Short answer: there isn't one. But what we do know, is that exercise is FAR better than rest! The best exercise for lower back pain is the one that suits your body, your pain and your daily life, and that you can do regularly and build up gradually. For most people that means a mix of gentle movement (like walking), some simple strengthening, and a little mobility work.
Why there's no single "best" exercise
Lower back pain isn't one problem. For one person it's a stiff, achy back after a long week at a desk. For another it's a flare-up that keeps coming back, or pain that has hung around for months. Different backs respond to different things. Research shows that lower back pain isn’t simply the result of an injury or incident, it involves multiple factors including an individual’s stress levels, sleep, beliefs around pain and recovery, perception on their ability recover amongst other factors.
Because there are so many factors, you can imagine why there isn’t a “best” exercise. Therefore, it is important to have a thorough dive into physical, personal, work and psychological factors, to properly understand a person’s back pain, and deliver a tailored plan and program to assist.
“But I want to start exercising now, what can I do?!”
Clinical guidelines generally encourage people to stay active and exercise, but no one type of exercise clearly beats all the others. What matters most is that you:
This question Speaks to me greatly because as someone who doesn't like sitting around I completely understand the desire to want to get started immediately. When starting exercise with the lower back pain there are a few principles that I recommend and they are:
start at a level you can manage
build up slowly over time
do it consistently
choose movements you can stick with
Start with walking
Walking is one of the simplest places to begin. It's free, it's gentle on the back, and you can control how much you do. Start with a short walk, even 5 to 10 minutes, and add a little each week. It's a good idea to record on a piece of paper or the notes on your phone how you felt after the walk break your pain out of 10 and use this as a guide.
If walking is hard right now, that's okay. Gentle movement around the house, or an exercise physiologist helping you find a starting point, works too.
Four simple strengthening moves to try
A stronger back, hips and trunk can help you feel more supported in everyday life. These are common starting points. Keep the movements slow and controlled, and stay within a comfortable range.
1. Glute bridge. Lie on your back with your knees bent. Squeeze your bottom and lift your hips until your body makes a straight line from shoulders to knees, then lower slowly. It strengthens your glutes and hamstrings, which share the load with your lower back.
2. Bird-dog. Start on your hands and knees. Reach one arm forward and the opposite leg back, keeping your trunk steady, then swap sides. It builds control through your back and hips.
3. Side plank (from your knees). Lie on your side, prop up on your forearm, and lift your hips with your knees bent. It works the muscles along the sides of your trunk.
4. Sit-to-stand. Stand up from a chair and sit back down slowly. It's a simple everyday movement that builds leg and hip strength.
A good starting point is 1 to 2 sets of 6 to 10 repetitions, two to three days a week. You can add more as it gets easier.
Add some gentle mobility
If your back feels stiff, easy movements like pelvic tilts, knee rolls or cat-camel (rounding and arching your back on hands and knees) can help you feel looser. Move slowly, and stop if anything feels sharp or worsens your pain.
How much pain is okay?
This is one of the most common questions I hear. Evidence suggests using a rating out of 10 system in which the maximum pain expected is a 5/10 or considered moderate. Another way to look at this would be to assess if you feel worse the day after exercising compared to the day
If you're unsure, start with less than you think you can do. It's easier to build up than to recover from doing too much.
Common mistakes to avoid
Stopping all movement. Complete rest usually doesn't help for long. Staying gently active generally does more. Resting for too long or maintaining the same posture such as sitting standing or laying often causes muscles to get overly tight restricted and that can often exacerbate pain.
Doing too much, too soon. A big jump in activity is a common reason flare-ups happen.
Chasing the "perfect" exercise or posture. Consistency beats perfection.
Copying a program you found online. It may not suit your back, your history or your goals.
When to get checked
Most back pain isn't dangerous, but see your GP promptly if you have:
numbness around your groin or inner thighs
loss of bladder or bowel control
progressive weakness in your legs
fever or unexplained weight loss alongside back pain
back pain after a significant fall or accident
Also check in if your pain isn't improving after a few weeks.
How an exercise physiologist can help
An exercise physiologist can work out what's driving your pain, choose exercises that suit you, and adjust them as you improve. I see clients with back pain all the time and while there are some common themes to my exercise prescription it varies depending on the clients specific situation and pain.
At Move You Exercise Physiology, I come to you across South East Queensland, whether that's at home, a local gym or another place that suits you. If you'd like a plan built around your back, get in touch to book a session. Add call to action button
This article is general information only and isn't a substitute for personalised medical advice. If you have concerns about your health, speak with your GP or an accredited exercise physiologist.
