12 Best Physical Therapy (Physiotherapy) Exercises for Lower Back Pain Relief

There’s nothing worse than an ache in your lower back after a workday or waking up with pain at the base of your spine. Yet this is a reality for many of us, with 39% of Americans reporting back pain in the last three months. If you’re experiencing lower back pain, whether it’s constant or sudden, you don’t have to just “tolerate” it. There are options to rehabilitate your back and prevent future pain. Most of those options include some mobility and strength training.

If you hesitate at the words “mobility” and “strength,” it’s understandable. They can be intimidating, especially for those of us who don’t want to spend hours at the gym each day. Fortunately, there are quick moves you can incorporate into your daily routine to provide a big payoff.

Understanding Lower Back Pain and Exercise

More people than ever are experiencing lower back pain, and that number is only expected to rise, thanks to our increasingly sedentary lifestyles. To understand low back pain, let’s first talk about the two most common types: neurologic and musculoskeletal.

Neurologic abnormalities—problems with the structure or biochemical processes of the brain, spinal cord, and nerves—can cause chronic pain in the spine. Conditions linked to this type of pain include arthritis, degenerative discs, and herniated discs, among others. For neurologic pain, more intense treatment (i.e., surgery or medication) will likely be recommended alongside gentle exercises and physical therapy. 

If your pain isn’t neurologic, it’s probably musculoskeletal. The back’s musculoskeletal system is made up of muscles, bones, and soft tissue around the spine. This system, especially the muscles, protects the spine and back as a whole. You can think of the muscles in your back as a protective mechanism, offloading the physical demands placed on the spine by everyday life. An exercise regimen that strengthens and mobilizes these muscles keeps the back in tip-top shape. 

When experiencing back pain, it’s important to seek out a pain management specialist who will determine if your pain is neurological or musculoskeletal.

How Proper Exercise Supports Spine Health 

The World Health Organization says back pain is the condition with the greatest number of rehabilitation success stories. But what does successful rehabilitation look like? 

According to Brett Pugh, PT, DPT, a physical therapist at Commons Clinic, a successful plan involves a mix of mobility and strength training as well as any necessary pain management or PT support. “For back muscles to function effectively, they must possess both the strength and mobility necessary to perform their role efficiently,” he explains.

Mobility improves the functionality of the back, making it easier to twist your back or reach up and grab something. Certain stretches and exercises improve this health marker—and it’s best to do them daily, according to Dr. Pugh. 

For someone with a busy 9-5 and children, that may look like five minutes of mobility in the morning before everyone else in the household wakes up. Another person who is a night owl and wants to invest more time into mobility may spend 20 minutes on mobility before bed.

Strength training is another staple since it prevents future back pain and may help with rehabilitation. The good news is you don’t have to pump iron in the gym daily. Pugh often recommends strength training three days a week. And if the gym isn’t your scene, don’t fret. Resistance training, exercises with medicine balls, and bodyweight strength training, like yoga or pushups, count too.

Role of Professional Physical Therapy Guidance

“Everyone’s low back pain is going to be a little bit different, so everyone has to be treated a little bit differently,” explains Pugh. A physical therapist can often help you navigate the specifics of your case, creating a lower back rehabilitation plan that works. 

“When meeting with a physical therapist, you can dive into your situation, what’s going on, and what’s adaptable to your lifestyle,” adds Pugh. The physical therapist can then create a rehabilitation plan that fits your life. 

There are clear signs when it’s important to seek professional help for your pain. It may be time to seek out a pain management specialist or physical therapist if you experience:

• Tingling or numbness in the back
• Back pain after a single event, such as a fall
• Severe pain that isn’t improving
• Back pain along with trouble urinating, pain/numbness in the legs, or a fever

Lower Back Exercises

Cat Cow

This yoga classic targets multiple muscles in the lower back and boosts spine health. “Cat cow is a great move to do if you have spinal stiffness,” says Pugh.

For cat cow, start with your hands and knees on the ground. Drop your back and lift your head up to drop into the cow pose. After holding this move for a few seconds, drop your head and lift your back to come into cat pose. Move between these moves slowly and with control. 

Bird Dogs

While bird dog is a full-body stabilizer, Pugh says it’s especially great for preventing or recovering from back pain. When doing this move, there are a few variations to choose from. For all of them, start on your hands and knees, with your shoulders over your wrists. The first (and easiest) variation is to kick out alternating legs straight back. Once you have this down, extend your arms out, one at a time. 

With the most advanced variation, extend your opposite arm and leg out at the same time. 

Down Dog x Up Dog

What’s the best way to start your day? We suggest the down dog x up dog (sorry, coffee!). “I always tell people to do it in the morning when they first wake up, just to get everything lengthened out,” says Pugh.

To complete this stretch, start on your hands and knees. From there, tuck your toes under, shoot your hips back, and extend your knees until you’re in the down dog position. Next, drop your knees and hips down, shift your weight forward, and arch your back into the up dog position. Flow between these two moves, holding each position for about five seconds.

Knee-to-Chest

“Knee-to-chest is a super passive stretch that feels great in the low back,” says Pugh. He often recommends this move to those who are experiencing back pain or just getting into lower back exercises for pain relief.

To do this restorative pose, start on your back with the soles of the feet planted, knees pointing upward. Grab one leg and hug it close to your chest. Hold for about 10-15 seconds before letting go and grabbing the other leg. To deepen the stretch, extend your other leg out long instead of lying with the knee bent, with the soles of your feet on the ground.

Supine Marches

“This is a great one to work the core without putting too much pressure on the back,” says Pugh. He often recommends supine marches to patients with back pain, though it can work as a preventative exercise as well. 

For supine marches, start lying down, face up. Keep your knees bent and flatten your back against the table. From here, lift one foot up slowly and then bring it back down. Alternate which foot you lift to work both sides evenly. 

Side Plank Clamshells

Pugh suggests side plank clamshells to patients because this move strengthens the glutes and the obliques, two muscles that can help offset pressure on the spine. 

To set up the side plank clamshell, lie on your side, knees bent and stacked over each other. Your feet should also be stacked over each other while your shoulder should be above your elbow.

Once in position, lift your top leg up and down, keeping your feet together. For a more advanced option, bring both knees off the ground so you’re on your feet, but your torso and legs are lifted and do the same lifting move.

Child’s pose

For child’s pose, start on your hands and knees. From there, sink your butt onto your heels while walking your arms forward and laying your head on the ground. Shift your weight backwards and round your back as much as you can. 

Once in the pose, hang out for a minute or two for a gentle, restorative stretch. Dr. Pugh says, “Child’s pose is a fantastic one to do if you’re having back stiffness or pain.” Plus, it can be completed on the floor, a bench, or any other flat surface.

Dead Bug

While strengthening the core is important, some core exercises put the back at risk. One exercise that doesn’t? Dead bug. “Dead bug is a great exercise to target the core while keeping the back relatively safe,” Pugh explains.

To start, lie on your back with your legs lifted up and your knees at a 90-degree angle. From this position, reach your hands up, wrists stacked over the shoulders. While in this position, flatten your back against the table. From there, drop one leg down and bring it back up. For a more advanced option, bring down the opposite arm and leg. 

Leg Swing

Leg swing is a super easy move that stretches out the back. Start lying on your back, extend out both legs with shoulders flat on the table. Elevate the right leg and slowly let gravity pull it down across the other leg, rotate at the hips, and let it fall down. Keep your shoulders on the ground throughout the move and hold the position for thirty seconds. Then, switch and do the left leg. 

Bear Holds

Bear holds strengthen key muscles around the lower back, mainly the core. Along with strengthening the core, Pugh also recommends this as a mobility exercise. “Bear hold puts a lot of pressure in the shoulders and hips, which is great for mobility,” he explains.

For this exercise, start on your hands and knees. The wrists should be underneath the shoulders. Tuck your toes and lift so your knees are off the ground. At the same time, tuck in the pelvis so your back is in a straight line. Hold this move for 15-30 seconds. 

Windmills

To complete windmills, stand with feet shoulder-width apart and then walk them out until you’re in a sumo position. Stretch your arms out wide, then reach the left hand to the right foot, floating the other hand up to the side. Go back to the starting position and then repeat the move on the other side.

“Windmills are a great exercise to stretch out the spine,” says Pugh. They often make a fantastic addition to a daily mobility routine, whether you’re preventing future back pain or recovering from current lower back issues. 

Lumbar Rotations

“Lumbar rotations are a super easy exercise to perform that opens up the back and hips,” explains Pugh. To perform a lumbar rotation, lie on your back with your knees bent. Keeping your back flat, drop your knees over to one side, bring them back through the center, and drop them to the other side.

Frequently Asked Questions (FAQs) 

What is the single best exercise for lower back pain?

When researching how to relieve lower back pain, it’s important to note one single “best move” doesn’t exist. Instead, you want to build out an exercise routine that prioritizes mobility and strength in the lower back and doesn’t aggravate any current injuries or pain in the region. 

What does a physiotherapist do for lower back pain?

A physical therapist creates customized rehabilitation plans with physical therapy exercises for lower back pain. A physical therapist will also recommend ways to fit the exercises into a patient’s life. In severe cases, lower back pain may also require other treatment, like surgery or medication.

Should I stretch my lower back if it hurts?

If the lower back hurts, you should stretch it lightly. Not stretching can actually make the lower back more stiff, causing more pain. When stretching, notice if any back exercises aggravate the pain. If so, move out of the stretch slowly and try a different one.

How to reduce lower back stiffness?

A daily mobility routine can help reduce lower back stiffness. Some of the best exercises include windmills, bear holds, leg swing, dead bug, cat cow, and downward dog to upward dog.

How often should I exercise?

The recommended minimum time to exercise is 150 minutes of aerobic training (biking, walking, running, etc.) and two strength training sessions a week. Keep in mind this is a minimum, and many people find it beneficial to exercise more often and to add in a daily mobility routine, which helps prevent future pain and preserves your body’s functionality. 

When should I see improvement?

Improvement can occur in as little as one week or take more than six weeks. It’s hard to give an exact number, since improvement depends on the type of back pain and rehabilitation plan. For a more accurate estimate, talk to a physical therapist or other pain management specialist. 

Conclusion 

“Mobility and strength-based exercises are critical for maintaining spinal health,” says Pugh. For maximum effectiveness (and to prevent injuries), the exercises you do should be tailored to your lifestyle, fitness level, and any current lower back injuries. 

A physical therapist can provide the necessary guidance to get the most from your lower back exercises. If looking for a physical therapist, consider Commons Clinic. Our team helps patients rehabilitate the lower back and prevent future pain or injuries.

Sources

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