Exercises to Relieve Low Back Pain
Low back pain is the most common condition treated by physical therapists, affecting 30% of Americans each year. Low back pain can involve dull, burning, throbbing, sharp, or shooting pain in the lumbar spine and through the buttocks and leg. Physical therapy is the first line of treatment for low back pain. A physical therapist can improve and restore mobility in the low back as well as reduce low back pain without expensive surgery or pain medications. In the video below, Mangiarelli Rehabilitation physical therapist Bobby demonstrates exercises to relieve acute low back pain.
Anatomy of the Lower Back
The lower back, or lumbar spine, extends from just below the rib cage to the upper part of the buttocks. It is comprised of 5 vertebrae (L1-5), which are stacked on top of one another and are separated by discs that act as shock absorbers for the force placed on the spine during movement. The vertebrae and discs are connected by a series of joints, ligaments, and muscles that work together to provide support and movement.
The low back has three types of muscles that aid in movement: extensor, flexor, and oblique muscles. The extensor muscles attach to the back of the spine and allow you to stand and lift objects. They include the erector spinae muscles that help hold up the spine and the gluteal muscles. The flexor muscles attach to the front of the spine and allow the low back to flex, bend forward, lift, and arch. The oblique muscles attach to the sides of the spine and help the spine rotate and allow you to maintain proper posture. The low back supports the weight of the upper body and contains many nerves that supply feeling to muscles in the pelvis, legs, and feet.
What is Low Back Pain?
Low back pain affects approximately 30% of Americans each year and is the most common diagnosis seen by physical therapists. Low back pain can be acute (lasting less than 3 months), recurrent (acute symptoms that come back), and chronic (persistent pain lasting longer than 3 months). Low back pain can be dull, burning, and throbbing, or sharp and shooting and it may be felt at a single point or over a broad area. Pain can radiate down one or both legs or cause muscle spasms and stiffness. Pain may worsen when you move or stand up vs. sitting or lying down or get worse when you sit or stand too long.
Low back pain can be caused by a variety of factors:
Muscle sprains and strains from excessive or repetitive physical activity that causes muscle or ligaments in the low back to stretch or tear (improper lifting technique, repetitive work activities)
Herniated disc that slips or ruptures, compressing a nerve
Degenerative disc disease due to natural wear and tear from age, causing the disc to be unable to absorb shock sufficiently
Osteoarthritic joint deterioration of the discs of the lumbar spine
Osteoporosis, thinning and weakening of bones, including the lumbar spine that can lead to compression fractures
Sciatica, radiating pain down the path of the sciatic nerve due to compression of the sciatic nerve
Hyperlordosis, a postural issue that involves an exaggerated inward c-shaped curvature of the spine that causes the stomach to lean forward and the buttocks to push out
Spinal stenosis, narrowing of the spinal canal or openings for nerve roots, putting pressure on spinal nerves
Facet joint syndrome in which the facet joints on the back of each vertebra become inflamed and stiff
Sacroiliac joint dysfunction, inflammation and pain in the ligaments that connect the tailbone and pelvic bone
Pregnancy-related back pain due to changes in tissue extensibility from hormones and the pressure of the growing baby
There are three types of back pain: mechanical, radicular, and chronic. Mechanical back pain is the most common form of low back pain that comes from injured muscles, ligaments, vertebrae, facet or sacroiliac joints, or discs in and around the spine. It tends to be localized in the low back and buttocks.
Radicular low back pain, or sciatica, occurs if the spinal nerve root of the sciatic nerve becomes impinged and compressed, radiating pain from the back through the buttocks, and down the leg. Pain can be sharp, burning, tingling, and numbing and involves muscle weakness
Chronic low back pain that lasts for longer than 3 months more commonly results from excessive overuse or repetitive use of the low back during sports or due to repetitive motion at work, lifting incorrectly over an extended period of time, or from arthritis, fractures, or degenerative diseases.
Physical Therapy Exercises to Relieve Low Back Pain
Physical therapy is the first line of treatment for low back pain. A physical therapist can improve and restore mobility in the low back as well as reduce low back pain without expensive surgery or pain medications. The physical therapist works to improve structural impairments in the spine and pelvis and strengthen the lower back musculature through a customized therapeutic exercise program. The therapist often uses a graded-activity approach where the painful activity is broken down into smaller, pain-free movements which allow the nervous and musculoskeletal system to learn that those movements are safe and desensitize the painful area.
Physical therapy treatment for low back pain can include:
Pain management using ice, heat, and electrical stimulation to relieve pain
Manual therapy: spinal manipulation and soft tissue mobilizations to improve mobility and relieve stiffness in the spine and surrounding soft tissues
Targeted stretching and flexibility exercises to maintain normal range of motion, minimize muscle spasms and provide relief for muscles that have shrunk and begun to atrophy due to lack of use. Stretching focuses on the low back muscles, abdominal muscles, hips, and legs.
Dynamic stabilization exercises using exercise balls, balance equipment such as a rebounder, or specific active stabilization exercises to strengthen the muscles of the spine and help support the spine through various ranges of motion.
Core strengthening: targeted strengthening of the abdominal muscles and lower back muscles, such as the erector spinae, to provide greater trunk support and stability to the spine.
Therapeutic exercise: aerobic movement for improved overall movement and to able to perform daily activities.
Aquatic therapy: therapeutic exercise performed in our warm water therapy pool allows low back pain patients to be able to move with greater ease. The warm water not only provides a compressive force that relieves pain, but the water also supports the body and reduces the impact of movement on joints.
Lumbar traction: this involves the patient laying on their back on a traction table. The traction table has a cable at the foot-end of the table that attaches to a strap that is placed around the patient’s hips. The cable is attached to weights that provide a continuous, gentle-pulling force on the hips toward the foot-end of the table. The goal is to unload the disc space and muscles in the lumbar spine.
Dry needling: using thin filiform needles, the physical therapist places the needles into a taut trigger point (tight band of muscle) to release the muscle tension and restore mobility in the affected area.
Pain neuroscience education: the physical therapist provides education on the process of pain in the body, specifically the perception of pain by the brain during chronic low back pain. The therapist helps the patient understand the mechanism of chronic pain and take steps to desensitize the chronic pain area through gradual, gentle movement.
Proper lifting technique education
Mangiarelli Rehabilitation physical therapist Bobby demonstrates exercises you can perform to relieve acute low back pain:
When you experience low back pain, resting for more than a day can be detrimental. It’s essential to stay active and try to maintain a normal routine. Research has found that exercise therapy is effective in reducing low back pain and associated disability. A review of 249 studies assessing 24,486 individuals with low back pain noted that exercise therapy, involving core strengthening, Pilates, and aerobic exercise, reduced low back pain and disability. Patients who received exercise therapy rated their pain, on average, 15 points better and their disability 7 points better three months after treatment than those who received no treatment or common treatments.
A 2022 study noted that aquatic therapy is an effective treatment for chronic low back pain. The study involved 113 low back pain patients. Half of the patients received two regular physical therapy sessions per week while the other half received two aquatic therapy sessions each week. After twelve weeks, half of the aquatic therapy patients showed an improvement in their pain scores compared to 21% in the physical therapy only group. The aquatic therapy patients reported feeling better than the land exercise patients one year later. Therefore, combining both a therapeutic exercise and an aquatic therapy program for low back pain can be quite effective in reducing pain.
Seeing a physical therapist first for low back pain can save patients thousands of dollars in medical costs. One study found that patients with low back pain who received an MRI first instead of physical therapy first spent an average of $4,793 more with similar health outcomes in each group. A 2018 study showed that early physical therapy for low back pain has numerous benefits for the patient, including effective treatment, pain management, and lower medical costs. Researchers analyzed 150,000 insurance claims in five northwestern states and found that those who saw a physical therapist first for low back pain had an 89% lower probability of receiving an opioid prescription, 28% lower probability of having advanced imaging services, and 15% lower probability of an ER visit.
Are you experiencing low back pain? Work with a physical therapist to address your back pain and regain mobility!
