Do’s and Don’ts of Lower-Back Pain Exercises Learn the Right Activities to Address Back Issues

The right kind of lower back pain exercises can give you relief, but the wrong moves can leave you in even more agony – and possibly send you on a trip to the ER. How do you know which kind of back exercise is best? Follow these 10 expert tips on what you should and shouldn’t be doing – from stretching to sports – and you’ll recover more quickly... Back bothering you? Join the club. Four out of five people will have lower-back pain symptoms in their lives, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Your back pain symptoms may be continuous and dull or sudden and sharp, lasting from a few days to several weeks. It’s considered “chronic” if pain lasts longer than three months. “Most back pain is mechanical, meaning day-to-day life stresses lead to overload,” says Ted Dreisinger, Ph.D., research coordinator for the U.S. Spine and Sport Foundation in San Diego and associate editor of The Spine Journal. “A small number of cases – less than 1% – are caused by something more serious, such as a fracture, spinal tumor or systemic [bodywide] inflammatory disease,” he adds. “These require medical attention.” Other reasons to see a doctor are if the pain is constant, wakes you up at night, includes leg pain, or follows an injury. But for less-serious back pain symptoms, the best way to keep them at bay is to stay active, Dreisinger says. “It may sound counterintuitive, because the natural response to pain is to do less – but the opposite actually holds true” with back pain symptoms, he says. That’s because exercise helps muscles relax and increases blood flow to the area, which helps to clear byproducts of inflammation. However, not all back pain is the same, and different kinds of exercise help different people. “Finding what makes your pain better or worse is most important,” Dreisinger says. Doing the right exercises – and avoiding the wrong ones – can either help ease the pain or prolong recovery for your back issues. Here’s expert advice on the best activities for your back pain symptoms. What to Do 1. Don’t just lie there. It may be tempting to rest until pain subsides, but taking to your bed for more than a day or two may actually make your back pain symptoms worse, according to the National Institutes of Health (NIH). Back exercise tip: Simple activities are best when you’re starting to recover from pain, Dreisinger advises. “Walking is an excellent activity to start,” he says. “Walk 10-15 minutes twice a day at a moderate pace.” 2. Stretch out. “The right stretches help calm low-back spasms,” Dreisinger says. Do the following back-friendly stretches in the morning and evening, 8-10 times each, he advises. Back-pocket stretch: Stand up and place both hands behind you as if putting them in the rear pockets of your jeans; look up and extend (arch) your back. Press-ups: Lie on your stomach and place your hands on the floor as if you were starting a push-up. Press just your upper body up, allowing your lower back to sag by keeping your hips close to the ground. Hold for a few seconds. 3. Determine which moves make your pain worse. The most common type of back pain is “extension syndrome,” which usually causes discomfort while standing upright, says physical therapist Rick Olderman, owner of Z-Line Training in Denver, Colo., and author of Fixing You: Back Pain (Boone Publishing). Causes include sitting for hours without using your chair's back rest, and habitually standing with locked-out knees (where they’re straightened to the point that they’re hyperextended backwards, putting pressure on the joint), he says. Here’s how to tell if you have extension syndrome: Lie on your back for 30 seconds with your legs out straight. Then bend your knees so your feet are resting on the ground near your behind and wait 30 seconds. “If your back feels better with your knees bent, you probably have extension syndrome,” Olderman says. Back exercise tip: While standing, keep your knees slightly bent, Olderman advises. And when lying on your back, put your feet near your behind or on a chair or bench. Two other major back-pain categories are flexion and rotation syndromes. “Flexion syndrome, which can cause pain while sitting, is the opposite of extension syndrome," Olderman says. It often results from sitting against the back of your chair too much, causing your spine to flex forward easily. This leads to tight hamstrings and weak and lengthened back muscles. To test for it, lie on your back with knees bent and then straighten them to see if you feel relief. Back exercise tip: If you have lower-back pain caused by extension syndrome, keep your knees bent and up on the bench while doing exercises that require lying on your back (such as chest presses) – or skip the bench entirely, and lie flat on the floor with knees bent. Rotation syndromes occur when the spine is more or less permanently rotated in one direction, Olderman says. It may hurt if you twist to one or both sides. It often results from repeatedly rotating in a particular direction, such as to look at a computer monitor or reach a desk drawer or other frequently used object kept off to the side. If you experience back issues like these, avoid turning too much in either direction. Be careful with sports like tennis or golf, which can further increase the imbalance – consult with a professional familiar with biomechanics (such as a golf pro) who can make suggestions on ways to modify the moves. Back exercise tip: Also, try to center the spine through core-strengthening exercises. 4. Exercise in a pain-free zone. Don’t “work through the pain,” advises Marc Tinsley, D.C., a chiropractor with a practice near Pittsburgh, Penn. “If it hurts to bend backward, don’t,” he says. “Pressing into a painful position can cause further tissue damage and aggravate [existing] damage.” Back exercise tip: If workouts hurt, focus on stabilization moves like planks or the Bridge Pose, Tinsley says. Do 10-20-second holds for 3-5 repetitions. 5. Straighten up. Slumping and slouching are often a culprit in back pain symptoms, especially among overweight or obese women, says LynnAnn Covell, a physical therapist and senior fitness specialist at Green Mountain at Fox Run, a women’s weight-loss center in Vermont. “The pelvis can tilt to stabilize additional weight on the skeletal system, causing lower-back muscles to tighten,” she says. If you tend to slouch, practice good posture. Align your spine a few times a day by standing straight, lining up head, shoulders, hips, knees and feet. This helps alleviate tension when you have lower-back pain, Covell says. And wear shorter-heeled shoes. “Wearing high heels may also contribute to an unstable postural alignment,” she adds. What Not to Do 6. Don’t skip your warm-up. Many back pain issues occur when we suddenly put pressure on the spine without warming up, says Covell. “Before attempting activities such as resistance exercises or working in the garden, perform some simple stretches.” Back exercise tip: One good pre-activity stretch is a yoga move called the cat-cow: Start on your hands and knees with your back straight and your head and neck in line. On an inhale, drop your belly toward the ground and look up toward the ceiling (cow pose). On an exhale, tuck in your stomach, arch your back and lower your head to your chest (cat pose). Do it gently, and stop if you feel any pain. And before any exercise, warm up for 5-10 minutes with a low-level cardio routine (such as walking); this gets blood circulating and may help you avoid injury or worsened back issues over time. 7. Don’t lift heavy objects or practice high-impact moves. Avoid activities that cause pain during or immediately after exercise, says Ian Armstrong, M.D., founder and medical director of Southern California Spine Institute in Westlake Village, Calif. (Mild muscle soreness that comes on 24-48 hours after a workout is normal and should go away on its own.) If you lift weights, make sure you use correct form and amounts of weight you can handle. (Weight machines may be easier to control than free weights, especially if you’re inexperienced.) Back exercise tip: High-impact activities – running, jumping, step aerobics, basketball and anything that puts stress on your joints – can also worsen back pain symptoms and should be avoided until pain subsides, Armstrong says. “Replace these with non-impact activities, such as walking or working out on an elliptical trainer or recumbent stationary bicycle,” Armstrong says. 8. Don’t lift weights overhead or on your shoulders. Shoulder presses and other overhead weight moves stress the spine and shouldn’t be done when you have back pain, says Jeff Winternheimer, D.C., a Chicago-area chiropractor. “Using weights overhead adds pressure to the spinal discs,” he says. Back exercise tip: Also avoid exercises in which a weight rests on your shoulders, such as weighted squats, he adds. 9. Don’t limit yourself to land-based exercises. Water aerobics and other pool exercises may help you get on your feet faster, according to a 2009 study published in the journal Spine. When 65 patients with chronic low back pain either did aquatic exercise or worked out in their homes for six months, those in the pool program experienced greater improvement. Swimming is also a great back exercise that can help ease the pain, Armstrong says. “It’s a good, non-impact aerobic exercise that doesn’t put pressure on the spine.” 10. Don’t ignore the hurt. Most back pain symptoms are self-limiting – if you don’t make them worse, they’ll probably heal within days or weeks, Armstrong says. “But if it doesn’t go away on its own, don’t ignore the pain and continue to work out,” he says. “This can cause further damage.” Plus, excessive activity can just reinforce the movement patterns that helped you develop back pain in the first place, says Olderman. So take another look at the back exercise you’re doing. Is it too intense? Could the movements be aggravating your back issues? Chronic pain should disappear once these issues are corrected, says Olderman. If it doesn’t, see a doctor. For more information and expert advice, visit our Pain Health Center. How Bad Is Your Back Pain? So your back hurts? Take our back pain quiz to see how severe it really is. You may need to see a doctor but have just been avoiding it, thinking it will get better. On the other hand, your back pain may be more normal than you suspect.