Exercise and Physical Therapy

By: Peter F. Ullrich, Jr., MD

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A regular routine of back exercises can prevent low back pain and/or reduce the severity and duration of any “flare-ups.” Controlled, gradual, progressive back pain exercises can help the back retain its strength and flexibility. Also, back movement promotes the delivery of nutrients to spine, keeping discs, muscles, ligaments, and joints healthier.

Prior to starting a new exercise program, it is always advisable for patients to first see a spine specialist who is trained in developing individualized back exercise programs and in instructing patients in using the correct form and technique for each exercise. Low back pain exercise regimens will vary widely depending on the patient’s diagnosis and level of pain.

Stretching to reduce low back pain

Nature designed the spinal column and all of the connected muscles, ligaments, and tendons for motion, and limitations in the back’s range of motion can cause low back pain. While it may take several weeks or months of regular stretching to see improvement, patients with chronic low back pain often find that better range of motion in their low back leads to relief of their low back pain. Some of the stretching exercises below may help alleviate low back pain.

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Hamstring stretches. Researchers have noted a link between tight hamstrings (the large muscles in the back of the thigh) and low back pain, although it’s not yet understood which way the causal relationship flows. However, it is known that hamstring tightness limits motion in the pelvis and can place it in a position that increases stress across the low back. Hamstring stretches often help ease the intensity of low back pain and the frequency of recurrences. There are a variety of hamstring stretching techniques that are gentle on the low back, such as sitting on a chair and placing one’s leg on another chair to gently stretch the hamstring.

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Psoas Major muscle stretching exercise. A tight Psoas Major muscle (in the front of the lower spine) also limits low back movement. This muscle can be stretched by kneeling on one knee and rotating the leg outward, tightening the gluteal muscles on the side being stretched, and leaning forward through the hip joint (rather than bending through the lumbar spine). A stretch should be felt in the front of the hip that the patient is kneeling on.

Strengthening the low back to reduce pain

For the mechanical instability, dynamic lumbar stabilization exercises for patients with degenerative disc disease can help stabilize the spinal segments. Good muscular control of the spine can help compensate for a degenerated disc and reduce both instability and pain. Focusing on training the lumbar extensor muscles is most important.

These exercises, which are best learned with a physical therapist, consist of the following:

Finding the position the spine is most comfortable in (neutral spine)
Educating the back muscles to keep the spine in the neutral position
Maintaining the neutral position through a series of movements that apply more and more degrees of freedom of motion.

Dynamic lumbar stabilization exercises are commonly prescribed for reducing sciatica-type pain from degenerative disc disease, or pain that radiates into the buttock and/or down the back of the leg.

Low-impact aerobic conditioning

Finally, aerobic exercises that get the heart rate up and the blood flowing, but do so without jarring the spine, are very important for both rehabilitation and maintenance of the lower back. Aerobically fit patients will have fewer episodes of low back pain, and will experience less pain when an episode occurs. Patients with chronic low back pain who do not work on aerobic conditioning are more likely to gradually lose their ability to perform everyday activities. Examples of low-impact aerobic exercises that are gentle on the low back include: