Roughly 80 percent of Americans have back pain at some point in their lives. Historically, many of those people were told that, barring a specific, treatable injury, there’s one prescription for back pain: rest. But research today tells us that the answer is actually just the opposite.
“The advice to rest and not stress your back runs counter to what we now understand to be the best course of action,” says Eric Robertson, a spokesperson for the American Physical Therapy Association and an associate professor of clinical physical therapy at University of Utah and University of Southern California. One of the main issues that physical therapists and physicians alike have run into is that we don’t actually know what causes the pain.
Pain in any muscle can come from being too tight or stiff, but it could also be from a weakness or if it’s not moving in the right way, explains Robertson. Like a car, he says, if there’s one weak spot other parts of the vehicle are going to wear down more quickly—and that’s where you can get pain.
Strengthening your core and back muscles, then, can be incredibly helpful in treating and preventing back pain. And the good news is that you don’t need to do serious weight training to see benefits. The more you move generally, the less likely you are to have pain.
“Standing frequently throughout the day, walking or pacing whenever feasible, and stretching the hips, hamstrings, and hip flexors regularly are a good way to be proactive in preventing these issues,” says Lauren Shroyer, Senior Director of Product Development and a Certified Athletic Trainer (ATC) at the American Council on Exercise. Robertson agrees.
He says walking is one of the best exercises for back pain, since it’s non-load bearing and easy to do—but even just moving more overall is going to be helpful (and research backs him up). Back pain can often be the predictable result of a sedentary lifestyle that more and more Americans have, so it may not take much movement to increase strength in the core and back enough to relieve pain.
Still, lifting may be able to help even more. Studies suggest that even low-levels of strength training can improve back pain. Discomfort in the back can often be the result of weaknesses elsewhere, like the gluteal muscles and adductors, both of which are in your hips and legs. Strengthening those muscles with exercises like squats, leg presses, or any single leg movement, can help with the pain, Robertson says.
If you’re having pain right now, you should consult a physical therapist who can design a program specific to your body and your pain. But if you want a general exercise regimen to help prevent back issues, Shroyer has some recommendations.
For beginners, try these exercises:
Once you’ve mastered those, or if you’re already more experienced, try these:
You may also want to incorporate stretching in with your strength training. Shroyer recommends a basic program for staving off back issues. “In general, when you are not experiencing acute pain and want to be proactive in preventing it, a regular program of stretching the hips and strengthening the legs, abdominals and spine is best.” If you want specifics, check out Williams flexion exercises, the figure-4 piriformis stretch, the cat-cow stretch, and the spinal twist.
You can also determine from your lumbar (or lower) spine position which types of other exercises may be the most helpful, Shroyer says. If you look at yourself from the side in a full-length mirror, check out how much your lower back curves. If it’s fairly straight, hamstring stretches are going to give you the best benefit. If you have a deep curve, hip flexor stretches may be best.
If you’re experiencing minor pain or are simply trying to prevent back problems in the future, the recommendations so far may be all you need. But many people who have chronic back pain find that even doing basic stretches or exercises are overwhelming.
“All pain experiences are a combination of physical and emotional responses,” Robertson says. That might seem tangential to solving your back pain, but the truth is that a large part of overcoming that discomfort is about overcoming the fear of being in pain.
If you’re in pain every time you move, he explains, it’s normal to become afraid of moving—and it’s a physical therapist’s job to enable you to start moving enough that you can move past the fear. Lots of people are told that they simply have a bad back. But the truth is that about 90 percent of back pain isn’t serious, Robertson says, and that means most people can get on track to being pain-free with the right training.
Some folks will get flare-ups, but recurrences don’t mean that you have to live with a bad back for your whole life. (If you have changes in bowel or bladder like trouble peeing, tingling or numbness especially in the groin, or neurologic symptoms like weakness or numbness that may be a sign that you are in the 10 percent of people with a more serious issue—and you should go see a doctor!).
Robertson says that he’s personally experienced back pain intermittently throughout his life, and that it’s still a struggle for him. “Every time, I have this feeling that it’s going to be forever. It’s an okay thing to acknowledge—it’s scary and overwhelming,” he says. We all need to talk about back pain in a more positive light, he says, as something that might be awful now but can be overcome.
By: Sara Chodosh