Exercises For General Low Back Pain

Author: Dr. Aaron Bass, PT, CSCS

Low back pain is one of the most prevalent causes of pain and disability in the United States. It is also one of the most expensive conditions to treat in aggregate, accounting for over $100 billion in care each year.¹ Of the low back diagnoses, the most common is referred to as nonspecific low back pain.¹ On the surface, this may sound like a lazy diagnosis. It can be frustrating to go to your doctor with the complaint “my back hurts and I don’t know the specific reason or cause”, only for them to respond with “well then I am going to diagnose you with nonspecific low back pain.” Fortunately, there is a reason behind the terminology that should put your mind at ease. When your doctor says nonspecific low back pain, what they really mean is they have thoroughly assessed your symptoms and presentation, and feel confident in ruling out sinister pathologies such as fracture, large disc herniation, nerve damage, spinal cord involvement, etc. It may be more helpful to think of it as general low back pain. Your back hurts, but there is no indication that treatment needs to involve major interventions such as surgery or other expensive procedures.

Fortunately, there is a plethora of research on how to address general low back pain and most of it points to the same thing… exercise.^1,2 When compared to all the other treatments including injections, ultrasound, electrical stimulation, massage, traction, laser therapy, thermotherapy, etc, exercise outperforms the others in terms of outcomes the overwhelming majority of the time. You will get a variety of answers for what are the best exercises for general low back pain. The truth is, it is unlikely that one exercise is significantly better than all the others, because everyone’s presentation of general low back pain will be different.² That is why there is no singular answer. What is most important is that you are performing regular exercise at an appropriate intensity without flaring up your back pain. If you want to simplify your exercises for general low back pain, it can be helpful to break them down into different categories of mobility, stability, and strengthening.

Mobility exercises for general low back pain should include all planes of movement for the low back. If you want to simplify these planes, you can break them down into flexion (bending forward), extension (bending backwards), and rotation. If one of them seems more difficult than the other, that is where your focus should be.

• Lower Trunk Rotation
  • Begin by laying on your back with your knees bent and feet on the surface. Slowly let your knees fall to the side, allowing rotation at the hips and low back. Allow rotation as far as you can without pain, hold this position for a few seconds, then repeat movement in the opposite direction.
• Prone Press Up
  • Begin by laying on your stomach with arms under your shoulders as if about to do a push up. Press through your arms to lift your upper body off the table and arch your back. If unable to press through hands, bend your arms and press through elbows and forearms.
• Knees To Chest
  • Begin by laying on your back with your knees bent and feet flat on the surface. Slowly bring both knees up towards your chest, grasp your knees with both hands, and pull into your chest. Hold this position for 30-60 seconds, or until you start to feel decreased tension or discomfort

Stability exercises for general low back pain are going to focus on the muscles surrounding the spine that help provide support.

• Cross Core March
  • Begin by laying on your back with your knees bent and feet flat on the surface. Gently draw your belly button in towards your spine and march one knee up while reaching across with the opposite hand to meet the knee at about 90 degrees hip flexion. Press your hand and knee together with moderate force for 3-5 seconds. Return to the starting position and repeat with the other leg. To ensure core activation, try to perform this movement without any movement in the low back. You should not feel your back arch or flatten into the surface.
• Suitcase Carry
  • Begin by standing upright with a weight in one hand. Limiting any accessory movement in the trunk or shoulder, slowly walk with the weight by your side for 1-2 minutes. Repeat with the opposite arm.

Strengthening exercises for general low back pain work to improve the capacity of muscles surrounding the low back and improve tolerance for resisted activities. Ideally, these exercises will somewhat mimic functional activities such as squatting, lifting, bending, pushing, pulling, etc.

• Squat
  • Begin by standing upright. Slowly lower yourself into a squat. Return to upright standing position and repeat
  • If you want to make it easier, begin by standing in front of a counter or something about the height of your lower rib cage, preferably with something you can hold onto with a good grip. Stick your hips back and slowly lower yourself into a squat to whatever depth you can tolerate. This can be performed for repetitions or you can hold this position as a stretch to low back, hips, or knees.
  • If you want to make it harder, perform the squat while holding a weight at your chest
• Deadlift
  • Begin by standing upright with a weight in front of you on the floor between your feet. Bend at the hips and knees, grab the weight with both hands, and slowly lift to an upright standing position. Lower the weight back to the floor in the same pattern and repeat.
  • If this is too difficult or painful, place the weight on an elevated surface, such as a step, and repeat.

As stated before, these exercises are not the end all be all exercises for general low back pain. They are just a great place to start. The most important thing is you start moving and gradually introduce some mobility, stability, and resisted activity. If you feel like you are not managing your low back pain well on your own, you may need a more in-depth assessment by a physical therapist who can give specific exercises based on your impairments.

1. Julia N. Chronic Back Pain Statistics in the US (2023). CFAH. Published January 14, 2023. https://cfah.org/back-pain-statistics/
   1. Back pain statistics show that this condition is one of the most expensive conditions to treat in aggregate — accounting for over $100 billion in care each year [12].
   2. Physical therapy is perceived to be the most effective treatment for back pain — and it reduces the costs of back pain treatment by 72% within the first year of treatment [10].
   3. Approximately 85% of low back pain is classified as nonspecific
2. Middelkoop M, Rubinstein S, Verhagen A, et al. Exercise therapy for chronic nonspecific low-back pain. Best Practice & Research Clinical Rheumatology. 2010; 24(2): 193-204, https://doi.org/10.1016/j.berh.2010.01.002.
   1. Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function. The authors conclude that evidence from randomised controlled trials demonstrated that exercise therapy is effective at reducing pain and function in the treatment of chronic low back pain. There is no evidence that one particular type of exercise therapy is clearly more effective than others.
3. Lizier D, Perez M, Sakata R. Exercises for Treatment of Nonspecific Low Back Pain. Brazilian Journal of Anesthesiology. 2012; 62(6): 838-846, https://doi.org/10.1016/S0034-7094(12)70183-6.
   1. exercises, back schools, transcutaneous electrical stimulation, low-level laser, education, massage, behavioral therapy, traction, multidisciplinary treatments, and thermotherapy
   2. The conclusion was that therapeutic exercises promote reduction of pain intensity and disability for a long period, whereas cognitive behavioral therapy is more effective in reducing pain intensity for short periods