Discover simple exercises that can save your lower back

The last few years haven’t done me any good. The physical strain of pregnancy, taking care of the baby, and working from home have left me with constant pain in my lower back. And I’m not the only one. It is estimated that up to 80% of Americans will experience low back pain during their lifetime, and between 15% and 20% of adults in the country, on average, report this problem each year.

Could exercise prevent these pains? The short answer is: maybe. A consistent mix of core and cardio exercises can help. However, exercise does not guarantee that the pain will subside, because there are many mistakes that many of us, even experienced athletes, can make.

The spine is susceptible to pain when the muscle core is weak

“The lower back is the center of our body,” said Dr Krishna Shah, a pain management specialist at Baylor College of Medicine. The spine must have mobility, the ability to bend and twist in multiple directions, and at the same time support the weight of our body.

The muscular core of the body are the muscles that surround the spine. While the tendency is to define the core as the muscles in the abdomen, it also includes the muscles in the back, hips, quadriceps, and hamstrings, which support our spine and pelvis.

The muscular core works in a similar way to a spinal brace, keeping the central portion of the body stable and upright. That’s why wearing a support vest offers pain relief, for a while, for patients suffering from low back pain; but relying too much on its use can weaken the muscle core. Instead, the goal should be to strengthen the muscles so they can perform the same function as the vest.

“If you develop the muscles to have internal support, the solution will be more effective,” said neurosurgeon Sean Barber, a specialist in spinal problems at Houston Methodist Hospital.

Sharp back pain often results from trying a movement and straining a muscle that has lost strength or flexibility. If the muscle in question is not able to provide the necessary force, the pressure transfers to the spine in a way that causes pain.

Developing muscle core strength, flexibility and muscle control can help prevent muscle injuries.

Exercise strengthens the spine

The simplest way to strengthen your spine is to move regularly throughout the day, in whatever way works for you. This could mean increasing the number of steps you walk each day, taking short walks during work, or prioritizing a slightly longer walk in the morning or early evening.

People who are physically active tend to have a lower incidence of low back pain, and a recent comparative analysis of 25 studies found that the most effective way to prevent low back pain from returning is regular exercise, preferably combined with some form of physical education.

“Exercise doesn’t cure everyone, but on average it is an effective intervention,” said Mark Hancock, a professor of physical therapy at Macquarie University and one of the study’s authors. There is no single type of exercise that is demonstrably more effective, he said. “If you do a lot of exercise, chances are you’re getting everything you need,” he said, adding that “it’s like your diet.”

Physical activity also strengthens the bones and cartilage of the spine, and offers protection against deterioration caused by age; in addition, it increases blood flow to the spinal cartilage discs that don’t receive much blood supply, Shah said.

If you have time, try brisk walks or jogs. Several studies indicate that runners have thicker, healthier cartilage discs in their spines than people who are not as active.

Work the neglected muscles

Working your core is crucial to preventing future lower back pain, but that doesn’t mean you need toned abs like Chris Hemsworth’s. Popular core-strengthening exercises such as sit-ups and situps primarily work the larger, outer muscles but neglect the deeper muscles.

For example, the transverse abdominal muscle is a delicate deep muscle that wraps around the midsection of the body like a bodice. There’s also the multifidus muscle, which lines the spine and has multiple extensions that wrap around each individual vertebra, much like a bicycle chain fits over a sprocket.

“It doesn’t take a lot of effort to activate these deep muscles, but they are neglected because you can’t see them” on the beach, said Femi Betiku, a physical therapist at the New Jersey Physical Therapy Center and a specialist in back pain. People with six-pack abs can still experience back pain, he added, if they only work the strongest, outer muscles.

The deeper muscles are engaged when a person makes movements that require more control than strength. One way to activate the deep muscles is to plank, either regular planks, side planks or other variations.

If maintaining a regular plank position is uncomfortable, start with your knees on the floor and then work your way up to balance on your toes.

Shah also suggested squats, push-ups, and bridges. To build and maintain core muscle strength, he recommends two or three core muscle sessions per week. “This requires a lifestyle change,” he said.

There are also sports and physical activities that require a light contraction of the core muscles, such as kayaking, cycling, dancing, boxing, rock climbing, and swimming. Any activity that requires a certain level of control over the central part of the body will require the deep muscles to be activated and engaged.

Work on pimple control

In addition to strengthening exercises, emerging research indicates that it is important to develop muscle coordination and control over the spine. This is equally true for athletes, who focus on performance and sometimes neglect exercises aimed at controlling the spine and pelvis.

In a 2018 study, researchers compared elite athletes to a population of moderately active people. Half of each group had low back pain.

To the researchers’ surprise, both elite athletes and ordinary people suffering from low back pain felt similar stiffness and lack of control over their spines, which is indicative of a similar pattern of weakness in their back muscles.

“The key factor is the ability to control the muscles,” said Mariá Moreno Catalá, a researcher at the Humboldt University in Berlin and one of the study’s lead authors.

To combat this, Betiku recommends Pilates, because in addition to strengthening the deep core muscles, his exercises promote muscle control. In many of the exercises, the spine either remains stable or moves very slowly, which develops muscle control along the spine when it is in different positions.

Incorporating Pilates into your exercise regimen can be simple: just watch instructional videos, many of which require little or no equipment, two or three times a week.

Incorporate an element of stability into your workouts

The slow, controlled movements in exercises like Pilates teach the muscles to move the spine efficiently. The next step is to start exercising in a more variable environment, which allows for the development of greater coordination and control.

In another study, Moreno Catalá and his colleagues found that adding instability to exercise — for example, balancing on an uneven surface, or even exercising in a noisy environment — was effective in relieving lower back pain.

According to her, muscle strength matters less than the ability to exert fine control over the activation and deactivation of the muscles that stabilize the spine.

“We believe that muscle size is the most important quality, but the quality of activation is just as important,” she said.

Choosing sports that include an element of reactivity, whether it’s hiking on a rocky surface or playing tennis, which requires reacting to sudden throws, can result in a similar level of muscle development and control. Exercises such as push-ups, pull-ups, burpees, and squats combined with weights also help, because they require full-body coordination rather than just the isolated movement of lifting weights.

Like a lot of people, I’m guilty of working the outer core muscles and neglecting the inner ones. But in the last few weeks, I’ve started following some short Pilates videos, 10 to 20 minutes each, focusing on slow, controlled movements. After two weeks, I started to feel less stiffness in my back, and the lower back pain would go away for hours. What my lower back really needed, actually, was for me to develop a little more coordination and control.

^{Translation by Paulo Migliacci}