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What exercises should I avoid with lower back pain?

What exercises should I avoid with lower back pain?

Dr. Michael Derry, DPT, PT, OCS Jacksonville, Florida
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What exercises should I avoid with lower back pain?

To say that there is one or two exercises to avoid with lower back pain is incorrect. With that said, you can potentially do harm if you do too much, too quick. If you haven't worked out in a while or if you have discomfort you may want to start with easier exercises first. Such as gentle mobility to improve range of motion and pain! 

You can safely exercise your lower back in many ways. Every body is different and everyone’s experience with lower back pain is different. Exercising with back pain is necessary not only for recovery but also prevention.

We can’t forget that exercise helps us to live longer and more resilient lives.  

What I have seen over and over when treating lower back pain is that people give up too early on exercise because of fear, pain, or they just aren’t sure if what they are doing is right. This leads to more doctor visits, missed time from work, and higher likelihood of undergoing imaging or taking medications. My job is to get you better without all the other stuff I just mentioned. To move forward, we need to recognize that exercise is GOOD for lower back pain. However, we need to have an understanding of what exercises are good for back pain and how to do them.

It is worth noting that determining the exact source of low back pain is difficult most of the time. Don't get stuck on determining the exact cause of your lower back pain because that will only lead to frustration. I know we all want to know what is exactly what is going on, but when it comes to the human body, that isn't possible.

We treat back pain with pattern recognition to help you on the path of recovery. Shifting our focus from the cause of your lower back pain to what you feel is the best way to treat lower back pain and what exercises are best for you.

We know that exercise for lower back pain is very beneficial and figuring out your directional preference, or specific movements your body prefers, can be a helpful place to start. We want to listen to your body, not go against it. Some people with lower back pain really don’t like bending over. While bending over is safe, you may have an extension bias if bending over makes your symptoms feel worse. Other "extension bias" patterns are: a preference for walking over sitting and lying on your belly versus your back.  On the other side of the spectrum is "flexion bias". In these folks, they typically prefer sitting over walking and lying on their side versus their back. Then, there are people who dont fit one pattern perfectly, possibly because their pain is making most motions hurt. In the end, most back pain is non-specific but we do know that it can improve.

Below is a great 10-minute workout to help build resilency in your lower back. It includes a great warm up followed by essential strengthening that I have used with many patients. The key is to listen to your body and give yourself some grace.


Is exercise bad for lower back pain?

Exercise is not bad for lower back pain! Too much of anything can be bad but when you do it correctly, exercise can be very beneficial. When we look at the best evidence for lower back pain treatment, we see that building strength is at the top of the list. The more resilient and stronger your back is, the better off you will be. We can prevent and treat lower back pain with a safe and effective exercise routine. Exercise is considered a high value treatment for lower back pain. The determination of high or low value comes from the ability to reduce pain and improve function as part of initial management of lower back pain. Honestly, which would you prefer? 

This is a great webinar I put together on lower back pain and how conservative treatment options such as exercise can be perfect for you! 

High value treatment for lower back pain includes education, physical therapy and re-assurance.

Low value treatment for lower back pain includes MRI, injections, and opioid therapy. These lead to high change of chronic pain and surgery.

In context, do you feel that you would be more willing to exercise when you have lower back pain after a doctor tells you have you normal age-related findings on a MRI or if you have degeneration of your spine? While these are saying the same thing in two different ways, one leads to much better outcomes and long-term results. Not that the degeneration isn’t true but arthritis and degeneration of your spine isn’t scary and most of the time isn’t painful. It's just proving you have been on this earth for a year or two! 

lower back arthritis or degeneration
Lower back arthritis or degeneration? 

When I treat lower back pain, my short term goal is to make your lower back pain better. But my long term goal is to help develop a long term solution to stay better. That almost always comes from figuring out what your body is able to tolerate and building an exercise program around that. I focus on building a plan around your life with the convenience of treating you in your home.

7 necessities for the at home workout for your lower back pain.

  1. It can’t hurt. If you have back pain during a workout, we are not likely to continue because we are worried it may make us worse or do damage. While most of the time this isn’t the case, we are still cautious.
  2. No equipment. Let’s be honest if we have to buy fancy things or make sure it’s around us, the less likely we are to do it.
  3. It has to be quick! We are all busy and while most of us know strengthening is good for lower back pain and for our general health, the time commitment is a challenge. Let’s do as much as needed but no more than necessary.
  4. Instructions. We need to know what to do, how it should feel, and how much to do it. This video is a great workout for lower back pain and it will help you feel less stiff and stronger.
  5. You don’t need a lot of space for a lower back pain workout. Your living room, bedroom, or even family room will have just the right amount of space.
  6. You should warm up. For lower back workouts, warming up your joints and muscles is important. Most don’t do this but it is vital. You should improve your stiffness and range of motion then strengthen to teach your body and improve your lower back pain.
  7. Be cleared to workout. For most, your doctor will tell you that you are safe to workout. Even if you have comorbidities such as hypertension, diabetes, or even a history of past surgeries working out can be completely safe. To make sure always consult a healthcare provider first to make sure you are ready to get stronger and feel better.

In summary: We have covered what exercises should you avoid with lower back pain and learned that exercise is strongly supported by evidence. I have seen it help 1000’s of people who have lower back and who want to prevent it. It’s what you do and how you do it that matters. We need to be smart and listen to our body. We are all busy but we also want to be able to feel better and do more despite our lower back pain.

Quick and effective lower back pain workouts at home are perfect for those who work from home or have busy lives. Try to the 10 min workout to improve your pain, mobility, and strength.

If you want to know more about improving hip and lower back pain check out this webinar I did. It covers differences between hip and back pain as well as common treatments for both as well as best evidence for recovery! 

Make sure to subscribe to be up to date about more tips and tricks around lower back pain!


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Dr. Michael Derry is a Doctor of Physical Therapy and board certified in orthopedics. He is very passionate about treating lower back pain and helping people build their resiliency. He has spent time assisting at universities as well as managing large clinics before starting his own practice in Jacksonville, FL.

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