28 Mar Dr. Chris’s Workouts with Low Back Pain Exercises
Having had chronic low back pain, there are specific principles I follow when doing low back pain exercises.
I also owned a CrossFit gym for 5 years and got my CSCS (certified sports & conditioning specialist). I’ve learned a lot what doesn’t work.
We’ve had many patients do physical therapy and their pain doesn’t get better or gets worse.
How you do your low back pain exercises and respecting the principles matters.
A patient asked me:
What exercises do you do for low back pain and how do you incorporate them into your workouts?
I explain my workouts here.
How to Rotate Low Back Pain Exercises into Your Workouts
Here’s how I think about it.
This is a simple routine that many will find boring, but will go a long way to keeping your low back health in the long run.
I divide all of the body regions into sections so they all get hit:
- Core – Front
- Core – Side – includes sides of glutes (glute medius)
- Core – Back
- Posterior Chain – Glutes, hamstrings
- Functional – Step-ups, lunges
Then, I have my bag of isolation exercises for each body region.
I typically choose one exercise per body region and rotate in super-set fashion through them.
A super-set means doing ALL of the exercises for one round before doing them all again for 2nd and 3rd rounds.
Core – Front
This area includes rectus abdominis.
- Plank with a posterior pelvic tilt
- Ab Roll-out with a barbell or wheel
- H0llow Body
Curl-ups are the most peeled back ab exercise you can do.
Rx: You should be able to do 2 x 2o reps without poking the chin forward before advancing to any other movements.
I prefer planks with a posterior pelvic tilt.
You can advance this a ton to make it difficult for the abs, pelvis, and shoulders.
i.e. I add a push-up plus and keep my toes pointed so the toenails are on the ground, resembling how gymnasts train.
Gymnasts are arguably the most functional and strongest athletes. I want to do what they do to make my body as bulletproof as possible.
If you’re just getting started, don’t worry about the toes and shoulders. But DO focus on tucking your tailbone under you as you pull your pubic bone up towards your rib cage.
As my high school strength coach used to tell us:
Pretend like you’re squeezing an olive in your butt cheeks and there’s no way in hell you’re going to drop it.
Rx: You should be able to do 2 x 30 seconds for basic fitness or 2 x 60 seconds for more advanced fitness.
Ab roll-outs put an eccentric stress on rectus abdominis and make my abs more sore (and hence, stronger) than the other movements.
This is a more advanced movement and should progress slowly in reps because you’ll be cursing me 1 day after if you do too much too fast.
Rx: Start with 2 or 3 sets of 5 reps and don’t bring the wheel all the way out, especially if you’re compensating in your pelvis.
Hollow bodies are the front core exercises I do the most.
They don’t require any equipment and gymnasts do them.
Again, I don’t need to remake the wheel, so I follow what works for the best athletes.
Rx: A good goal is 2 sets of 15 secs for beginners or 2 sets of 30-45 seconds for more advanced.
Core – Side
This area includes the sides of glutes (glute medius and minimus), obliques, and QL.
- Side Planks
- Jane Fondas
- Suitcase Carry
Side planks lock your pelvis and abs and are a great place to start to build the side core.
Rx: You should be able to do 2 x 30 seconds for basic fitness, or 2 x 60 seconds for advanced fitness.
I use Jane Fondas to target the glute medius/hip external rotator area.
I target the:
- hip external rotators by rotating up hip externally so my toes are pointed to the ceiling
- glute medius by rotating up hip internally so my toes are pointed to the ground
Keep your toes pointed to the ground (plantar flexion) and fully lock your knee and quad.
Rx: You should be able to do 2 x 15 per side.
Side planks and Jane Fondas are not very functional.
Meaning, we don’t move that way very often in everyday life.
But a suitcase carry?
Many of us do this movement every single day, carrying items like babies or shopping bags.
Core – Back
This area includes all of the low back erector spinae.
- Good Mornings
We’re able to skip bird-dogs and go straight to good mornings with most of our patients after getting the adhesion removed.
But if someone has a severely degenerated low back, we will scale back good mornings and do bird-dogs.
The only thing I’d add to this video that is not communicated is to keep the ribs locked down to the belly so the spine stays in neutral and doesn’t hyper-extend.
Rx: You should be able to do 2 x 8 reps (alternating).
Good mornings are one of the first exercises we give our patients once they can handle some load after getting their adhesion removed.
Rx: You should be able to do 2 x 15 reps.
If you’re an athlete or need to be able to use your body more than the average Joe, you should be able to do 2 x 15 reps with a 15-25 pount DB or plate held to your chest.
After we sent this blog post out to our email list, one of our patients, Melissa, who finished care and got out of low back pain asked us how to progress the good mornings.
Thank you for sending this over! I was really interested in how I could diversify the workouts that were given to me and this helps a lot! I was also wondering if you could go into detail about when it would be safe to add a dumbbell to good mornings at my level. I do feel like I’m getting stronger but I definitely need to be even more consistent with working out each day. Lately most weeks I get in about 4-5 days but that’s much better than I was doing before so yay!
Just wanted to say thanks again for all you do! It is very much appreciated!!
We made this video in case any of you had the same question.
This area includes the low back erector spinae, glutes, and hamstrings. You can also include “flossing” of the sciatic nerve.
- Good Mornings
- Glute Bridges
- Hamstring Bridges
We already discussed good mornings above.
They target the butt and hamstrings in addition to the low back.
I LOVE glute bridges.
I just feel better when I do them.
The cool part about glute bridges is you can maintain glute size (nice butt!) and squat strength by doing high rep glute bridges WITHOUT weight.
Rx: Aim for 2 sets of 15 reps to start and build up to 2 sets of 50-60 reps (you’ll be surprised how good you feel after high rep sets)
Hamsting bridges/hip lifts are an amazing way to target the hamstrings without putting a lot of load (or stress) on the low back or knees.
Rx: Do 2 sets of 15 reps with both legs. When that’s easy, advance to 1 leg at a time, but start at 4-5 reps, building up to 15.
This is a very new addition.
Over the past year, I’ve gotten into Knees over Toes Guy and his program.
In the past, I’ve noticed when I stand for long periods of time, my legs (below my knees) feel weak.
After standing for a long day, my back will hurt.
I’ve noticed BIG differences by targeting my shins and calves with Knees over Toes Guy.
Below, KOTG does a backwards sled walk.
I started this exercise by simply walking really slowly backwards.
A functional exercise is one that resembles a real-life movement, often using multiple body regions.
You’re training the body to work in everyday life.
Step-ups are a peeled-back version of lunges.
They’re amazingly functional if you like going up stairs. I ALWAYS go up 2 stairs at a time to maintain this strength.
You should start with a low step and build height only as your body is able to maintain good form and you can get ALL THE WAY up with the leg you’re using.
I use step-ups when someone has restricted hip extension, often from a severe disc issue, stenosis, or a labrum tear in the hip.
You can measure your own hip extension with our Lunge Stretch Test.
Lunges are arguably my favorite lower body exercise. They are the functional equivalent to being able to walk well.
Everyone wants to be able to walk pain-free, don’t they?
Low Back Pain Exercises Principles to Keep in Mind
The Pain-Free Principle
All exercises should be able to be done 100% pain-free.
We will allow our patients to do these exercises with a 1 or 2 out of 10 pain level, but nothing more than that as they might cause more harm than good.
We keep an eye on these exercises. As someone gets stronger, the pain levels should reduce. If they do not reduce, we change the reps or exercises up to see if we can get load on these muscles another way to make it pain-free.
If they have a pain level of 3 or higher, we tell them they need to get adhesion removed first.
Adhesion will glue up muscles, weakening them, putting further stress on the spin and cause faster arthritic changes that become less permanently fixable as one ages.
If a patient is pain-free in a portion of the range of motion but not in another part of the range, then we’ll often have them do the exercise ONLY in the pain-free portion.
i.e. The 1st, lower-half of the glute bridge is pain-free, but the 2nd, top-half is painful — then they’ll only do the glute bridge in the 1st, lower-half of the movement.
The Direct Feedback Principle
Do your Low back pain exercises for any body region you’re concerned about DAILY to get direct feedback .
When we are actively treating chronic low back pain, we have our patients do these exercises everyday, compared with conventional physical therapy that tends to have people do them 2-3 days/week.
The reasons why we want our patients doing them every day is because:
- More frequent exercise means smaller bits of stress done more frequently – it’s safer!
- More frequent attention on doing these exercises and how easy they get from day to day give’s a patient’s mind DIRECT FEEDBACK. Once they get the feedback, they’re more motivated to keep doing them.
The Hips & Shoulders Move but the Spine Doesn’t Principle.
The hips and shoulders are ball-and-socket joints.
We evolved to be able to move those joints 360 degrees to move our feet and grab things in the wild.
The spine, as a generalization, isn’t meant to have so much movement.
The spine is meant to be stable, or NOT-move.
When you do planks, side-planks, deadlifts, squats, shoulder presses, the idea is to PREVENT the spine from moving.
And that is what makes the core stronger.
Play with these Low Back Pain Exercises Mindfully and at you Own Risk
Now that we’ve discussed these foundational low back pain exercises, play with them.
Be very mindful not only each day you workout, but zoomed out over a 1-4 week window to assess if they’re helping you or not.
If you notice you’re stronger with them but your low back pain has worsened with other movements or postures, I’d seriously consider stopping and getting checked by an adhesion removal specialist.
If you choose to do these, please be aware that I have idea what your diagnosis is and if you might be doing harm.
Doing exercises when you have pain is kinda like giving someone with high blood sugar insulin without doing any other tests. You may have diabetes, but you could have a lot of other issues as well.
Just because your muscles feel weak doesn’t mean that they are. You could have neurological weakness caused by some randomly damaged tissue.
Want to learn more about what other pieces of your low back pain diagnosiss are missing?
Consider getting baseline measurements for your hip flexion, knees, ankles and your low back.
What are you numbers? Please share range, effort, and symptoms below and we can discuss what you should be doing to restore musculoskeletal integrity.