Updated 7/20/21:
Alright, so there is an absolute plethora of information out there on how to get out of low back pain. On top of that we've got all sorts of products and interventions to do the trick. We've got pain relief creams, massage chairs, pills, potions, surgery, stem cells, and magnets. With all of these answers you'd think we've got it figured out right?
Wrong.
Low back pain continues to be a tremendous problem throughout the world that isn't really improving (1,2)... However, I think if there is one thing all experts can agree upon is that an ACTIVE approach to low back pain is still a tried and true (and inexpensive) way to reduce pain (1,2,3). That means some sort of exercise intervention is still going to be one of the most effective strategies to reduce low back pain levels (1,2,3) What's even better is that strength training has actually been shown to be quite effective for getting out of low back pain (4).
Now, this is absolutely music to our ears given how much we love lifting weights. But, if you're reading this article I'm already guessing your lower back hurts but you haven't stopped exercising. It kind of seems like right now the exercise isn't doing the trick. So maybe it's not just all about continuing to exercise but applying the right exercises to help us get out of pain and back to training.
I put this article together to share with you my FAVORITE movements for getting out of low back pain and back to training. When choosing appropriate exercises we need to ensure that these movements are SPECIFIC to the activities we're trying to get back to. This article is for you if you want to get back to one or several of these activities:
- Weight training
- Powerlifting
- CrossFit (TM)
- Olympic Weightlifting
- Bodybuilding
- Generally training hard in the gym...
So, if you have some low back pain or work with folks who have low back pain and are trying to get back to some heavy lifting in the gym, let's go over some movements to get the job done.
Disclaimer: The following is only information. Always consult a qualified healthcare provider before attempting to exercise your way out of lower back pain. When in doubt get it checked out...
I've outlined my favorite movements by category. A well rounded rehabilitation program should contain a variety of movements, target specific areas of weakness and be specific to the activities you're trying to get back to (squats, deadlifts, olympic lifts).
I've also decided NOT to include the primary lifts in the gym. Although squats and deadlifts can be helpful for getting out of pain (4) I've decided not to include them or their variants in this list. However they certainly can and probably should be included in some form or another. If you want some help figuring out how to do this, click HERE to read an article to help you.
I've outlined my favorite movements by category. To make it easy for you to navigate the exercise waters I've also include a "quick navigation" section below. If you'd like to skip around and check out a particular section quickly you can do it there. Without further ado, my favorite exercises...
Crawls
Forward / Backwards Crawls (Weighted and Unweighted)
I am an enormous fan of crawls for helping to get out of back pain. They just have a ton of benefit really:
- Core strength and stability (anti-extension, anti-rotation)
- Shoulder, elbow and wrist strength and stability
- Posterior neck strength and endurance
- Hip dissociation (moving through the hips while maintaining a neutral spine)
On top of this they're fun to perform and take minimal to no equipment to perform. Here are my favorites in no particular order:
Lateral Crawls
Lateral inchworm
Army Crawl on Sliders
Carries and Marches
Double Kettlebell Front Rack March
Carries are phenomenal for low back pain rehab. They provide a strong training stimulus to the hip as well as the paraspinals and QL (quadratus lumborum). On top of this you can vary the implement to get the desired rehab effect you'd like. Off-set or suitcase variations provide more challenge to one side of the body. Front rack and zercher variants place more stress on the spinal erectors because the load is out in the front of the body. You can also choose to go nice and heavy with a traditional farmer's carry to get the low back ready for the compressive forces it will need to be able to tolerate during squats and deadlifts.
Lastly, carry and march variations are also fantastic because they are generally well tolerated in folks with low back pain that don't tolerate squats and deadlifts well. This allows us to still get a nice training stimulus even when injured. Check out some of my favorite variations below:
Zercher Carry
Suitcase (and Chaos Variants) Carries
Offset Kettlebell Carry
Farmer's Carry
Anterior Core
Anterior core training! What would our low back rehab programs be without good old plank and deadbug variations?!?! All kidding aside a low back rehab program should be well rounded and training the front portion of the core is an integral part of this. There are literally hundreds of exercises that would fit into this category and here are some of my favorites:
Dead Bug Variants
Ab Wheel Variations
Planks and Planks with Extremity Movement
Physioball Stir the Pot
Posterior Core
Here is our main bread winner of the core family. The posterior core is what powers our favorite movements like squats, deadlifts and olympic lifts. This would be the home of the spinal erectors, glutes and hamstrings. Without it our numbers in the gym would be sad and unimpressive. Besides being vital for performance, these muscles need to be trained to show the body what it needs to be able to handle in the future so you can adapt, get out of pain and back to training. The importance of hitting the back side of the core can not be understated. If you aren't hitting this area then your core program has some major missing pieces.
With that being said, training the posterior core can be a little painful early on in rehab. We generally have to go a bit slower with these movements when starting a program. This will most likely mean lighter loads, slower movement and a little TLC when performing these movements initially. Over time though make sure you increase the load and speed of execution back to normal.
Barbell Good Morning
Romanian Deadlift (RDL) Variations
Glute Ham Raise (GHR) Hip / Back Extensions and Iso Holds
Barbell Hip Thrust
Lateral Core
I'm a big fan of training the lateral core for my low back pain athletes. Keep in mind that low back pain can often cause weakness and firing issues on one side of the hip, core and spine. For this reason lateral core variations are an excellent addition to a complete core program to help fix problems with asymmetry left to right.
If you're like me you can only do so many side bridge variations until you're a side bridge master and you're also bored to tears. Check out my video below to see some harder side bridge variations but also scope the lateral pillar holds on the GHR. The lateral pillar hold is an easy way to take frontal plane core training up a few notches and definitely worth a shot when side bridges become too easy. Also keep in mind that the marches and carries we discussed previously are great to work the lateral core as well.
Side Bridge Variations
Copenhagen Plank Variants
Lateral Pillar Hold on GHR and Variants
Rotational Core
The next section of exercises is focusing on the musculature that controls rotation of the core. This includes the obliques mainly but the exercises included also do a good job of recruiting the opposite side hip and shoulder. For example, renegade rows will fry your obliques but also provide a strong training stimulus to the stance side arm stabilizing on the floor. Anti-rotation presses are also great for the obliques but require both the shoulder and hip to stabilize as well.
Renegade Row Variants
Anti-rotation Press Variants
Chop Variants
Single Leg Strength
Last but not least come our favorite friends, the single leg strength exercises. Single leg strength exercises are phenomenal for a myriad of reasons including:
- Posterior and lateral hip strengthening (medial as well depending on the variant chosen)
- Contralateral paraspinal and QL strength
- Postural strengthening - changing based on the variation chosen
One of the reasons why I like single leg strengthening so much when folks have low back pain is because bilateral movements like squats and deadlifts aren't always tolerated. This is because in bilateral movements both legs cooperate to produce force for the lift. Because of this the spine generally becomes the limiting factor in the lift (You've got 2 legs but only 1 spine).
When we switch to a unilateral exercise like a step-up, the leg now becomes the limiting factor. Therefore we get a large load on the legs without the same stress to the lower back. This can be a godsend for folks with low back pain. This allows us to get some great training stress in for the lower body without overloading a painful low back.
I also love changing up the variation during single leg exercises. More quad dominant movements like step-ups and lunges are great to minimize low back stress and maximize leg stress. Single leg deadlift variants shift a bit more stress to the hips and spine (and away from the quads) but still generally stress the low back a bit less then their bilateral hinge bretheren (deadlifts and good mornings).
Another variable to think about when designing rehab programs is where the load is placed. Utilizing a single contralateral load will provide a stronger training stimulus to the lateral core musculature (while minimizing total compressive stress to the spine given you are only loading one side). Placing a barbell in front of the body (front rack) will provide a nice challenge to our postural muscles.
Lastly, I'm a big fan of kickstand movements to really load up on a single leg movement. The kickstand leg provides us with a bit more balance and stability allowing us to increase the weight greater then we'd able to handle compared to single leg exercises that require us to balance on one leg.
For this reason I find kickstand variations are an excellent last step bridging exercise to get back to bilateral training (squats and deadlifts). Check out some of my favorite variations below.
Barbell Front Rack Lunge and Step-up Variants
Lunge and Step-up Variants with Contralateral Load
Single Leg Deadlift Variants
Well, that's a wrap! I hope you enjoyed this article on my favorite rehab exercises to help you get out of pain and back to training.
If you liked this article and want a little more guidance on how to get out of low back pain I have a completely done for you training program to help you get out of pain and back to training. It's called "Ultimate Low Back" and it will be out soon!
I've taken the guesswork out of finding the right amount of sets and reps and which exercises to use and which to avoid. It's all 100% outlined. Consider it your roadmap to get out of pain and back to training.
The Ultimate Training Program to Get Out of Lower Back Pain
Low back snack pack,
Dan Pope DPT, OCS, CSCS, CF-L1
References:
- Oliveira, C. B., Maher, C. G., Pinto, R. Z., Traeger, A. C., Lin, C.-W. C., Chenot, J.-F., … Koes, B. W. (2018). Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal.
- Delitto, A., George, S. Z., Van Dillen, L., Whitman, J. M., Sowa, G., Shekelle, P., … Godges, J. J. (2012). Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy, 42(4), A1–A57.
- Shiri, R., Coggon, D., & Falah-Hassani, K. (2017). Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials. American Journal of Epidemiology, 187(5), 1093–1101.
- Welch, N., Moran, K., Antony, J., Richter, C., Marshall, B., Coyle, J., … Franklyn-Miller, A. (2015). The effects of a free-weight-based resistance training intervention on pain, squat biomechanics and MRI-defined lumbar fat infiltration and functional cross-sectional area in those with chronic low back. BMJ Open Sport & Exercise Medicine,