Exercise and low back pain

Exercise and low back pain

by Ravi Ramachandran, M.D.

Exercising with low back pain.  It seems like an oxymoron but it is common.  I hear this often in the clinic.  ”I can’t exercise because of my back pain.”

Traditional thinking is that low back pain means no exercise and “take it easy”.  In the past, doctors would prescribe several days of bed-rest.  We have learned that movement through exercise is not only important but often is necessary to improve low back pain.  When I see someone in the office with low back pain, I often discuss core strengthening and exercise.  But how do you exercise when your back hurts?  Here are several things you should know about exercising with low back pain.

  1. Warm up before and after.  Stretching before and after an exercise routine is essential.  This gets your back warmed up and ready to go before and after the exercise routine.  Tony Horton who is the modern-day version of Jack LaLanne, has a nice lower back stretching videoto watch on this subject.
  2. Focus on core and gluteal strength.  Strength in the core muscles and the gluteal musclestakes pressure off arthritic joints and aging ligaments in the back.  I emphasize core strength in the office for this reason.  There is a balance between the core muscles that flex your trunk and the back muscles that extend your trunk. In the office, most people with back pain have soft abdominal muscles and very tight back muscles.  That imbalance needs to be addressed.  Some basic core exercises you can do are described here.
  3. Choose a program that fits your comfort level .  With exercise, not everyone fits into the same program.  Some people have significant pain that prevents typical exercise programs.  I recommend people explore all possible options to get the heart rate up and burn calories.  One article I like in particular that discusses this further is referenced here.
  4. Cross train.  Mix up exercise during the week.  It’s important to write down a program before the week begins or speak with a trainer if you have one.  Options include walking, swimming, biking and resistance exercises.  Cross training has the benefit of taking stress of the low back and releasing endorphins.
  5. Take 1-2 days off per week.  It is important for the body to recover after periods of exercise.  The body will be in a rebuilding phase and rest is important.  I encourage patients to stretch during this time period and include foam rolling into their regimen.  If you are not familiar with foam rolling, here is a video link for the gluteus muscle and piriformis.

I understand that there are many examples where someone has had surgery on their back or a bad accident and exercise seems impossible.  Keeping the body moving however is key.  With extreme cases of back pain you should start simple and work your way up to more involved exercise programs over time.  The key is to be realistic about the goals you set.

I also want to emphasize to have your low back pain examined by a qualified professional if you experience prolonged bouts of low back pain.  Having a good understanding of what issues you have in your lower back helps with designing a individual training program.  So there you go.  Exercise can be a wonderful form of prevention and rehabilitation for the back.  Keeping your body stretched out and moving makes you more durable for the long-term

Ravi Ramachandran M.D. - Spine Surgeon in Sacramento, CA