Low Back Pain – Exercise 101

The human spine is an amazing piece of engineering! It provides stability and flexibility while at the same time carrying signals back and forth between the brain and the rest of the body. It sits a bit like a mast on a boat, except that this mast is flexible. The stiffness and stability of the mast is provided by the muscles around the spine, especially those at the bottom of the spine – the low back.

Without good muscle tone at the bottom of the spine, commonly referred to as the “core”, there is no stability and this will inevitably cause pain and discomfort at some point in life.

By the time someone comes to see me, they usually have pain already. 100% of these patients have some deficit in flexibility and muscle strength. In other words, the joints of the spine are not mobile enough and the muscles supporting the spine are not strong enough. So the solution is simple: stretch what is stiff and strengthen what is weak. This may sound simple, but it’s not always easy to attain. Why? Because of pain.

When pain is present, muscles will not strengthen, no matter how diligently you exercise. And without strength, the problem will not go away. The trick then is to get help to deal with the pain and do exercises that do not exacerbate the pain.

The exercises below work for many if not most people suffering from low back pain. This is an early phase exercise routine. As you get stronger and suffer less pain, you’ll be able to engage in more challenging routines.

Do the exercises below at least once per day, preferably at the same time of the day. I recommend people do them as soon as they wake up, even before getting out of bed. Do NOT skip a day. Create the exercise habit, just like brushing your teeth.

Breathe in slowly and deeply through your nose and out again slowly through your lips. Let your stomach rise when you breathe in, let it drop when you breathe out. As you breathe, scan your body from your feet all the way up to your head. Wriggle your toes, turn your ankles, flex the muscles around your knees, squeeze your buttocks, tilt your pelvis back and forth, roll your shoulders, flex your elbows, and move your wrists and fingers. As you move your body parts, ask yourself how they feel, quietly observing any tension or stiffness that may be there. Continue breathing while gently moving your body parts for at least 10 deep breaths.

While still laying on your back, pull your knees towards your chest one leg at a time and hold them there with your hands around your knees/shins. Pull the knees as far as you can until you feel a stretch in your low back. Pull the knees only as far as is possible without making the pain worse. You may have to do this one knee at a time at first. Hold them here while breathing in and out deeply. Relax your low back with every breath out. Repeat for 10 deep breaths.

Bend your knees so your feet are flat on the mattress about hip-width apart. Now lift your hips and pelvis until your upper body makes a straight line from shoulders to hips to knees. Go only as high as is possible without making the pain worse. Hold this position for 15 seconds, then lower. Repeat 3-5 times. Keep breathing in through your nose and out through your lips as you do this.

While still lying flat on your back with your legs straight, lift one knee towards your chest and grab your thigh with both hands. Pull your toes and ankle up as far as possible, then straighten your knee. You will feel a stretch in the back of the leg. The pain in the leg may feel very uncomfortable, like a nerve pain. This is OK. Hold it for a few seconds then lower the knee. Repeat 10 times. Do the same for other leg.

This is the last exercise while lying on your back. Bend your knees and place both feet together. Now lazily drop the knees to the one side, then to the other. Drop them only as far as is possible without making the pain worse. Repeat 10x to each side.

Do this exercise either lying on your stomach or in standing, whichever works better. When on your stomach, prop yourself on your elbows and let the spine sag to the floor or bed. The more relaxed, the better. Go as high as pain allows – no pain is good! Hold for 30 sec if possible. Repeat at least 3x. Do the same in standing if this is easier.

Stand facing a wall or a kitchen counter top. Lean against it with your arms outstretched. Slowly lower yourself towards the surface by bending your elbows and then push yourself back up. Make sure to keep your middle – your core – immobile as you move up and down. You may make it harder by standing further away from the surface. Eventually you’ll be doing it as a regular push up.