turn to medication. Experts recommend that low back pain sufferers should stay as active as possible, avoid bed rest, and try to get back to their normal activity levels as soon as possible.
Studies have shown that staying active helps patients get back to their normal lives sooner than best rest. Where the guidelines sometimes differ is in the exact type of exercise that people should be doing, which can be somewhat confusing for people trying to figure out what is best - especially if they look at the internet which can be very overwhelming with everyone having an opinion on what you should be doing!
There are a few main types of exercise that have been studied for their effectiveness in treating low back issues. Flexion/extension exercises, abdominal strengthening, McKenzie method and stretching. Since exercise is one of the key components to treating low back pain, is it helpful to know what type of exercise is the most targeted when it comes to low back pain management.
Stabilization Exercises For Low Back Pain
The first study we looked at was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy in low back pain patients.
The study looked at specific exercises done over a six week period and measured the reduction in pain experienced by 120 patients who were doing either exercise or physical therapy.
The researchers found that there was significantly less pain experienced by the group who did specific core exercises versus the group who just participated in routine physical therapy.
Something that is important to note, however, is that physical therapists differ greatly in their approach to low back pain and since this trial was done in 2017 there may be more physical therapists who now incorporate more core training into their physical therapy sessions.
Core Muscle Strengthening For Chronic Low Back Pain
A second study that we looked at was done in 2014 and looked at the effects of core muscle strengthening on 30 low back pain patients.
The researchers split the patients into two groups - those who had complained about low back pain for more than 12 months and those who had complained about low back pain for 3-6 months.
Using numerical pain scale ratings and the Oswestry Disability Index, both groups reported significant improvements in pain using core muscle strengthening exercises. The researchers concluded that “core muscle strengthening exercise… is an effective rehabilitation technique for all chronic low back pain patients irrespective of different duration of their pain".
5 Top Exercises For Low Back Pain
So, now that we know core strengthening is key for the prevention and management of chronic low back pain, what exercises will help you get stronger abdominal muscles? Crunches? Sit Ups? Where do you start?
Many low back pain sufferers are understandably nervous about doing any sort of exercise that could either not work, or make things even worse. This is the number one fear of low back pain patients.
This makes choosing the right exercises super important. Looking at the science behind these moves can help patients to have confidence that the moves they are doing are the right ones.
Before starting a new exercise program you should always check with your healthcare provider as they often have a thorough history of any other issues that you might be experiencing.
They will be able to let you know if there are any modifications that you might want to make, based on your individual medical history or situation. Generally speaking, however, these are some of the top exercises for managing chronic low back pain.
Bridges are an amazing exercise for helping to prevent low back pain. Not only do they work the abdominal muscles but they also work your gluteal muscles (glutes), hamstrings, and your lower back muscles. Bridges help to strengthen your low back and hip muscles, and work to stabilize your spine.
One of the best things about bridges is that they have all the benefits of a squat but they don’t put pressure on your lower back, which reduces your risk of further injury. They are also very simple to do.
A 2016 study measured the effectiveness of different bridge poses by using EMG (electromyography) sensors. These sensors were able to show how engaged the abdominal muscles were during this pose and wanted to see what specific bridge pose worked the best.
The researchers found that a prone bridge pose (plank) showed the highest engagement of most of the core muscles, but many low back pain patients might be hesitant to try what many feel is an “advanced” exercise.
Doing a bridge pose on your back actually showed the highest engagement of the erector spinae muscles, these muscles are key muscles for supporting the back and helping with rotations - a common culprit for back pain injuries. So, no matter what level of activity you are at, bridge poses are a great way to strengthen your lower back muscles and help support your spine.
How To Do A Bridge Pose
Lie on your back with your arms by your side, your knees bent, and your feet hip-width apart. Your knees should be in line with your feet. Your feet should be flat on the floor.
Squeeze your abdominal muscles, pressing your heels into the floor and slowly raising your hips, causing your glutes to contract. Make sure you don’t raise your hips too high as this can cause your back to overarch and take the work out of your glutes.
Hold your pose for a few seconds (or you can do small pulsing movements) then slowly lower your hips back to your starting position on the floor.
Pelvic tilts are another fantastic exercise for your lower back. This exercise stretches out your lower back as well as strengthening your abdominal muscles. Stretching out your lower back helps to reduce stiffness and improve flexibility and mobility, while the exercise itself helps improve the strength of your glutes and your abdominal muscles.
Pelvic tilts are a very subtle movement of the spine which makes them a great beginner exercise for low back pain sufferers. Like the bridge pose, they can be done lying on the floor but you can also do them in a standing position, on all fours, or even while sitting on an exercise ball. This means that you can do them virtually anywhere, any time!
Looking at the science behind this particular exercise, a study was published in the Journal Of Physical Therapy Science in 2013 that looked at Individual Strengthening Exercises For Anterior Pelvic Tilt Muscles On Back Pain. Although this study was only conducted on one person, the researchers did find that the study participant’s back pain reduced by 50% when completing individual strengthening exercises for pelvic tilt muscles.
How To Do A Pelvic Tilt
Lie on the floor with your knees bent and the soles of your feet flat on the floor.
Gently tilt your pelvis towards your head, pressing the arch of your back against the floor, thereby taking out the arch and flattening your back. (You may need to contract your stomach muscles to do this).
Stay in this position for a few breaths, then inhale and return to a neutral position again, you should feel the return of the arch under your back, creating a small space between your back and the floor.
Repeat this exercise 5 - 10 times.
Lying Lateral Leg Lifts
Lying lateral leg lifts are highly beneficial exercises for strengthening your core and reducing low back pain. Some exercises that are recommended for core strengthening can be challenging for those just starting to work out, or for those who are scared of further injury. Lifting both legs together when you are lying on your back can be very demanding on your core and might be too challenging for many people.
While this exercise strengthens the core, it does focus on the hip abductor muscles which support the pelvis and therefore the back. These muscles are key for maintaining balance and mobility.
A study published in the Journal Of Physical Therapy in 2017 looked at a 56 year old woman with continuous severe low back pain. The subject did modified active leg raising exercises for 2 weeks and found that her VAS (visual analogue scale) pain rating was reduced by 50%.
How To Do A Lying Lateral Leg Raise
Lie on your side on the floor. You can use a mat if the floor is too hard.
Make sure that your body is in a straight line from your head to your toes, with your legs extended and your feet stacked on top of each other.
Extend your arm above your head, flat on the floor, to support your head. If you need a little extra stability you can bend your elbow or put your other arm out in front of you.
Slowly raise your top leg into the air, stopping when you feel a contraction of the muscles in your lower back.
Gently lower your upper leg back down to rest on top of the lower leg.
Repeat about 10 times and then switch sides.
Superman pose is a highly effective exercise for helping relieve low back issues. This move targets your glutes, hamstrings, lower back muscles, and your abdominal muscles. It is designed to strengthen and improve stabilization of the hip and lumbar extensors. It is another exercise that can be done no matter what your fitness level.
A 2017 study found that the superman exercise was just as effective in engaging the paraspinal muscles as a bodyweight squat which many people find more taxing on their lower back.
It is also important to note that while the superman is generally safe for most people, if you have had a recent injury to your lower back, hamstrings, glutes or abdomen, then it might not be the right exercise at the right time for you. Doing some of the previous exercises we have talked about might be a better option while you slowly build up your lower back muscles.
How To Do The Superman
Lie on your stomach on the floor with your face looking down at the floor, not in front of you.
Stretch your arms out in front of you as far as you can reach.
Slowly raise both your arms and your legs, as if you were flying. Be careful not to extend your back too much. Hold this position for 5 seconds.
Slowly lower your arms and legs back to the floor in a resting position.
Repeat this exercise 10 times.
When you think of working your abdominal muscles one of the first exercises that comes to mind is generally a sit up. While sit ups are great for building core strength, they aren’t so good for those with low back pain issues. A great alternative to the traditional sit up is what is known as a “Curl-up”.
Curl ups were developed to activate the core without involving the spine too much. This movement is associated with less injury risk since the spine isn’t being forced into repeated strained movements. This type of movement can actually aggravate the spine and increase your pain.
The Power Of A Curl-Up
Curl-ups, also known as crunches, will strengthen your abdominal muscles and stabilize your core. Start on your back with your knees bent and your feet flat on the floor. Cross your arms over your chest and slowly raise your head, neck, and upper back as you exhale and squeeze your abdominal muscles. One of the best curl ups for low back pain is the McGill Curl-up which doesn’t rely on lumbar spine movement at all.
McGill Stabilization Exercises
A 2018 Canadian study compared the effects of McGill stabilization exercises with conventional physiotherapy. The study looked at 34 patients with chronic non-specific low back pain and had them perform specific exercises for a period of six weeks.
Using the visual analogue scale (VAS) and the Quebec Low Back Pain Disability Scale Questionnaire, they found “statistically significant improvements … in pain, functional disability, and active back extension range of motion in McGill stabilization exercises group”.
Again, this finding does not mean that physical therapy is not highly recommended for low back pain, as many therapists may incorporate these exercises into their treatment plans.
What the finding does demonstrate is that McGill stabilization exercises can provide benefits to patients with chronic non-specific low back pain, especially when it comes to pain and functional disability improvement.
How To Do The McGill Curl-Up:
Lie on your back on the floor with one knee bent and the opposite leg straight out in front of you, on the floor.
Put your hands underneath your lower back so that you can stabilize your spine and make sure that it isn’t moving.
Tucking your chin in, gently lift your head and shoulders a few inches off the floor.
Squeeze your abdominal muscles and hold this position for 10 seconds.
Gently lower your head back to the floor, relax your abdominal muscles and return to a neutral position.
Repeat this in sets doing 5 reps, then 3 reps, then 1 repetition with 20-30 seconds between each set.
Exercising for low back pain is essential for both a faster recovery, as well as preventing future flare-ups. One of the best ways to prevent low back pain is to strengthen the muscles that support your spine.
There are lots of different exercises out there that are specifically designed for those who are suffering with chronic low back pain, we have shared just a few of our favorites.
For more suggestions on exercises check out our Top 5 Exercises For Low Back Pain. By doing these exercises for just a few minutes each day, you can have a stronger, healthier back.