Exercise and Back Pain

A typical response to experiencing back pain is to take it easy - either staying in bed or at least stopping any activity that is at all strenuous. While this approach is understandable and may even be recommended in the short term, when done for more than a day or two it can actually undermine healing. Instead, active forms of back exercises are almost always necessary to rehabilitate the spine and help alleviate back pain.

When done in a controlled, gradual, and progressive manner, active back exercises distribute nutrients into the disc space and soft tissues in the back to keep the discs, muscles, ligaments and joints healthy. Consequently, a regular routine of lower back exercises helps patients avoid stiffness and weakness, minimize recurrences of lower back pain, and reduce the severity and duration of possible future episodes of low back pain.

Depending upon the patient’s specific diagnosis and level of pain, the back pain exercises and rehabilitation programs will be very different, so it is important for patients to see a spine specialist trained to develop an individualized program of back exercises and to provide instruction on using the correct form and technique.

To be effective, a patient’s program of back exercises should be comprehensive, working the whole body even if it targets the back. Two back exercises commonly advised by physical therapists to treat back pain are McKenzie exercises and dynamic lumbar stabilization. See back strengthening exercises.

A balanced workout of back exercises should include a combination of stretching, strengthening, and low impact aerobic conditioning. See low-impact aerobic exercise.

Stretching as part of a routine of back exercises

Almost everyone can benefit from stretching the soft tissues - the muscles, ligaments and tendons - in the back and around the spine. The spinal column and its contiguous muscles, ligaments and tendons are all designed to move, and reduced motion can accentuate back pain. Stretching different muscles and ligaments during back exercises is essential for gaining and maintaining mobility and flexibility. Patients with chronic back pain may find it takes weeks or months of stretching to mobilize the spine and soft tissues, but will find that meaningful and sustained relief of low back pain typically follows the increase in motion experienced via back exercises.

The most important muscles to target during back exercises are:

• Hamstrings in the back of the leg to aid correct posture while sitting and standing, and support the gluteus muscles in the buttocks and the hip flexors and minimize stress on the low back.
• Piriformis, which run from the back of the femur (thigh bone) to the sacrum (the base of the spine). When tight, this muscle can cause sciatica-like pain, and has been linked to sacroiliac joint dysfunction.
• Psoas Major, which is attached to the front portion of the lower spine and can greatly limit low back mobility if tight, making it hard to stand for extended periods or kneel on both knees.
• Gluteus muscles of the buttocks, which support hip flexibility as well as the pelvis.

Stretching should be done daily, perhaps several times a day, to ensure flexibility. See also Stretching for back pain relief.

• Article written By:
• Peter F. Ullrich, Jr., MD

June 15 , 2009

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