The Best Physical Therapy Exercises for Lower Back Pain (And What to Avoid)

When most people think about lower back pain relief they think "Abs". We get it, everybody wants washboard abs. However, having strong "abs" doesn't necessarily mean you have core stability. You can do hundreds of crunches every day and still have back pain. Let us explain.

Core stability is accomplished by activating and strengthening your deep, internal muscles that act as your natural spinal brace. Weakness or de-coordination in these muscles can often cause low back pain.

Unlike typical bodybuilding exercises, physical therapy exercises for lower back pain are designed to correct dysfunctional muscles by restoring proper movement and coordination. Research has shown that when combined with other therapies, PT exercises can dramatically reduce pain and keep it away longer than other treatments.

Consult first with Summit Physical Therapy before beginning any exercise program. Some back problems actually feel better with forward bending motions, like spinal stenosis. Herniated discs that press on nerves can actually feel worse doing these stretches. That is why exercise should always be individualized based on your specific condition.

That is why we take such a personalized approach to treatment at Summit Physical Therapy. Your physical therapist will assess your condition and help determine what exercises will increase your mobility, and decrease your pain.

Performing the wrong exercises can cause more damage and make your injury worse. If an exercise increases pain, numbness, or weakness down your leg, that is your cue to STOP and consult with a professional.

Phase 1: Mobilization (Let's Get Moving)

This is the absolute opposite of what most people do when they hurt their back. We know that when you are injured, your body goes into protective mode by guarding (tightening up) the muscles around the painful area. However, prolonged periods of non-use can make your condition worse.

Below are some great lower back pain exercises for at home to help you return to normal, pain-free range of motion:

Knee-to-Chest Stretch

Lie on your back with your knees bent. Pull one knee up towards your chest until you feel a gentle stretch. Hold for 15-30 seconds while taking deep breaths. Slowly lower leg and repeat on other side.

Pro tip: Don't yank your leg toward your chest! If you cannot reach your knee, place a towel around the thigh and gently pull on the towel.

Lower Trunk Rotation

This motion is often one of the first things we notice when we hurt our back. Pain free rotation is important to restore while keeping your spine safe.

• Lie on your back with your knees bent and feet flat on the floor. Arms should be straight out to your sides.
• Keeping your shoulders on the ground, slowly roll your knees to one side.
• Only go as far as you feel comfortable. You should feel a gentle stretch, not pain!
• Hold for a couple seconds then return to center and repeat on the other side.
• Aim for 10 slow controlled rotations per side.

Phase 2: Activation (Let's Turn These Muscles On)

Mobility is great, but it's just as important to activate or "wake up" muscles that have gone dormant from being in pain. Safe core strengthening exercises for lower back pain like these help to regain strength and muscular control:

Posterior Pelvic Tilt

This exercise is critical for core stabilization. It teaches your body how to flatten out your lower back by contracting your core muscles.

• Lie on your back with knees bent and feet flat on the floor. Tighten your abdominal muscles by pulling your belly button toward your spine. Continue to flatten your lower back into the floor. Hold for 5-10 seconds, then relax. Repeat 10-15 times.
• Remember to breathe! Many people hold their breath when trying to contract their abdominals. Don't do this!

Clamshells

Weakness in the buttocks can often overload your lower back. The clamshell exercise allows you to specifically target the gluteus medius to help stabilize your hips.

Lie on your side with knees bent at 90 degrees and feet together. Keeping your feet together, lift your top knee while squeezing your glutes. Hold for 2 seconds, then slowly lower back down. Repeat 12-15 times per side. Place a resistance band around your thighs for added difficulty.

Phase 3: Stabilization (Let's Build Endurance)

Strength without endurance is useless. Phase 3 lower back pain exercises will help you build endurance with your core muscles during your daily activities such as walking, standing upright, picking kids off the ground, etc.

Dead Bug Variations

A great exercise to strengthen your core while increasing overall coordination:

• Lie on your back with arms extended overhead. Bend both knees to 90 degrees.
• Slowly lower your right arm out straight overhead while extending your left leg out straight.
• Return to the starting position and repeat on the other side. Complete 8-10 repetitions per side.
• Keep your lower back glued to the floor during the entire exercise. If your back lifts off the floor, scale back the movement.

Modified Planks

There are many variations of planks that target your core muscles without putting excess strain on your back.

• Knee Plank: Start on your hands and knees. Walk your hands out until you are in a straight line from your head to your knees. Hold plank for 10-30 seconds. Repeat 3-5 times.
• Wall Plank: Similar to a knee plank, but lean forward with your hands on a wall. Your body should form a straight line from your head to your hands on the wall. Hold for 20-60 seconds.

Once you build up strength, try progressing to incline planks by using countertops, tables, and benches.

Lower Back Pain Exercises to Avoid

When it comes to lower back pain some exercises are better than others. The following movements can cause increased irritation to your injury.

Full Sit-Ups

Sit ups are terrible for your back! Not only do they cause extreme amounts of compressional force to your low back discs, but they also overwork your hip flexors. The hip flexors pull directly on your lumbar spine and can make your pain worse. Try crunches instead!

Double Leg Lifts

Okay, so you're lying down reading this going… Doesn't everyone do these when they workout their abs?! WRONG. When you lift both legs at your waist while lying down, you are essentially forcing your lower back into the biggest "diet-OMG!" you have ever seen. Save yourself the pain and try lifting one leg at a time. Or, even better, don't do them at all if your back is injured.

Toe Touches (Standing Forward Bend)

If your back is hurting, putting your body into this position is basically asking for more pain. When you bend over with straight legs, you are maximizing the pressure on your spinal discs. Plus, you're probably thinking you are stretching your hamstrings… you are, but at what cost to your back?

Do This If Lower Back Pain Exercises Hurt

• Sharp or stabbing pain
• Radiating pain down your leg
• Numbness or tingling in your foot that is new or worsening
• Weakness in your leg or foot
• Loss of bowel or bladder control (call 911)

Remember, recovery takes time. Some days you will feel great, some days you may not feel like you can even get out of bed. The best exercise for lower back pain is to be patient and consistent. These exercises WORK, but only if you do them on a regular basis and with proper form. Start slow and take it day by day, before you know it you'll be back to playing with your kids at the park pain-free!

FAQs related to Lower Back Pain Exercises

How long will it take before I see improvement?

Consistency! If you perform your physical therapy exercises for lower back pain every day as part of your rehabilitation program you can expect to start feeling better in as little as 2-3 weeks. For long term, lasting relief you can expect it to take 8-12 weeks.

Note: 10 minutes of exercise each day is much more beneficial than 1 long session a week!

Can I perform these lower back pain exercises in bed?

Yes and no. Exercises such as knee-to-chest stretches and clam shells can easily be performed in bed. However, your bed is not a stable enough surface to perform core activation exercises such as planks and dead bugs. If you plan on doing your morning exercises in bed, try performing them on the floor with a yoga mat for more stability. At Summit Physical Therapy, we can also teach you modified versions if reaching the floor is difficult for you.

I felt a pop when exercising, is that bad?

It depends on the type of pop you feel. Often when joints pop it is called benign joint cavitation. Essentially, the gases in your joints are being released which can cause a pop / click feeling. Many people even feel instant relief or improved range of motion when this occurs. However, if you feel a pop accompanied by sharp pain, swelling, or loss of function you may have injured a ligament, muscle, or disc. Do not perform any exercises that cause pain, apply ice, and rest. If symptoms persist for more than 1-2 days, please consult your doctor or physical therapist.

Should I wear a back brace when exercising?

If you just injured your back and the doctor recommended bedrest, then yes you should wear a back brace while exercising. But for the most part, bracing your back while exercising is not recommended. Internal bracing (strengthening your core muscles) is always preferable to having a hard piece of plastic supporting your back. The only exception would be if you plan on performing strenuous labor or have recently had spine surgery that your doctor recommended you wear a brace.

Can I continue to exercise if it hurts?

While it is normal to experience some discomfort when performing these exercises, you should NEVER experience pain. Pain is your body's way of telling you that you are hurting yourself. If an exercise causes you pain, stop immediately and consult with your physical therapist. You can always modify the exercises to make them easier. But NEVER ignore pain!