Following on from the number 1 rule “UIOLIBDAI” in “Should I do exercises with lower back pain / sciatica?“, the answer to “Which are the best exercises for lower back pain?” could simply be “Any exercises that don’t increase your pain immediately or within the next 24 hours”. But let’s dive a bit deeper than that.
There are different causes of of lower back pain. In technical terms, “Lower Back Pain (LBP)” is a symptom and not a diagnosis. It’s like “sciatica” or “headache” – it tells you where the symptoms are but not why you have them. There are all sorts of underlying causes (the common name for which is “diagnosis”), but interestingly there is very little research evidence that one type of exercise suits one diagnosis. However, from an exercise and movement perspective, there are different ways of classifying LBP, which do lead to different exercise prescriptions.
Instability or no-instability
Instability in your lower back means that there are one or more vertebral joints over which you have poor muscular control, and this is often associated with excessive movement at that joint. What’s confusing is that most people who have lower back pain feel their lower backs are “stiff and inflexible”, but when assessed by an experienced clinician (who knows how to test for instability), we discover that there are joints that are anything but stiff. These joints are overly-flexible compared with the neighbouring spinal joints and often cause protective muscle spasms when some movements are attempted. These movements frequently include (but are not limited to) turning over in bed, getting up from bed, or from a chair, and getting out of or into a car, and sudden unexpected movements. However, if you have pain on these movements, it doesn’t necessarily follow that you have instability. Sorry if this seems less than clear, but that’s the world I work in 😉 A lot of this approach and the related exercises are from the work of Professor Emeritus Dr Stuart McGill (now retired) of the University of Waterloo, who spent most of his 32 years as a professor researching spinal mechanics. As a side-note, if you have instability, it will almost certainly feel worse if a therapist manipulates those joints.
In a clinical setting, we have ways of testing for instability; and if you test positive (i.e. we determine that you do have instability) then we give you very specific exercises, including Abdominal bracing and Front Back and Side muscular endurance exercises. As it says, these latter exercises are designed to improve the endurance of your front back and side abdominal muscles – all the muscles that support the spinal column.
If you don’t test positive for instability, in the long-term, we will almost certainly still give you Front Back and Side exercises, but not immediately. There’s good evidence for these exercises helping to minimise the risk of recurrence in lower back problems generally, but not for helping to ease current symptoms.
For non-instability lower back pain, we sub-categorise into 3 groups:
- Flexion Intolerant
- Extension Intolerant
Flexion Intolerant Lower Back Pain
If your LBP is worse sitting, after sitting, bending forwards, or returning from bending forwards it is described as “Flexion Intolerant” and is likely to benefit from back-bending exercises.
Extension Intolerant Lower Back Pain
If your LBP is worse standing, after standing, bending backwards, or on returning from bending backwards it is described as “Extension Intolerant” and is likely to benefit from – you guessed it – forward-bending exercises.
Unspecified Lower Back Pain
If both movements – forward-bending and back-bending – aggravate your LBP or if neither of them affects your pain, your pain would be described as “Unspecified”, and I simply encourage you to try a range of exercises but be governed by the UIOLIBDAI rule.
What about stretching exercises for lower back pain?
If you have instability LBP, stretching it is probably a bad idea – and that’s what the research shows; you can make it feel worse and/or prolong your recover time. Many people feel (which isn’t the same as really having it) they have stiffness in their lower back and hips, and feel better in the short-term for doing stretching exercises. This is probably because when you stretch muscles you stimulate certain nerves which send messages to your spinal cord that effectively block the pain messages. However this is a short-lived effect and there’s no evidence that stretching lessens pain in the long-run or prevents it. That is not to say that you shouldn’t stretch or that it’s a total waste of time – stick to the UIOLIBDAI rule!
Sample Exercises for lower back pain
The below exercises are all taken from our online course for lower back pain. Within the course there are a progression of these exercises i.e. as you get better, you move up a level, so that you’re always improving and steadily moving yourself further back from the edge of The Cliff of Pain. I have been doing Level 5 of this program for over 20 years, and my back is as strong as it’s ever been – even though I’m clearly a good deal older than when I started!
Above is an audio recording of me talking you through abdominal bracing, because it’s very difficult to show in a picture!
Front Exercise Sample
Curl Ups Level 1 (entry level)
Back Exercise Sample
Bridge Level 1
Side Exercise Sample
Side Plank Level 1
Forward bending sample exercise for Extension Intolerant LBP
Back bending sample exercise for Flexion Intolerant LBP
For non-instability and instability LBP there are a huge number of movements you can do that will help. Always follow the number 1 rule “Use it or Lose it, but Don’t Abuse it” and you won’t go far wrong. There are many other exercises in the Online Course for lower back pain. Within the course we split exercises up into:
- Reliever exercises – that get you back up to the cliff top
- Preventer exercises – that get you back from the edge of the cliff
- Foundation exercises – all about how to move well and improve your daily postures, which will also help reduce the risk of recurrence and help to relieve your initial LBP.
For all types of LBP it’s also important to learn how to use your back most efficiently in day-to-day movements, such that you’re building strength and endurance rather than weakening and straining it. This includes learning the hip-hingeing sequence proposed by Dr Stuart McGill – thank you again Dr McGill. This isn’t included here, but is the topic of another article entitled “Why is hip-hingeing good for lower back pain?”