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What is the best exercise for lower back pain? Part 3: Other Exercise

I find in practice that my patients often think that only Yoga and Pilates type exercises can help lower back pain. If the thought of you being told to breathe in deep while contracting this and moving that fills you with dread, you’ll be happy to know that these are not the only forms of exercise that can improve lower back pain!



In this series of 3 blog posts, I have so far looked at:

Part 1: Does Pilates benefit people with lower back pain?

Part 2: Does Yoga hold any benefits for lower back pain sufferers?

My third and final post in this series will now look at other forms of exercise that have been shown to help people with lower back pain.


So, do you have to do Yoga or Pilates if you have lower back pain?


You may have guessed the answer to this by now. No, there are plenty of other forms of exercise that you can do that can also help lower back pain.


The most effective exercise for lower back pain


Hayden et al. looked at all the different exercise strategies employed in studies that investigated exercise for lower back pain. They identified that the most effective strategies:

  • Were individually designed exercise programmes,

  • delivered in a supervised format (for example, home exercises with regular therapist follow-up),

  • done often.

  • Adding other conservative treatment, such as advice to stay active, NSAIDs, or manual therapy, also resulted in improved pain and function outcomes when compared to exercise only.

What type of exercises should be included for lower back pain?


Researchers have found that stretching exercises appear to be the best type of exercise to decrease pain while strengthening exercises are the most effective at helping people function better. A recent study has even shown that free weight training can be an effective treatment for lower back pain.


Other types of exercise that has been found to be useful include aerobic exercise, mobilising and coordination exercises.


My ideal exercise programme for lower back pain


I usually prescribe a combination of stretching, mobility and strengthening exercises that should be done daily and cardiovascular exercise that should be done at least 3 times a week.


My patients usually consult me on a weekly basis for 2 or 3 weeks, during which we adapt their exercise programme to make sure it works for them. I usually also include self-massage techniques that help with their pain.


Once their pain starts to settle and they are confident with their exercises, I send them away to continue their exercises and only see them every few weeks to progress their programmes.


1. Stretches


These should be very gentle to start with and what I choose will depend heavily on the cause of my patient’s lower back pain. Someone with acute nerve pain down the leg will for instance make their symptoms worse if they try to stretch their hamstring, since this stretch will also stretch the irritated nerve. I have included some examples of my favourite stretches for lower back pain in the next section.


2. Gentle mobility exercises


People who have had severe pain or have been in pain for a long time can be very fearful of movement. Prolonged lower back pain can also cause the subconscious brain to be over-protective and cause it to shout “Pain!” for things that is not supposed to be painful.


You can switch this over-protective system off by doing gentle movements in positions that the “brain” feels safe in and then slowly move on to more challenging positions.


A good example of this is the spine curl exercise (see below) that you do while lying on your back. I use it often for patients with lower back pain who cannot bend forward in standing or who try to avoid flexing their spine when I tell them to touch their toes.


3. Strengthening exercises


These can take many forms and can include: bridges, squats, abdominal exercises, back extension exercises etc. The main point to remember is that you should be able to do very simple stable exercises first, before you can progress to more dynamic things e.g. kettle bell swings. You can find an example of a strength training programme for lower back pain here.

Your exercise selection will once again be dictated by the cause of your lower back pain.


4. Cardiovascular exercise


This is a very important component of any exercise programme for lower back pain and one that I feel is often neglected. It helps to improve the whole body’s health status, but can also act as a potent pain killer due to the "happy hormone" released during cardiovascular exercise.


My weapon of choice is usually cycling on a stationary bike. I prefer this exercise due to its low impact and your ability to play with your position on the bike. I find it especially useful for people who spend a lot of time sitting during the day.


In my experience, the gluteal muscles (your bum muscles) can often contribute to my patient’s lower back pain and cycling seems to have a positive effect on them, which is likely due to increasing their blood supply.


Other useful choices can include walking, using a cross-trainer and swimming. Your choice should be influenced by your personal preference and how your back reacts to it. I usually ask people to avoid breast stroke, because the rotation movement of the legs can sometimes stir things up a bit.


Choose something you enjoy! Otherwise you will not stick to it. Try to do it at least 3 times a week.


Example exercise programme for someone with acute lower back pain:


You should feel either better or the same after you have done these exercises – not worse. These exercises will not suite everyone.


1. Be as active as your back allows you to be.


Do any activity that does not cause an increase in your pain. Swim, cycle or walk.

You may have to decrease the time you do these activities for e.g. swim for 30 minutes rather than your normal hour.


2. Piriformis and gluteal stretches


You should only feel a gentle stretch – not pain. DO NOT PULL TOO HARD.




  • Lie on your back with your knees bent.

  • Place the outside of your right ankle on your left thigh.

  • Place your right hand on your right knee and your left hand on your right lower leg.

  • Now pull your leg up to your chest so that your right knee moves towards your right shoulder.

  • Hold the position for 30 seconds. Repeat with your other leg.

  • Do 3 repetitions on each leg.



  • Then repeat the exercise, but pull your leg diagonally across your chest so that your right knee approaches your left shoulder.

  • Hold the position for 30 seconds. Repeat with the other leg.

  • Do 3 repetitions on each leg.

You should feel a stretch in your buttock and/or back of your thigh. You can sometimes feel a stretch in your back if you are really tight.


3. Lumbar rotation stretch


You should only feel a gentle stretch – not pain. DO NOT PULL TOO HARD.




  • Lie on your back with your legs straight. Place your left foot on your right thigh just above the knee.

  • Now use your right hand to pull your left knee over to the right so that your lower body rotate to the right.

  • You should feel a stretch in your left buttock or lower back. Your buttock and lower back are allowed to lift off the bed, but your upper back should stay flat.

  • Hold the position for 30 seconds and repeat it 3 times to both sides.

4. Spine curls


This exercise is great for regaining some mobility, but it is also a gentle strengthening exercise for the back, gluteal and thigh muscles.




  • Lie on your back with your knees bent.

  • Pull in your lower tummy muscles so that your pelvis tilts backwards and your lower back flattens into the bed.

  • Slowly lift your bottom off the bed and then imagine lifting one vertebrae at a time until your trunk forms a straight line. If you find that it causes you pain to lift your back up, only lift to before you feel the pain (this may sometimes mean that you only do the pelvic tilt and do not even lift up). The more you do it to just short of pain, the better you will get. Eventually you will be able to do the full movement.

  • Once you reach the end position, maintain the position for 10 seconds before slowly rolling down to the bed. Make sure that your bottom is the last thing to touch the bed. So you roll up in a wave and then come down in a wave.

  • Repeat this 10 times.

Be careful not to try and lift too high. It can cause you pain if you try and over-extend your back.


Let me know if you have any questions. Need more help with an injury? You can consult me online using Skype video calls.

Best wishes

Maryke

Sports Physiotherapist


References:

  1. Hayden, J. A., van Tulder, M. W., & Tomlinson, G. (2005). Systematic Review: Strategies for Using Exercise Therapy To Improve Outcomes in Chronic Low Back Pain. Annals of Internal Medicine, 142(9), 776-785.

  2. Mostagi, F. Q. R. C., Dias, J. M., Pereira, L. M., Obara, K., Mazuquin, B. F., Silva, M. F., et al. (2014). Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects. Journal of Bodywork and Movement Therapies.

  3. Patti, A., Bianco, A., Paoli, A., Messina, G., Montalto, M. A., Bellafiore, M., et al. (2015). Effects of Pilates Exercise Programs in People With Chronic Low Back Pain: A Systematic Review. Medicine, 94(4), e383.

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