Back Pain: Lumbar Stabilization and My Favorite Back Exercises

As everyone knows, back and neck pain are exceedingly common issues. 

Studies have suggested that:

• 85% of all Americans will have a back or neck problem at some point in their lives
• 50% of those report they do not know where to go or who to see for treatment
• 70% believe their pain is something they must live with for the rest of their lives

While there is no magic bullet for back pain, the evidence is clear that exercise can “reduce the severity and activity interference from low back pain.”  (J Occup Rehabil. 2009 Mar;19(1):8-24. Feb 14).

There is not yet a solid consensus about what type of exercise is the most effective.  This lack of consensus is most likely a result of the fact that all back pain is not alike.  That is, the treatment for back pain secondary to a disc is surely going to be different from the proposed treatment for a facet joint.  That makes sense to practicioners and patients alike.  It is, however, difficult to study and subgroup out patients with different pain generators for different types of interventions.

My leanings in terms of exercise-based intervention for back and neck pain begins with personalizing and exercise program to work around (1) the pain generator or source of pain symptoms, (2) individual experience and feelings towards exercise, and (3) posture or imbalances specific to the person with whom we are working. 

So, I have my personal favorite exercises that I think are generally great.  But any program needs to be personalized to each person’s situation and needs.  My “big four exercises” are taken largely from Stuart McGill, a reknowned exercise physiologist who has studied extensively exercise and the spine.  There is good evidence that this form of dynamic lumbar stabilization is more effective than so-called “conventional techniques” in rehabilitation of chronic low back pain.” (J Strength Cond Res. 2009 Oct 24)

Following are images of my favorite general back exercises.  These exercises are ideally intended for back injury prevention.  They may be helpful in the context of current back pain but may aggravate certain conditions.  Articles that are forthcoming will give some suggestions for exercises that can be done with ongoing or current back pain symptoms.

Someday I will update these and get a more svelt model for these pictures.  For now, Jim was a good enough sport to demonstrate the exercises (though he is a touch out of shape).

• Curl-up: the focus with this exercise should be on engaging the lower abs.  It can be done with one knee bent or both.  The curl-up should be held for a count of 5 or so with a goal to improve endurance in the lumbar stabilizers.

McGill curl up lumbar stabilization exercise

• Side bridge: a great exercise for engaging the quadratus lumborum and obliques.  The leg on the upside can be raised to advance the level of difficulty for this exercise.  A beginner level of this exercise can be done with the knees bent and the knees and arm used as the two points of support for the side bridge.

Side bridge McGill lumbar stabilization exercise

Prone bridge: the focus should be bracing the abdominal wall diffusely and on building endurance

Prone bridge McGill lumbar stabilization exericse

• Cook hip lift: the focus should be on engaging the hip extensors.  The more the bent knee is pulled towards the chest the more the hip extensors will be engaged (as opposed to perpetuating the common pattern of overusing lumbar extensors and not using hip extensions.  I like this version much better than the more commonly used but related supine bridge exercise.

Cook hip lift lumbar stabilization exercise