How to Exercise Despite Low Back Pain

Christina Lasich, MD Health Pro March 31, 2010
  • Back pain happens. Even though the pain is constant, sometimes life just has to move on. Because life is an Olympic event, staying fit is the best way to stay healthy. But how does one safely exercise with a pain in the back? Some may say that such a feat is impossible without causing further injury or worsening pain. Others have found that by following some simple rules, exercising despite chronic low back pain is possible.


    Here are ten rules for developing a workout with back pain.


    1)    All the movement should come from the hips not the back. When exercising on a treadmill, stationary bike or other equipment that uses the legs, one should be mindful to keep the back still while the hip joints do the work. If the lumbar spine gets too involved in the movement of the legs, this is called lumbar compensatory movement because the low back is trying to compensate for the inadequate action in the lower legs. Learning to separate the movement of the lower extremities from the lumbar spine, through improved lumbar-hip coordination, serves a back patient well during exercise activity and life activities.


    2)    Find a sustainable pace. Pushing the body too hard, too fast, without adequate recovery time, will only add more pain to the low back fire. Even world class athletes have to learn how to set a sustainable pace. This concept not only applies to the actual time spent during the workout, but also to the entire program as the weeks, months and years goes by. Sustainable means that the pace can be maintained without interruption or weakening during the allotted time or distance.


    3)    Find your baseline amount of exercise that will not cause a flare-up. Along with the need for a sustainable pace, one with back pain also needs to find the baseline amount of exercise that will not cause a major flare-up that lasts more than two or three days. From this baseline, the programmed amount can build. For example, a walking program may get off on the wrong foot if one suddenly decides to start the program by walking for one hour. That one hour can cause a huge increase of pain that lasts for weeks if one is not used to walking, benign as walking may seem. Walking is not benign to a painful low back; so, starting with five minutes might be a more appropriate baseline. Remember, mountain climbers who climb Mount Everest do not start by climbing Mount Everest. All mountain climbers should start small and aim big.


    4)    Avoid reaching. The lumbar spine experiences so much stress picking up a five pound weight with a fully outstretched arm. A better way to exercise is by reducing the reaching and picking up objects with the hands close to the body.  Those who remember some principles of physics will remember the concept called a lever arm force. The use of lever forces can accomplish great things like building pyramids. On the other hand, the lever arm created with an outstretched arm really torques the low back, especially if the person who is reaching does not have good core strength.


  • 5)    Increase the base of support for the back. If the back starts to hurt during an exercise, one strategy is to increase the base of support for the body. This means that if the feet are together, place them further apart. If the feet are already shoulder width apart, try touching a finger down to create a third “leg” of the “stool”. This strategy can be used in the gym while exercising or at home while washing dishes. The more support the low back has during an activity, the more activity tolerance the low back will have.


    6)    Unload the spine while exercising. Unloading and depressurizing the spinal discs throughout a workout can help to control pain during the workout. One way to unload the spine while using a stationary, upright bicycle is to place a walker around the seat so that the handles of the walker can support the body weight while one is sitting and pedaling on the bike. An upright bicycle can even be used with a slant table to allow a person to nearly lie down while pedaling.  Imagination and creativity can make exercising with back pain possible by unloading while exercising.


    7)    Start with low repetition at a slow pace. Most exercise programs fail on the first day primarily because day one causes too much pain. Back pain is frustrating and discouraging to anyone who is not smarter than the problem. Initiating a workout program takes strategy and baby-steps.  Trying a new exercise for just one minute on the lowest weight or resistance reduces the likelihood of a flare-up and can increase the chances of trying it again and again and again. With each try, an exercise can eventually be done for longer periods of time, at higher weights or speeds. Progress from low repetitions, low weight, low speeds is accomplished with a sustainable pace, slow and steady.


    8)    Use proper body mechanics that maintain a neutral spine posture. Overextending the lumbar spine while doing a push-up will cause more pain. Flexing the spine too much while doing a sit-up will cause more pain. Maintaining a neutral, comfortable posture throughout an exercise will be much more sustainable. At this point, working with a professional will help because posture awareness does not come naturally to one who already has back pain. Exercises should not be done without proper body mechanics and proper instruction.


    9)    Unload the spine after exercising. After all the work is done, it is time to reward the lumbar spine with a deposit into the “back account.” Traction, inversion, and use of a Zero Gravity chair are all ways to take the most amount of pressure off the low back. In fact, unloading should be done throughout the day.


    10)    Have fun! You are in less pain if you are having fun. This point is true and should be taken advantage of when designing an exercise program. Find something you enjoy doing and just do it.


    All of these rules may seem like common sense; yet, it is surprising to see how many of these rules are broken by those who wish to exercise despite low back pain. Just by following these simple tips, even the seemingly impossible feat of fitness can become possible.