The lower back is a complex area of many joints of the spine and SI joints, ligaments that support them and muscles that control them. Muscles of both the legs and the core attach to the bones around the spine and pelvis. In the distant past, all the news about back pain said to lay down and be immobile. We have learned a lot since then and now know that proper stretching and strengthening and movement is best. Back pain exercises prescribed by your physical therapist that help chronic and acute lower back pain will typically provide relief through proper stretching and strengthening of these muscles. Pain relief will be achieved when the region is functioning well.
Safety for Lower Back Pain Exercises
All Physiotherapy exercises pictured and described here are a guideline of general exercises prescribed by physical therapists and are commonly used at Inertia Physio+ by both our Physiotherapists and Athletic Therapists. If you have more pain doing them or need help addressing your pain or injury, please seek professional medical advice for proper guidance from one of our Physiotherapists or Athletic Therapists before continuing. As always, these Physiotherapy exercises should be part of an overall spine and lower back pain care program that should include an assessment, identifying the underlying cause of pain, and treatment plan including manual therapy and an exercise program that is specific to you, your pain and injury. These or other individualized stretching exercises may work for you.
What is the single best exercise for lower back pain?
We believe this to be either the core activation or the hip flexor stretch or both together!
What is the fastest way to recover from lower back pain?
Stay active even when in pain as long as it doesn't make you worse, seek help from physical therapy for your lower back pain and do these exercises regularly.
Can a Physiotherapist, Athletic Therapist or other Physical Therapist fix lower back pain?
Any type of physical therapist can do an assessment of the reason for your low back pain determining the underlying cause and the proper guidance needed to address it. They can then provide the needed manual therapy and exercise program to help get you back to pain free functioning.
Lower Back Pain Exercise Program
Core Activation - Transverse Abdominus and Pelvic Floor with Glute Max
One of the most important lower back pain exercises provided through physical therapy is the activation and strengthening of the core stomach muscles, including the pelvic floor, transverse abdominus and gluteus maximus.
Lie on your back with your knees bent.
Place your fingers just inside your hip bones so you can monitor the deep abdominal muscles contracting.
To engage the pelvic floor muscles, pull up inside as if you were stopping yourself from peeing.
To engage the transverse abdominus deep stomach muscles, draw your belly button in towards your back and up towards your head.
Make sure that your superficial abdominal muscles stay relaxed as you take a deep breath.
Finally, contract your glutes, by squeezing your bum muscles. Once you have activated all three muscle groups, you will take a deep breath and hold this activation for a few seconds before releasing it. You can repeat this exercise multiple times until you reach fatigue and have trouble doing it properly before you rest. Fatigue will feel very different in this muscle compared to something like the burning quad fatigue in squats. You can do up to 3 sets at a time of this exercise with rest between sets and it can also be done in sets of 1-5 very frequently throughout your day to ensure you keep your core working for you all day long, but also ensuing proper rest time.
Stabilization Hip Extension
Lie on your front with your back in neutral position.
Activate your core and gluts as in the first exercise and use the glutes to extend through the hip, lifting your left leg up, keeping it straight and keeping your back and pelvis completely still. Use your hands to ensure no dropping of the pelvis on either side as you lift. You will use some lower back muscles on this exercise too, but try to ensure that most of the lift is coming from the glutes.
Return slowly to the initial position and repeat, beginning with the right leg.
In this exercise, you will advance on the hip extension exercise above. You will start by lying on your stomach with your chin tucked in and your arms by your ears.
You will then activate your core as you did in the core activation above. Maintain this activation and a steady pelvis and upper body while you lift your arm and opposite leg up.
Lower and repeat with the other side.
The key to this exercise is to ensure that you are not dropping through either side as you lift one leg at a time.
This is a great stabilization exercise. You will get on your hands and knees with your knees directly under your hips and your hands directly under your shoulders. Your back is straight and your chin must be tucked in.
Contract your core and glute muscles as described in the first exercise and then lift one leg and the opposite arm without allowing the upper body, trunk or pelvis to move or rotate.
Lower and repeat with the other side. The key to this exercise is once again, complete stability and no movement in your core as your limbs move.
Bent Knee Fall Out
Lie on your back in the same position as the first core activation with your lumbar spine in a neutral position (slightly arched).
Engage your core as in the first exercise. Are you starting to understand how important that first Core Activation exercise is?
Maintain a steady pelvis while you open one leg to one side, keeping your lower back completely still.
Return to the middle and repeat with the other side. The key to this exercise is absolute stillness of all of your body except for the moving leg.
Another common exercise to control low back pain is a pelvic tilt. It is important to understand what is meant by anterior and posterior pelvic tilting.
To perform the exercise, you will lie on your back and bend your knees. Activate your core as in exercise #1. Then, gently tilt your pelvis and flattening your back to the ground. This is referred to as a posterior pelvic tilt. Return slowly to the initial position and then arch your back, lifting it away from the floor and tilting your pelvis in the opposite direction. Return to neutral and repeat.
Kneeling Pelvic Tilt
Kneel down on your hands and knees with your knees directly under your hips and your hands directly under your shoulders. Tuck your chin.
Activate your core as in the first exercise above. Then begin tilting your pelvis in both directions as described in the previous exercise of floor lying pelvic tilting.
Alternate between these two positions.
The movement should come only from the pelvis. Do not accentuate to back arching/rounding using your upper back.
Lie on your back with your knees bent and feet at hip width as pictured above.
Contract your core as in the first exercise. Use the gluts to lift you and squeeze them at the top of the movement. For a little extra squeeze at the top of each repetition, do posterior pelvic tilts by activating the lower abdominal muscles and pushing your hip bones towards your belly button.
Control the movement with your glutes and stomach muscles as you slowly return to the initial position and repeat.
Lie on your side with the knees bent to 90 degrees and the legs in line with the trunk.
With your upper body supported on your elbow, make sure the elbow is directly under the shoulder.
Engage your core as in exercise #1.
Lift your pelvis until you are in good alignment shown in the picture below. Hold until fatigue. Rest and then repeat on the opposite side.
Start in all fours. Activate the core as in the first exercise. Then prop yourself up on your forearms and toes, with your chin tucked in.
Lift up your body, creating a straight line. Keeping your feet at hip width or wider will make this easier.
Maintain the position without arching the spine.
Lie on your back and bend your knees with your feet flat on the floor.
Begin as in all exercises by activating your core.
Then feel your stomach muscles tighten and flatten your lower back against the floor. Place your arms behind your head to support it.
Tuck your chin in and lift your head and shoulders up, bringing your elbows closer to your knees. Breathe out as you lift up.
Lower Back Physical Therapy Stretches
Many muscles around the hips and pelvis and lower back can cause lower back pain. Proper physical therapy exercises can help you alleviate some of these tight muscles and your lower back pain.
Lie on your back on the ground and lift the right knee to chest and grabbing it with your opposite hand.
Gently pull across your chest to the left side and maintain normal range until you feel it deep in the glute/piriformis.
Maintain the position and relax. Repeat with the left knee to chest.
Hip Flexor Stretching Exercises
Kneeling Hip Flexor Stretches
Kneel on one side creating a 90° angle with the opposite hip.
Tilt your pelvis underneath you to flatten your lumbar spine and gently press forward and extend your hip until you feel a gentle stretch on the front of your hip. Hold and then relax, repeating on the other side.
Standing Hip Flexor Stretches
Stand with your feet staggered and the back knee slightly bent.
Tilt your pelvis underneath you and bring your weight forward onto your front leg until a stretch is felt in front of the back hip.
Stretch the arm up over head and reach to feel more of a stretch.
Maintain the position and then relax, repeating on the other side.
Lower Back Stretching - QL Stretching Options for Low Back Pain relief
Kneeling QL Stretches
This lower back stretch will target the sides of the lower back muscles, alleviating low back pain caused by the QL muscle.
Start on all fours. Curl the trunk to the left while looking toward your left hip and tilting your left hip toward your head-at the same time. Alternate sides. This movement is like a dog wagging its tail, but slower.
Sitting QL Stretch
This is another version of the above for the lower back muscles.
Sitting on the edge of a bed or chair, straighten the opposite leg to the side you want to work on and place it slightly out to the side. The other side should be bent in a comfortable position. Lean over to the straight side, turning your body to face away from the leg. You should feel it in your lower back side-on the opposite side of the straight leg. Hold the position.
Foam Rolling for the Glutes or Other Muscles
In physical therapy, we often recommend foam rolling as a form of self treatment.
Place your foam roller on the floor and sit on it on one of your glutes as your starting position.
Roll along your glute in a front to back motion over your glute.
Rolling can be done for any muscle. Sometimes a small ball works better than a roller.
Give these exercises a try and if they are not solving your low back pain, it may be time to seek our help. Call Inertia Physio+ today to book your appointment at 613-672-2200.