What you need to know about lower back pain? Part 4

Now that you have self assessed your lower back (see Part 3 if you missed it) its time to start the long road to improving your overall back health.

One common question I get asked is “what is the best exercise to do for my lower back pain?” In short it’s any exercise, but luckily Dr Stuart McGill has done all the research for us! His research has found that an isometric program (holding one position; no change in joint angle or muscle length) was superior to a dynamic program (joint movement during exercise, e.g. a squat) for improving lower back pain. It effectively increased core stiffness immediately after the workout and over entire period of the study.

Why is isometric better?

Muscle responds to an increased load, which the body perceives through time under tension. Performing an isometric exercise, such as a side plank, will lead to greater core strength gains because the muscle is engaged for a longer period of time before it can relax compared to dynamic exercises like a crunch.

What are the other benefits?

Research has also proven isometric exercises enhance speed and power, an essential component in explosive lifts or sports. McGill explained that greater core stability and stiffness increase limb athleticism because the body has a stable base from which to work off. This makes core training, specifically with isometric exercises, a key component for improving performance.

Where do I start?

Firstly start by walking at least half an hour each day on a flat surface at a moderate pace, then complete the big 3: Bird-dog, side plank, and core sit. These three core exercises should be done daily without fail as part of your spinal health regime, like brushing your teeth. I would avoid doing them first thing in the morning, as this is when your spinal discs are most prone to injury.

Bird Dog

This is essentially an opposite arm and leg reach, but we want to focus on:

• Maintain neutral spine and engage the core
• Avoid hyperextension or excessive arching of your lower back by keeping your heel below your bottom.
• Engage the muscles of your leg by pulling your toes towards your knees and pushing your heel out as if you are pressing it against an imaginary wall behind you.
• Make a fist with your hand and keep it below your shoulder.

How many? You will perform 3 sets, with repetitions decreasing each time. This will ensure you maintain good form as you fatigue.

• Set 1: Complete 6, 10 second holds each side
• Set 2: Complete 4, 10 second holds each side
• Set 3: Complete 2, 10 second holds each side

Core Sit

The core sit is perhaps the most difficult of these three daily exercises to complete, but one of the most beneficial. Some key points to focus on are:

• Lie on the ground with one knee bent and the other leg straight
• Place your hands under the arch of your lower back to ease pressure on the sciatic nerve
• Tuck your chin in and lift your head and shoulders a few inches off the floor. Hold this position and try to relax your neck
• The goal is to perform this exercise without any movement in the lower back

How many? You will perform 3 sets, with repetitions decreasing each time, as described above. This will ensure you maintain good form as you fatigue.

Side Plank

The side plank is another key movement in the spinal hygiene series. It is perhaps the simplest move, but one I think is often underrated and under utilised. For lower back pain sufferers, a lot of emphasis is placed on strengthening front abs and back muscles, but if you think of the “core” as a corset, you need the side layers to function correctly also.

The side plank engages the obliques (side abdominals) and quadratus lumborum (lateral lower back), which are often weak links in lateral core. The glute medius is also activated providing stability to the hip/pelvis. Start with a side plank on your knees, progressing to legs extended and feet stacked keeping the following points in mind:

• Ensure the elbow is directly underneath the shoulder
• Keep top shoulder and chest open
• Ensure hips stay stacked one on top of the other
• Keep your head in line with the rest of your spine by gazing forward in front of you (not down to the ground)

How many? You will perform 3 sets, with repetitions decreasing each time, as described above. This will ensure you maintain good form as you fatigue.

Once you have mastered these basics you can look at adding more complex exercises such as;

• Pallof press
• Suitcase holds
• Stir the pot

The core is active in all sorts of movements such as the deadlift, squat, farmer’s carry, overhead carries, med ball carries etc. So start by using the big three, then add in one more complex move listed above, before applying these principles in a training setting utilising more dynamic movements.

To summarise, the take home messages from our four part series are:

1. Stop stretching your lower back! It’s more likely your body is craving stability and spinal stiffness, not flexibility.
2. Correlation doesn’t equal causation. Tight hamstrings don’t cause back pain, they are a symptom of lower back problems.
3. Complete your daily spinal hygiene exercises as described above or prescribed by your physiotherapist.
4. Walk half an hour each day as a non-negotiable part of your lower back rehab.
5. Lower back pain and stiffness is a normal part of lower back health in the morning because the discs swell overnight and loose hydration throughout the day.
6. And finally move, move, move! Rest won’t resolve the problem of lower back pain, but movement and strength will.

Happy back strengthening!!

1. McGill SM. Low Back Disorders: Evidence Based Prevention and Rehabilitation(3rd ed). Champaign, IL: Human Kinetics Publishers, 2016.

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