For Back Pain, Exercise May Be the Best Prescription

Exercising when you've got lower back pain might be the last thing you want to do, but it may be your best bet for finding relief.

Specifically, strengthening your core muscles can help reduce chronic lower back pain and the disability it causes, according to guidelines from the Orthopaedic Section of the American Physical Therapy Association (APTA). Core exercises can even help prevent future pain episodes.

The core, defined

Your core is essentially the center of your body. It includes the diaphragm and muscles in your abdomen as well as those in your back and hips. Among these are the paraspinals that run parallel to your spine on either side and provide support and stability.

Working with other muscles like the abdominals and obliques, the paraspinals also allow the spine to move and rotate while maintaining its alignment. The muscles of the pelvic floor form the bottom of your core. These are muscles that attach to the end of your spine and support and protect the organs in your pelvic region.

Your core muscles are meant to work together. When they do, they provide stability, support, and protection for your spine and other organs. They make it easier to breathe, to be flexible, and to move while maintaining balance—all while protecting your body from injury.

Core training is not about enhancing individual muscles. It aims to improve overall coordination of these muscles so they can work together to do their job.

What the research says

Recommendations in the APTA guidelines for treating lower back pain are based on analysis of current research.

They included the following randomized trials:

A study published in 2009 in Spine compared the results of a treatment plan including an exercise program focused on stabilizing the core with the results of a treatment plan that included a general walking program. The study showed that core exercises were more effective than the walking program at meeting treatment goals. This was true at the end of the treatment period as well as at one-year and three-year follow-ups.

Another study in Spine involving 39 patients compared the results of a treatment plan that included core exercise with the results of a plan without exercise. In the core-exercise group, 35 percent of the patients reported having recurring episodes of lower back pain over the next three years. But in the no-exercise group, 75 percent of the patients reported recurring back pain during the same time period.

Using these and other similar studies, the APTA concluded that core exercise was an effective treatment for improving lower back pain as well as preventing recurrent episodes.

Research is continuing. A 2014 study in the Journal of Physical Therapy Science compared treatment including core training to routine care without exercise. Adding core training not only had a greater effect on pain, but also made a significant difference in restoring range of motion.

A study published in 2015 in the same journal reported significant improvement in treating pain and lumbar instability when hip exercises were added to other core exercises in the treatment plan.

In another study, published in a January 2016 issue of JAMA, a team led by experts from the University of Sydney analyzed data from 21 randomized clinical trials that tested a variety of ways to prevent low back pain. Together, the studies included more than 30,000 people. Some trials looked at exercise or back education (how to bend and lift safely, for example). Others examined products like back belts and shoe insoles.

Only one approach seemed to help prevent recurring bouts of low back pain: exercise, either with or without back education.

The review concluded that back support belts and shoe insoles didn’t offer measurable benefit. The evidence for ergonomic adjustments, such as specially designed chairs or desks, was found to be inconclusive.

Precautions to take

Here's what to keep in mind when considering core training as part of your back pain treatment plan:

Understand that core exercises may not be appropriate for everyone, especially during the first episode of acute lower back pain. Your doctor may want you to wait until the cause of your pain has been determined.

Exercise with the supervision of a health professional, someone trained to work with people who have back problems. A physical therapist or rehab specialist can show you how to do the exercises to get the most benefit. The therapist should also individualize the program to meet your particular needs and then monitor your progress. Patients who exercise on their own seldom get the benefits that supervised core exercise offers.

Pay attention to your body. Exercise should improve your symptoms, or at the very least keep them from worsening. If an exercise intensifies pain or causes pain to spread (down your leg, for example), stop exercising and let your therapist know.

Combine core training with aerobic exercise; doing so can greatly enhance the benefits of pain reduction derived from both types of exercise. Again, your doctor or therapist can help you find the right balance.

If you aren’t currently exercising, don’t start until you discuss with your doctor what you should and should not do.

A core exercise sampler

Here are three examples of exercises you might do while working with a therapist. Before you start, be sure to warm up. Walking for 5 or 10 minutes or riding a stationary bike for 10 minutes are good warm-up exercises.

1. Stretching. An exercise session typically starts with a series of stretches. The following will help stretch your lower back:

Start by lying on your back.

Raise your right leg and bring your knee toward your chest.

Hold your knee with both hands and pull it as close to your chest as it will go.

Hold for 5 seconds. Eventually, you’ll likely hold the stretch for about 30 seconds.

Repeat with the left leg.

Check your back. If the pain has increased, stop. If not, repeat the stretches for a total of three with each leg.

2. Strengthening. Bridging is a common exercise that will work on strengthening your lower back as well as the muscles in your hip and thighs:

Lie on your back with your knees bent and feet flat on the floor. Keep your arms at your side.

Tighten your hips and abdominals, and lift your buttocks from the floor.

Hold for 5 seconds and then return them to the floor.

Repeat up to 20 times.

Your therapist may work with you on raising your pelvis higher with the goal of forming a straight line from your knees to your shoulders.

3. Flexing. Some exercises like the lumbar rotation will help you increase the flexibility of your lower back:

Lie on your back with your knees bent and your feet flat on the floor.

With your knees together, move them to one side as far as is comfortable while keeping your feet flat on the floor.

Hold for 5 seconds, then roll your knees to the other side.

Hold for 5 seconds, then return to the starting position.

Repeat up to 10 times.

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HealthAfter50 was published by the University of California, Berkeley, School of Public Health, providing up-to-date, evidence-based research and expert advice on the prevention, diagnosis, and treatment of a wide range of health conditions affecting adults in middle age and beyond. It was previously part of Remedy Health Media's network of digital and print publications, which also include HealthCentral; HIV/AIDS resources The Body and The Body Pro; the UC Berkeley Wellness Letter; and the Berkeley Wellness website. All content from HA50 merged into in 2018.