Exercise program for lower back pain
Exercise program for chronic or recurrent lower back pain. The goal is to strengthen the stabilizing muscles of the lumbar spine (core) and improve hip mobility. Scientific evidence shows that active exercise is the most effective long-term treatment for lower back pain.
Warning signs — consult your physiotherapist if you experience:
- •Pain radiating down the leg below the knee (possible sciatica)
- •Loss of strength in the foot or leg, difficulty walking on tiptoes
- •Loss of bladder or bowel control (medical emergency — go to the emergency room)
- •Pain that worsens with coughing/sneezing and radiates down the leg
Phase 1 — Pain management
Goal: reduce pain intensity and begin moving safely. Bed rest is NOT recommended (2 days maximum only if absolutely necessary).
Single knee to chest
3x20 seconds each legLying face up with knees bent, bring one knee to your chest holding it with both hands. Hold for 20 seconds, feeling a gentle stretch in the lower back. Switch legs.
If you find it difficult, use a towel looped around your thigh to help.
Pelvic tilt
3x15 repetitionsLying face up with knees bent and feet flat on the floor, flatten your lower back against the floor (as if you were trying to crush a grape with your lower back). Hold for 5 seconds and relax. Do not lift your buttocks off the floor.
This is the foundational exercise for learning to activate the core.
Cat-cow
2x10 repetitions (10 cats + 10 cows)On all fours (hands and knees), arch your back up toward the ceiling (cat) while lowering your head. Then let your back sag toward the floor while lifting your head and pushing your buttocks out (cow). Use slow, fluid movements.
Supine lumbar rotation
10 repetitions to each sideLying face up, knees together and bent, arms out to the sides. Let both knees fall to one side as far as is comfortable. Hold for 10 seconds and switch to the other side.
Try to keep both shoulders in contact with the floor.
Phase 2 — Core stabilization
Goal: strengthen the deep muscles (transversus abdominis, multifidus) that stabilize the spine. Progress here when pain is <5/10 at rest.
Glute bridge
3x15 repetitionsLying face up, knees bent, feet flat. Squeeze your glutes and lift your hips until your shoulders, hips, and knees form a straight line. Hold for 5 seconds at the top and lower slowly.
Do not hyperextend (do not rise above the straight line). Engage your abdominals.
Front plank
3x20-30 seconds (progress to 60s)Supported on your forearms and the balls of your feet, keep your body in a straight line (like a board). Brace your abdomen as if you were about to be punched in the stomach. Do not let your hips sag or pike up.
If it is too hard, rest on your knees instead of your feet.
Bird-dog
3x10 each diagonalOn all fours, extend your right arm forward and your left leg backward simultaneously, keeping your back straight (without rotating the pelvis). Hold for 5 seconds. Switch to the opposite diagonal.
Place a glass of water on your lower back — it should not fall off.
Dead bug
3x10 each diagonalLying face up, arms toward the ceiling and knees at 90 degrees. Lower your right arm overhead and your left leg toward the floor simultaneously, WITHOUT letting your back arch off the floor. Return and switch diagonals.
If your back arches, do not lower your leg as far.
Phase 3 — Functional strengthening
Goal: return to normal activities with a strong, resilient back. Maintain long-term 3 times per week.
Bodyweight squat
3x15 repetitionsStanding, feet shoulder-width apart. Lower yourself as if sitting in a chair, pushing your buttocks back and keeping your back straight. Knees track over the toes. Lower until your thighs are parallel to the floor (or less if you cannot reach that depth).
Look forward, chest up. If you lose your form, do not go as deep.
Romanian deadlift with dumbbell
3x12 repetitionsStanding with a dumbbell or water bottle in each hand, hinge at the hips (push your buttocks back) lowering your torso with a straight back. The weights travel down the front of your legs. When you feel a pull in your hamstrings, return to the top by squeezing your glutes.
If you do not have dumbbells, use a backpack filled with books.
Side plank
3x20-30 seconds each sideOn your side, supported on your forearm and the side of your foot. Lift your hips until your body forms a straight line. Hold the position.
Daily walk
30-45 minutes dailyWalking is the best exercise for the back. Minimum goal: 30 minutes a day at a brisk pace. Gradually increase duration and speed.
Walking does NOT worsen lower back pain. If it hurts at first, it usually improves after 10 minutes.
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