September 9, 2021

Can Stretching and Exercise help with Low Back Pain?

Written by: Marina Peric, M.D.

Chronic low back pain is a pain in the lower back (between the lowest rib and gluteal area)that persists for more than three months. Many conditions can cause a painful back, yet, chronic back pain has no evident cause in most cases, and is therefore referred to as non-specific.

Studies say that 80-90% of adults in the USA will suffer from back pain at least once during their lifetime, so if you’re experiencing it, don’t be surprised. Associated with the sedentary lifestyle, it is one of the most prevalent health issues of modern society’s working population. The 2010 Global Burden of Disease marked low back pain as the leading cause of disability, and the prevalence and burden were shown to increase with age.

 

What causes low back pain?

 

Conditions, such as arthritis, discus hernia, or osteoporosis can be a cause of back pain, and these are serious health issues that require proper management by medical professionals.

However, most cases of non-specific low back pain are caused by poor physical condition and a sedentary lifestyle. Lack of physical activity and a lot of time spent sitting (usually in front of a computer screen) are devastating for the back muscles. Not being used, muscles become weak, and the mechanics of the back, hips, and thighs change, which may cause pain in the lower back.

It has been proven that the hamstring muscle, a major muscle in the back of the thigh, is shortened in many people with chronic non-specific back pain. The same stands for the muscle known as tensor fascia latae, the shortening of which decreases the range of motion in hip joints. Shortening of these muscles and weakening of back muscles lead to abnormal alignment of the lumbar spine, and this results in pain.

 

How do you treat chronic back pain?

 

Paying a visit to a doctor is the first step to take. The diagnosis of chronic non-specific back pain can only be made by excluding all other potential causes of back pain. This requires detailed examination and assessment of the level of pain and the ability to perform tasks such as walking or standing, and X-ray, MRI, CT, or other more sophisticated diagnostic procedures may be needed too.

Once the diagnosis is made, the doctor will propose a treatment strategy. You may have to try out different options in order to find out what works the best for you particularly. Cases that require invasive treatment (for example, surgery, or daily corticosteroid injections) are rare. The combination of pain-relieving drugs and non-invasive treatment methods, such as physiotherapy, behavioral therapy, manipulation and mobilization, superficial heating, or yoga, work well for most patients.

Most of the available guidelines and recommendations underline the importance of avoiding bed rest and returning to normal daily activities as soon as possible. Furthermore, exercise is recommended for improving posture, strengthening the core and spinal muscles, and stretching shortened muscles, such as the already mentioned hamstring, is helpful too. A 2012 review by Steiger and associates showed that exercise is beneficial for coping with low back pain even without measurable improvement in spinal muscle strength, and regardless of the exercise type. A 2010 study by Bachmann and associates stated the significant effect of exercise on work disability too.

How to stretch and what kind of exercise to do for chronic back pain?

It would be best to visit a physiotherapist and get the answers to these questions for your particular case. There are some common exercises and stretches which can potentially help you and which you can try on your own, and some of those are listed here. It is important to exercise regularly, and to be patient, as the results cannot come overnight. Bear in mind that exercise must not bring you more pain or discomfort – if this is the case with a certain exercise or stretch, do not force yourself into doing it. The point at which the pain starts is the limit that you should never pass.

 

Related Article: Back Straighteners and Posture Importance


Stretches for low back pain


Knee to chest stretch

Lie on your back and bend your knees. Put your hands around one knee, and pull it toward your chest. If it’s not painful, you can lower your other leg. You should feel stretching in your buttocks. Hold this position for 10-30 seconds, and repeat with the other leg.


Hamstring stretch

Lie on your back and bend your knees. Put your hands around one thigh, and slowly straighten the knee of that leg, keeping the right angle between the calf and the foot. Try to bring the extended leg towards yourself until your sole is parallel with the ceiling. Hold the stretch for 10-30 seconds, and repeat with the other leg.


Trunk rotation

Lie on your back and bend your knees. Place your arms on the ground at a 30 degrees angle to your body with the palms down. Rotate both of your bent legs to a side, while holding your upper body pressed to the ground. You will feel a stretch in your thighs, buttocks, and loins. Hold this position for 10-30 seconds, and repeat several times, changing the side every time.


Child’s pose

Start by kneeling on the floor. Push your hips back until you find yourself ‘’sitting’’ on your heels. At the same time, bend your torso over and rest it on your thighs. Extend your arms, and push them forward as much as possible, as long as it is comfortable for you. Hold the position for 10-30 seconds.


Cat cow pose

Start on your hands and knees. Your hands should be shoulder-width, and your knees hip-width apart. Keeping your arms straight, push your belly towards the ground and flex your spine as much as possible. Lift your head and gaze up to the ceiling. This is the cow pose. Now do the cat pose: flex your spine the opposite way, so that your back is round toward the ceiling, and move your chin toward your chest. Switch between the two poses several times.

 


Exercises for low back pain


Bridges

Lie on your back and bend your knees. Place your arms on the ground at a 30 degrees angle to your body with the palms down. Tighten your buttocks and abdominal muscles, and lift your hips until they’re in the same line with your shoulders and knees. Hold this position for five seconds, then lower your hips back to the ground. Repeat 10-20 times.


Forearm plank

Start on your forearms and knees. Your elbows should be shoulder-width apart, directly beyond your shoulders. Extend your legs, and lean on your toes. You’ll have to tighten all your core muscles to distribute the weight of your body evenly between your elbows and toes. Make sure your body is in a straight line, and that your spine is not bending in either direction. Hold this position as long as comfortable, and repeat several times.


Bird-dog

Start on your hands and knees, with your hands shoulder-width, and your knees hip-width apart. Extend and raise one leg and the opposite arm at the same time. Hold for a few seconds, go back to the starting position, and do the same with the other arm and leg. Repeat 10-20 times.


Pelvic tilt

Lie on your back with your knees bent, and your arms lying next to your body with the palms facing down. Lift your hips just a little bit, tighten your buttocks, and curve your spine, so that you tilt your pelvis toward your trunk. Hold for a few seconds and release. Repeat 10-20 times.


Superman

Lie on your belly, and extend your arms in front of you. Your head should be in a neutral position, face down, and you should try not to move it. Lift your straight, tightened legs and arms off the ground at the same time. Hold the position for 2-3 seconds, relax for 2-3 seconds, and repeat everything 10-20 times.

 


References

  1. Steiger F, Wirth B, de Bruin ED, Mannion AF. Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review. Eur Spine J. 2012;21(4):575-598.
  2. Oesch P, Kool J, Hagen KB, Bachmann S. Effectiveness of exercise on work disability in patients with non-acute non-specific low back pain: Systematic review and meta-analysis of randomised controlled trials. J Rehabil Med. 2010;42(3):193-205.
  3. Salzberg LD, Manusov EG. Management options for patients with chronic back pain without an etiology. Health Serv Insights. 2013;6:33-38.
  4. Bae HI, Kim DY, Sung YH. Effects of a static stretch using a load on low back pain patients with shortened tensor fascia lata. J ExercRehabil. 2017;13(2):227-231.
  5. Paolucci T, Attanasi C, Cecchini W, Marazzi A, Capobianco SV, Santilli V. Chronic low back pain and postural rehabilitation exercise: a literature review. J Pain Res. 2018;12:95-107.
  6. Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, Murray C, Burstein R, Buchbinder R. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968-74.
  7. França FR, Burke TN, Caffaro RR, Ramos LA, Marques AP. Effects of muscular stretching and segmental stabilization on functional disability and pain in patients with chronic low back pain: a randomized, controlled trial. J Manipulative PhysiolTher. 2012;35(4):279-85.
  8. Shamsi M, Mirzaei M, Shahsavari S, Safari A, Saeb M. Modeling the effect of static stretching and strengthening exercise in lengthened position on balance in low back pain subject with shortened hamstring: a randomized controlled clinical trial. BMC MusculoskeletDisord. 2020;21(1):809.
  9. Lee JH, Kim TH. The treatment effect of hamstring stretching and nerve mobilization for patients with radicular lower back pain. J PhysTher Sci. 2017;29(9):1578-1582.
  10. Sherman KJ, Cherkin DC, Wellman RD, et al. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Arch Intern Med. 2011;171(22):2019-2026.
  11. Owen PJ, Miller CT, Mundell NL, et al. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br J Sports Med. 2020;54(21):1279-1287.
  12. Shariat A, Cleland JA, Danaee M, Kargarfard M, Sangelaji B, Tamrin SBM. Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial. Braz J PhysTher. 2018;22(2):144-153.
  13. Hatefi M, Babakhani F, Sherman KJ, Wellman RD, Cook AJ, Cherkin DC, Ceballos RM. Mediators of yoga and stretching for chronic low back pain. Evid Based Complement Alternat Med. 2013;2013:130818.
  14. Maciel RRBT, Dos Santos NC, Portella DDA, Alves PGJM, Martinez BP. Effects of physical exercise at the workplace for treatment of low back pain: a systematic review with meta-analysis. Rev Bras Med Trab. 2018;16(2):225-235.
Article written by Marina Peric, M.D.
Marina is a medical doctor from Belgrade, Serbia. She graduated with high honors in 2020 and is aspiring to become a pathologist. During her studies, she took part in several scientific researches, mostly in the pharmacology niche. She was also an assisting teacher at the Department of Histology and Embryology for 5 years (2015-2020). Marina has years of experience as a writer on health-related topics. Apart from English, she fluently speaks several languages, including Spanish, Russian, and Czech.

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