Exercise to Prevent and Treat Low Back Pain

Low back pain (LBP) is a very common and significant public health issue. LBP is commonly described as pain and discomfort, which can be localized or radiate causing related leg pain. Non-specific LBP is defined as LBP not attributable to recognizable, known specific pathology (inflammatory, tumoral, or infectious process). Pain intensity, functional limitations, and associated psychosocial factors (fear-avoidance) are major factors that affect the prognosis and development of chronicity of LBP.

There is moderate quality evidence that exercise can help in treating and preventing future low back pain. Various U.S. and European guidelines as first-line treatment for non-specific and some types of radicular low back pain, currently recommend manual therapy interventions combined with exercise. Although a number of clinic-based options for exercise therapy are available, these can be costly for patients seeking care, so home-based exercise programs with some level of supervision should be emphasized as an option.

The vision of “Exercise is Medicine (EIM),” a global health initiative managed by the American College of Sports Medicine, is to make physical activity assessment and promotion a standard in clinical care, connecting health care with evidence-based physical activity resources for people everywhere and of all abilities. EIM encourages physicians and other health care providers to include physical activity when designing treatment plans to refer patients to evidence-based exercise programs and qualified exercise professionals. EIM is committed to the belief that physical activity promotes health and is integral in the prevention and treatment of many medical conditions.

Some published reviews have suggested that a reduction in risk of LBP can be achieved via various supervised exercises, including aerobic and resistance exercise training sessions, Pilates and stabilization exercises, and motor control exercises. There is no clear consensus on best exercise therapy, although supervised exercise appears to offer some advantages when available.

The data are also unclear regarding optimal intensity, frequency, and duration of exercise although the Physical Activities Guidelines for Americans 2nd edition, published by the U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion recommend that adults get at least 150 minutes of physical activity per week. They also recommend move more and sit less with physical activity encouraged intermittently throughout the day. They suggested that adults should add some vigorous activity that increases heart rate, and add moderate to high-intensity muscle strength training (resistance training) at least twice per week.

Dr. Mark Pfefer is a doctor of chiropractic, and the director of research at Cleveland University-Kansas City. He believes that although such physical activity is beneficial, there are other things to consider.

“The effectiveness of exercises for low back pain can vary depending upon individual factors and the underlying cause of pain,” Pfefer said. He recommends, “ …consulting with a chiropractor or another health care provider who can offer personalized guidance, and advise on exercises based on one’s specific needs and condition.”

When it comes to exercise to specifically strengthen the back and help with current pain, or to prevent future pain, the focus should be on core-strengthening exercises with emphasis on the back, abdominal, and pelvic muscles. Examples of core exercises that have demonstrated effectiveness include:

• Planks: Excellent core strengthening exercise but extend time gradually. Targets back, abdominal, and pelvic muscles. Assume a push-up position, resting on your forearms, with your body forming a straight line from head to toe. Hold position for a set duration (gradually increase time from 10 seconds up to 2 minutes or more) while engaging your core muscles.
• Bridge pose: Targets the muscles of the lower back, buttocks, and thighs. Lie on your back with your knees bent and feet flat on the floor. Slowly lift your hips off the ground, engaging your glutes and lower back muscles.  Hold the position for a few seconds before gently lowering your hips back down. Repeat the exercise for 10-15 repetitions.
• Bird Dog: Targets core muscles, including the lower and abdominal muscles. Start on your hands and knees, aligning your hands beneath your shoulders and your knees beneath your hips. Extend your right arm forward while simultaneously extending your left leg backward. Maintain a straight line from your fingertips to your toes. Hold for a few seconds, and then return to the starting position. Repeat with opposite arm and leg. Aim for 10 repetitions on each side.
• Cat-camel stretch: The cat-camel stretch is an excellent exercise for improving flexibility and promoting spinal mobility. Begin on your hands and knees, ensuring that your hands are aligned beneath your shoulder and your knees beneath your hips. Slowly round your back toward the ceiling while tucking your chin toward your chest (cat post). Hold for a few seconds before arching your back, lifting your chest toward the ceiling, and looking up (camel pose). Repeat the sequence for 10 repetitions, focusing on smooth, controlled movements.
• Superman Exercise: The superman exercise targets the muscles of the low back, glutes, and hamstrings. Lie face down on the floor with your arms extended in front of you. Simultaneously lift your arms, chest, and legs off the ground, focusing on squeezing your lower back and glute muscles. Hold the position for a few seconds before slowly lowering back down. Aim for 10 repetitions, gradually increasing the duration of the hold as your strength improves.
• Pelvic-Tilt: Targets the muscles in the lower back, abdomen, and pelvis, promoting stability and proper alignment. Lie on your back with your knees bent and feet flat on the floor. Gently flatten your lower back against the floor by engaging your abdominal muscles, tilting your pelvis backward. Hold for a few seconds before releasing. Repeat the exercise for 10-15 repetitions, focusing on controlled movements and maintaining proper breathing.

Maintaining consistency with a regular exercise routine, improving posture, avoiding prolonged sitting, and incorporating sound ergonomic principles into daily activities, can likely help both manage and prevent low back pain effectively.