Nearly everyone will experience lower back pain (LBP) at some point in their lives (1). Upwards of 32% of adults live with daily back pain (2). Most lower back pain is non-specific, making diagnosis a challenge. The most common causes of LBP are acute injury or excess strain on the spine, either from sedentary lifestyle, overexertion, or injury (3, 4).
If you are experiencing lower back pain, we may have the solution. Here we’ll describe the muscles of the back and core. We’ll also list some fundamental stretches and exercises known to strengthen them.
Introduction to the lower back
The spine consists of stacked vertebrae separated by spongy discs. A series of muscles run up and down the spinal column to maintain upright posture (5). Other muscles attach to the lower vertebrae to control hip movement while walking or lifting. The abs and obliques work to stiffen the spine when bending over or twisting sideways.
The large lats and shoulder muscles help keep the spine rigid during upper body movements. All these muscles play a vital role in spinal stability and mobility. The lower back, or lumbar spine, serves as an attachment point and anchor for much of the back muscles. This is a key feature involved in movement and overall core stability.
This is an important picture to paint to understand how the back works. Most lower back pain stems from some sort of postural distortion or muscle imbalance from within the deep core (5). These issues may go unnoticed but quickly become serious if they persist.
What Causes Lower Back Pain?
The most common cause of back pain is excessive stress or strain on the spine. This is something brought on by acute injury or years of repetitive micro traumas.
Over time, microtraumas or injuries worsen and result in severe inflammation, spasms, or physical damage to spinal structures. Sitting too long, bad posture, over training, and low activity are the main culprits of these traumas. When you sit too much, you over activate hip flexors and under activate spinal muscles (6). Standing and working all day can fatigue the back and core muscles (7). Rapid jerking motions or heavy lifting can stress these muscles (8).
Weakened muscles also contribute to back pain and injury. Other muscles pick up the slack if our core muscles are under active or weak. But these muscles overcompensate and place improper strain on the spine, while the primary muscles grow weaker.
This strain ultimately leads to physical injuries to the spine (9):
Bulging and herniated discs: Excess strain compresses vertebral discs. Over time the discs rupture and degrade. Neglected, they begin to bulge beyond the margins of the vertebra. This restricts spinal mobility and causes pain. If this worsens, it can progress to a herniated disc. This is a much more severe form of a bulging disc. The ruptured tissue presses against nerves which can cause severe pain.
Fractures: There are lots of ways to fracture the spine. Acute hyperextension, like during a deadlift, can fracture the bony protrusions on each vertebrae. These fractures can be mild and heal on their own. Other fractures leave nerves exposed and cause severe pain. These often require rehab or surgery. Spondylolysis is a severe type of fracture that occurs after extreme spinal hyperextension. Excessive heavy loading of the spine can cause fractures as joints move beyond their limits.
Osteoporosis and arthritis: These are progressive diseases of bone tissue, usually associated with older age (10). Osteoporosis is the loss of bone density with age. Bones become brittle and are more susceptible to fracture. Arthritis is a degenerative and inflammatory disorder. Arthritic bones may fuse over time and limit mobility.
Exercises for Lower Back Pain
The best treatment is prevention. Although we can’t prevent slips and falls, we can strengthen our bodies to help reduce the likelihood of severe injuries.
Stretches
Stretching is useful for relieving overworked muscles, and as a warm up for more rigorous activity. I recommend active stretching – take a stretch through a full range of motion.
Seated Back Twist:
This movement focuses on the shoulder, spine, and abdominal muscles, even the hips.
- Sit with your legs out; bend your right leg and cross it over the left
- Reach across with your left arm to the outside of your knee
- Keep your arm straight and twist your torso toward your knee
- Keep your butt and leg flat; don’t twist more than you can tolerate
Child’s Pose:
This is a great stretch to lengthen the spine and stretch the hip flexors.
- Start in a modified push up on your hands and knees
- Push your torso back and rest your bottom on your heels
- Spread your legs slightly and let your belly sink down
- Bring your arms alongside your legs, palms up
Cat-Cow:
This is one of the most effective stretches for the back. It helps with spinal extension and flexion. It also activates the core and hips.
- Rest on all fours with your back straight
- Inhale while looking upward and pushing your belly button downward
- Exhale, tuck your chin into your chest, and arch your back upward
- Repeat 5-10 times slowly
Exercises To prevent Lower back pain
The best way to prevent lower back pain and injuries is to exercise. You don’t need to overdo it with deadlifts. You just need the proper movements to strengthen the back and core. These exercises, known as the McGill Big 3, focus on exactly that. You’ll perform a reverse pyramid rep scheme for all the below. This consists of 3 sets of 6-4-2 reps, with 5-10 second holds per rep (12).
The Curl Up:
This is a modified version of the crunch. You will lie flat on the ground and focus on bracing your spine rather than sitting up. This will help strengthen the front abs while avoiding excess strain on the spine.
- Lie on your back with one leg flat and the other bent up at the knee
- Place your hands under the small of your back, right at the curve before your bottom
- With your abs engaged, lift your head slightly – only a few inches – off the ground
- Hold this position for ten seconds
Side Plank:
This exercise stabilizes the spine by activating the obliques as well as stabilizing the pelvis.
- Lie on your side with your legs stacked
- Raise your torso by coming up on your forearm and elbow
- Elevate your hip so you are being supported by your knee and forearm
- Hold for 5-10 seconds
- Modify this position by fully extending your legs and holding for more time
Bird-Dog:
This movement helps to stabilize the spine and strengthen the core while performing hip and shoulder movements. It presents a nice active challenge to balance.
- Get on all fours, keeping your back neutral and slightly arched
- Extend one leg and the opposite arm straight out – focus on kicking the heel straight back
- Don’t allow your leg or arm to elevate beyond the level of your back
- Bring the arm and leg back under you and switch
- You can modify this to focus on the legs or arms independently if you struggle to maintain a neutral spine
- For a challenge, rotate the arm while it it extended; or, draw an invisible box with each hand to your front for more engagement
Glute Bridge:
The glutes are one of the largest muscles in the body. They support spinal stability by keeping the hips and spine working together. Weak glutes are the culprit of much back pain.
- Lie flat on your back with your legs bent at the knees
- Place your arms flat on the ground beside you (or extend them upward)
- Squeeze your glutes tight, then lift your hips straight upward
- Hold when your legs, hips and upper back form a straight line
- Slower lower your hips to the ground
Final Thoughts
The best way to prevent back pain is to strengthen the spinal and core muscles. These exercises will help achieve that without placing undue stress on the back. Perform these before starting your day. You can add more intense strength training, but this is not the solution for back pain. Your exercise routine should include low intensity core stability and activation exercises, like those listed. You might also want to include regimented walking throughout the day.
Try to avoid stretching too frequently. Stretching can help with immediate relief and is good for warm ups. But they don’t address the real issue – weak muscles. Add stretching to your routine to improve mobility, ideally before exercising or moving.
FAQs
Q: When should I go to the doctor?
A: When you have frequent back pain that won’t go away after a few weeks, or if you experience severe, acute back pain.
Q: Does sleep position impact back pain?
A: It may. How you sleep or what you sleep on can influence back stability. There is no best sleeping position or mattress. Find a sleeping position that keeps your back neutral and doesn’t cause pain.
Q: How much should I exercise?
A: Depends on your goals and abilities. Gradually build up with bodyweight exercises a few times a week. Add cardio as you like. Use the exercises listed here as a guide. You should choose stabilization exercises like these. More intense strength training is always good. But avoid movements that place excess stress on the spine, like deadlifts, squats, and heavy abdominal work.
Q: Is deadlift good for back pain?
A: No. You should not perform a deadlift to alleviate back pain. The deadlift relies on a stable spine, but also adds lots of pressure to it. If you are not properly trained, the deadlift will only add to your back issues. I recommend performing deadlifts if you are well trained and conditioned and understand the movement.
References
- Clynes, Michael A, et al. “The Epidemiology of Osteoporosis.” British Medical Bulletin, 2020, https://doi.org/10.1093/bmb/ldaa005.
- Lucas, Jacqueline, et al. “Back, Lower Limb, and Upper Limb Pain Among U.S. Adults, 2019.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 29 July 2021, https://www.cdc.gov/nchs/products/databriefs/db415.htm.
- Hartvigsen, Jan, et al. “What Low Back Pain Is and Why We Need to Pay Attention.” The Lancet, vol. 391, no. 10137, 2018, pp. 2356–2367., https://doi.org/10.1016/s0140-6736(18)30480-x.
- Heneweer, Hans, et al. “Physical Activity and Low Back Pain: A U-Shaped Relation?” Pain, vol. 143, no. 1, 2009, pp. 21–25., https://doi.org/10.1016/j.pain.2008.12.033.
- Waxenbaum JA, Reddy V, Williams C, et al. Anatomy, Back, Lumbar Vertebrae. [Updated 2022 Aug 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
- Berger-Pasternak B, Brylka D, Sipko T. Lumbar Spine Kinematics in Asymptomatic People When Changing Body Position From Sitting to Standing. J Manipulative Physiol Ther. 2021 Feb;44(2):113-119.
- Wai, Eugene K., et al. “Causal Assessment of Occupational Bending or Twisting and Low Back Pain: Results of a Systematic Review.” The Spine Journal, vol. 10, no. 1, 2010, pp. 76–88., https://doi.org/10.1016/j.spinee.2009.06.005.
- Wai, Eugene K., et al. “Causal Assessment of Occupational Lifting and Low Back Pain: Results of a Systematic Review.” The Spine Journal, vol. 10, no. 6, 2010, pp. 554–566., https://doi.org/10.1016/j.spinee.2010.03.033.
- “Back Pain.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 18 Feb. 2023, https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906.
- Bax, Marieke, et al. “Genetics of Rheumatoid Arthritis: What Have We Learned?” Immunogenetics, vol. 63, no. 8, 2011, pp. 459–466., https://doi.org/10.1007/s00251-011-0528-6.
- McGill, SM. Back Mechanic: The step by step McGill Method to fix back pain. Backfitpro Inc. 2015 (www.backfitpro.com)
- Ahorschig. “The Mcgill Big 3 for Core Stability.” Squat University, 10 Oct. 2022, https://squatuniversity.com/2018/06/21/the-mcgill-big-3-for-core-stability/.
Author Bio
Zach Pierce is an experienced blogger and personal trainer. He served in Army infantry, during which time he deployed in support of OEF and OIF. After the military, he pursued an M.S. in nutrition and immunology as well as a Master’s in Public Health, both from the University of California, Davis. There he studied the relationships between gut bacteria, diet, and immune function. He became a CPT shortly after to help bridge the gap in knowledge between formal nutrition and practical fitness. He currently works in clinical research and trains individuals and small groups at the YMCA. He prefers to focus on beginner fitness enthusiasts, traditional strength training, and endurance performance.
