Do you have low back pain? You’re not alone – 31% of people worldwide have previously, or currently experience this common health problem.1 If you spend long hours sitting at a desk, lift weights with poor form, or experienced previous injury being active or playing sports, there’s a good chance you have pain in your back.
Low back pain is one of the most difficult areas for health care practitioners to treat. Not only are there several possible sources of pain (including lumbar discs, facet joints, muscles, nerves, and ligaments), but there are several ways to hurt them – from bending over incorrectly, chronic poor posture, untreated strains from overuse and misuse, sitting too much, exercising too much, the list goes on.
What makes it more confusing is that different causes of back pain require different types of treatment.
Let’s first understand the most common causes of low back pain.
Main Causes of Low Back Pain
1. Chronic Poor Posture
Chances are that if you work in an office, you sit a lot. Sitting for prolonged periods of time is less than ideal because the seated posture (especially bad posture) places increased pressure on your spine. Over time your muscles can adapt to this chronic posture leading to some major muscular imbalances. The hip flexor muscles on the front of your legs and your hamstrings on the back can become tight and shortened, which can impair your ability to move correctly.
For instance, if your hip flexors are tight, you’ll have less hip extension. This means that when your leg goes behind you, it will pull on your pelvis and spine, creating extra rotation and extension in your lumbar region. This isn’t good.
If your hamstrings are tight, you’ll lack the ability to flex at your hips and pelvis. Once this happens, you’ll compensate for the lack of mobility by bending your low back more, which puts the muscles in the back in a weaker position and increases your risk of rupturing your lumbar discs.
2. Poor Movement Mechanics
Even if you have the flexibility of a yoga master, you may not be moving correctly. When your spine is out of its neutral position, the muscles that support the spine are at a biomechanical disadvantage (either too short or too long). Your ability to stabilize your trunk will be compromised. Every time you pick something up with a rounded back, you’re putting yourself at risk. And if you’re picking up something heavy, the risk increases exponentially. This is why it’s critical to be aware of your spinal posture when lifting and exercising!
Low-Back Pain Strategy
1. Moving More (Not Less) Helps Your Lower Back
In the past, many health practitioners only prescribed bed rest. However, movement and return to ordinary activity help people recover faster.2
Unless it’s too painful to move, your back will benefit from light exercise, which can help increase circulation and speed up recovery. If you have pain from some sort of trauma or have nerve symptoms that travel down into your legs (or weakness of any kind), then see a health practitioner.
Otherwise, the sooner you can start incorporating light exercise, the quicker your recovery can be.
2. Be Mindful That Pain Affects How Your Body Moves
The human body is pretty incredible. Your body “remembers” where you’ve been hurt, and even once you recover from the pain, the control of your muscles often changes in ways that you may not feel or be aware of.
The main muscles that experience change after low back pain are the transverse abdominus (TvA) and the multifidus (MFD). These are both deep trunk muscles that help to stabilize the spine and prevent it from moving, especially under load.
After a bout of back pain, the timing of TvA and MFD is thrown off (often delayed), and they may also become weak. The hope is that by training and recruiting these muscles with targeted exercises, their function will normalize.
3. Improve Hip Flexibility & Lumbar Spine Stability
The primary strategy for successful low back pain recovery and prevention is to improve (1) flexibility in your hips and (2) stability in your lumbar spine. These two exercise strategies help combat the two primary causes of low back pain.
Maintaining flexibility in your hips helps to prevent excessive movement in your low back. For instance, if your hip flexors are tight, you won’t be able to bring your leg behind you without either rotating your pelvis or overarching your low back. You’ll also end up compensating when you want to bend from the hips – if you lack hip flexion, you’ll round out your back when you squat all the way down.
In addition to hip mobility, you should train your spine stability. Start with exercises where your focus is to keep your spine still, such as the plank. By doing this, you’ll strengthen your spinal muscles in a safe position and learn to feel what it’s like to keep your spine completely stable.
Here are the best exercises to loosen your hips and strengthen your core to prevent and relieve back pain.
1. Half-Kneeling Hip Flexor Stretch
As mentioned earlier, you’ll want to have flexible hip flexors. After your warm-up routine (when your muscles and tissues are more pliable), perform a half-kneeling hip flexor stretch for 30-60 seconds on each side.
Instructions: Kneel on one knee, tighten your abdominals, and push your pelvis forward without letting the pelvis tip anteriorly. To bias the psoas muscle even more, reach up and across with the same side arm.
2. Standing or Supine Hamstring Stretch
Flexbility Test: If you can’t bend forward at your pelvis to 70-degrees, then you most likely have tight hamstrings. But, if you feel tightness or a zinging sensation into your calves when you try this, the cause is actually your nerve and you may benefit from seeing a physical therapist.
Remember, if your hamstrings are tight, when you bend down to pick something up your back will be doing the movement instead of your hips. That increases your risk of back injury.
To increase your hamstring flexibility, perform this simple standing hamstring stretch for 30-60 seconds on each leg.
Instructions: Put your leg onto an elevated surface, then reach your navel towards your knee with a flat back. No need to reach forward with your hands as you’ll only be rounding out your back, which defeats the purpose of the stretch.
Alternatively, you could perform this stretch in a supine position (on your back) with the aid of a belt.
Core Strengthening Exercises
Recently, there has been a lot of focus on the Transverse Abdominus (TvA). Two things to know about your TvA: (1) You should definitely be able to exert voluntary control of your trunk muscles and (2) you should be able to maintain a stable and firm spine.
To strengthen the deep core muscles, some health practitioners try to activate the TvA in isolation of the other core muscles. Unless your TvA really doesn’t contract (which can be confirmed with ultrasound imaging), the focus should be on engaging all of the trunk muscles simultaneously.
3. Side Plank
The side plank is one of the best exercises to engage your trunk muscles including your obliques and TvA without compressing your spine. It’s also a great exercise to improve your posture and build shoulder strength.
Instructions: Start with the modified side plank, supporting your bodyweight on your forearm and stacked knees. Hold side plank for 10 seconds, resting for only 3 seconds. Complete 10 reps.
Once you can do that, increase the duration until you can hold for 100 seconds straight. For example, hold for 20s on, 3s off. Then 30s on, 3s off. And so on.
Progressions: Perform the modified side plank with your top leg straight. Then progress to feet stacked.
4. Supine Dead Bug March
The supine dead bug march is an excellent exercise for abdominal engagement & stability.
Instructions: Lay on your back while maintaining your natural arch (you can place a small folded towel under your lumbar spine to help). Raise your arms and legs up to the ceiling, knees bent to 90-degrees over your hips. Maintaining your neutral spine position, touch one toe to the ground. Then bring the leg back to the starting position and repeat on the opposite leg. Perform for 2 min straight, keeping your spine in a neutral position the entire time.
Progressions: Extend your leg straight to hover just above the ground. Progress to straight legs, and extending opposite arm and opposite leg to hover above the ground.
5. Bird Dog
While this exercise might look easy, it’s actually pretty challenging. Why it’s good: extending your opposite arm and leg out creates a force vector that moves diagonally across your back, challenging multifidus to contract to keep your spine from rotating. This is an excellent exercise to recruit multifidus & build spine stability.
Instructions: Start in a tabletop position on hands and knees. Your shoulders should be over your wrists, and your hips over your knees. Keeping your hips and shoulders completely square, reach your right arm forward and your left leg back. Hold for 5 seconds, then return to the start position before switching sides. Perform for 2 min straight, alternating sides every 5 seconds.
Progressions: Place a foam roller on your lumbar curve and don’t let it fall off. Another progression is to place your knees and your hands together, maintaining your balance as you perform bird dog.
Movement Training Exercises
When combined with a focus on spinal stability, these exercises are great for training proper movement and core stability.
Squats are a fantastic core-strengthening exercise – when you do them correctly.
Start with bodyweight squats. Do your squats facing sideways next to a mirror so you can see your form. The goal here is to keep a neutral spine throughout the squat movement. That means, no butt wink! If your pelvis rotates under, then your lumbar spine is flexing. Don’t add weights until you confidently squat with perfect form.
Instructions: Stand tall with your feet slightly wider than your hips, feet slightly turned out. Keeping your chest tall and your core tight, bend your knees and reach your butt back as if you were sitting in a chair. At the same time, drive your knees out over your second toe (don’t let your knees collapse in). Your spine should remain neutral the entire time. From the bottom position of the squat, push through your feet to bring yourself all the way back to standing.
Progressions: Squat with one weight on one side, squat with one leg
7. Hip Hinge
Learn to move from your hips, and not your back. After perfecting the move without weights, try the Romanian Deadlift or the single-leg deadlift. Once you can do these basic movements, start performing them asymmetrically. The unbalanced load will require your rotational stabilizers (i.e. multifidus) to contract, helping increase your stability and core strength.
Instructions: Start standing tall, shoulders over hips over heels. Holding a dowel or a broomstick along your spine (touching your head, upper back, and lower back), push your hips back to the wall behind you while keeping your knees over your ankles. When you feel a stretch along the back of your legs, drive through your feet and squeeze your glutes to stand all the way back up. The dowel should stay in contact with your head, upper-, and lower-back the whole time. Continue to reach the hips back and then stand tall for 10 reps. Complete 2 sets.
Progressions: Deadlift, Single-leg Deadlift
Note, I didn’t mention the benefits of yoga or pilates. It’s not that these exercise forms don’t help, because they do. Yoga is great for building flexibility, and holding certain positions can be very challenging. Pilates uses a very intelligently designed system of pulleys and levers to challenge the entire body. It might even be easier in pilates to isolate certain muscle groups. But personally, I prefer other movements. I’d rather train to stay quick on my feet or to lift heavy things. If you enjoy yoga, pilates, or other form of movement, they can definitely be good for you. However, they’re not something I recommend for everyone.
Proper mobility and strengthening is something I recommend for everyone. And finally, lifestyle considerations are important including your desk setup, how you sleep, and other factors.
Do you have low back pain? What are your favorite core strengthening exercises?
- Hoy D, Bain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028-37. ↩
- Malmivaara A et al. The Treatment of Acute Low Back Pain – Bed Rest, Exercises, or Ordinary Activity?New England Journal of Medicine. 1995;332:351-355 ↩