Physiotherapy for Lower Back Pain – Exercises & Management | Adelaide Physiotherapists
Low back pain can be debilitating. It often has a negative impact on your life, both socially and professionally. A back injury is not something you should ignore or hope will go away by itself; it could negatively affect your quality of life for years to come.
Our expert physios will help reduce pain, regain range of motion and prevent reoccurrence. We use a modern, evidence-based approach including hands-on treatment, education and exercise to get you moving and feeling better as quickly as possible. Common conditions include low back pain, including chronic low back pain, sciatica, nerve pain and postural pain.
Join the hundreds of people with back pain that we’ve helped to take control of, get past pain and move without limitation. You’re not alone. Back pain is an inevitable part of life, and with the right tools and management, it doesn’t need to be a hindrance in your life.
As the most common presentation to our clinic, we treat back pain sufferers on a daily basis.
70-90% of Australians will suffer from low back pain at some point in their lives, with 1/6 people currently struggling with low back issues.
Exercises to help with low back pain
Whether you’ve just hurt your back or have had it for a while, you may be wondering what the best exercise for lower back pain is. The simple answer is that no one exercise or set of exercises will ‘fix’ or ‘prevent’ lower back pain.
The good news is that research suggests many forms of physical exercise and exercise programs can help minimize lower back pain. This particular study, conducted in 2022 by Fernandez-Rodrigez et al., looked at how the different types of physical exercise for chronic low back pain fare in reducing pain and disability.
For reducing pain:
In order of most effective first, Pilates, Mind-body exercise (e.g. tai chi), Core-based exercise and strengthening exercises were the best for chronic low back pain.
For reducing disability:
Pilates, strengthening, and combination exercises (including strengthening, aerobic & mobility exercises) were the best for chronic low back pain.
This study also notes that most forms of exercise are effective at reducing pain and disability for those with low back pain – which means that you have options to choose from when considering the type of exercise program for your low back pain rehabilitation. This is consistent with the position of many other back pain guidelines.
Some other things to consider are:
- Safety – Is it safe for your current symptoms? Performing exercises that are too demanding when you’re in acute pain, for example, may exacerbate your symptoms in the short term.
- Goals & preferences – Can you adhere to an exercise rehab program? We advocate choosing a form of exercise that you enjoy and can stick with in the long term, as it can often take weeks or months of consistent exercise to experience long-lasting positive outcomes.
- Pain severity and irritability – If your pain is severe, you’ll need to start with less intense exercises and slowly build up. If your pain is irritable, e.g., it gets stirred up easily and takes a long time to settle down, then you’ll also need to start with less intense exercise and slowly build up.
- Pain onset and duration – i.e. sudden/acute low back pain or gradual/chronic lower back pain. This can dictate the types of exercises that you should do and when. Again, if your pain has been there for a long time, you’ll likely need to perform exercises for a longer period of time (e.g. weeks or months) to see some change happening. If its more acute, it might take shorter periods of time to experience relief (e.g. days).
Early – Mid – Late Stage exercises for low back pain
Early stage
Early-stage low back exercises could include clams, step-ups, sit-to-stands or performing a pelvic tilt.
A clam is when you lie on your side with your knees together. You then separate your knees apart from each other, using your hip muscles.
As the names suggest, step-ups involve stepping up and down from a step using one leg, just like sit-to-stands involve sitting up from a chair and controlling your descent back down. These are great leg strengthening exercises.
In the video below are some common examples of early-stage low back pain rehabilitation exercises:
Mid-stage
Mid stage exercises might begin to include exercises such as lunges, planks and deadlifts. Deadlifts are a great movement to build your body’s strength and ability to bend and lift things off the ground more comfortably.
In the video below are some other examples of mid-stage low back pain rehabilitation exercises:
Late-stage
Exercises such as kettlebell pull-throughs or barbell back squats can be great exercises to build really strong backs, hips and legs.
Similarly, a side plank with leg lifts can be a simple but effective exercise that challenges you and builds your body capacity.
In the video below are some other examples of end-stage low back pain rehabilitation exercises:
All of these exercises help to work the core, lower back muscles, and glutes, which are the main muscle groups supporting the lower back.
Exercises for the lower back aim to increase strength and resilience in the lower back and surrounding muscles, reduce fear of movement, and improve confidence in the lower back.
Core Exercises for Low Back Pain
Core strength and tolerance for movement through your core can be one of the many factors that contribute to low back pain. Building a stronger core is about building the tissue capacity and teaching the core and lower back to become adaptive to movement. It isn’t just about a six-pack!
There are so many exercises that target the core, and they come with varying difficulties.
In the early stages, bird dogs or dead bugs may be effective before moving onto knee planks and side planks. This can be progressed to full planks or other exercises such as suitcase carries. Suitcase carries involve holding a heavy weight in one hand and walking forward while trying to maintain your upright posture.
This can really challenge the core and help to build core and low-back resilience. There are also many fantastic pilates-based core exercises that can also be done in the early, mid and late stages of a core strengthening program.
The video below shows some examples of beginner, intermediate and advanced core exercises that can be used as part of a low back pain rehabilitation program.
Stretches for low back pain
Stretches, such as hip flexor stretches, hamstring stretches, and piriformis stretches, can help manage low back pain, particularly in the early phase.
When things are quite painful and you have limited movement, we know stretches can help alleviate some of that pain and provide some short-term pain relief. However, the effects often don’t last too long.
We regularly hear people say things like, “I keep stretching and stretching, but I still feel tight.” Stretches should be used in the early phase when your back is quite irritated to promote early movement, but they are often not a long-term fix. We like to think of them as providing a window of opportunity to undertake other exercises and movements that can have a more lasting impact.
In the early stages of a back flare-up, some nice stretches to help with symptoms may include a piriformis or hamstring stretch, knee rocks or a hip flexor stretch, a child pose or cat stretch, or even a cobra stretch.
Depending on your movement and pain, some of these may provide more relief than others.
What are the different types of low back pain?
Lower back pain is described as ‘pain felt in the posterior aspect of the body from the lower margins of the rib cage to the lower gluteal folds, with or without pain referred to in one or both of the lower limbs that last for more than one day.
Non-specific lower back pain (NSLBP)
This accounts for 90-95% of lower back pain issues. Generally, this diagnosis is made when serious or sinister pathologies or radicular causes of pain are ruled out. NSLBP affects people of all ages and abilities and can be acute or chronic in nature.
With this type of back pain, it is almost impossible to clinically determine the exact tissue responsible for causing pain. However, finding the exact source is not necessary, as it doesn’t change the management. In other words, the pain could be from the muscles, joints, ligaments, discs, or a combination of them all; however, the management does not change.
It can present as sudden or gradual, severe or mild and can feel sore in bending forwards, backwards or sideways.
Radicular Syndromes 5-10% of LBP (commonly referred to as ‘sciatica’)
- Radicular Pain: Generally caused by nerve root irritation (mechanical or chemical – such as a disc bulge or herniation / inflammatory response), which results in leg pain with NO neurological deficits.
- Radiculopathy: As above but WITH neurological deficits such as sensory or motor changes within the legs.
- Both radicular & radiculopathy can affect the sciatic AND femoral nerve roots
- Spinal stenosis: Narrowing of the spinal canal causing irritation of the spinal cord, which can be degenerative or acquired, which can cause no neural deficits, bilateral leg pain, worse with walking and ease with sitting or flexed positions.
More serious or sinister pathologies (less than 2% of LBP)
- Spinal Tumors
- Vertebral fractures
- Spinal Infections
- Cauda Equina Syndrome
- Spinal inflammatory Arthropathies
These are rare and should be screened for as well as other underlying conditions that can masquerade as low back pain, as part of an initial assessment with first-contact practitioners such as Physiotherapists or GPs.
How does Posture affect lower back pain?
There is no evidence to suggest that certain postures cause lower back pain (Swain et al. 2020). It may come as a surprise, but the research suggests that there is no good or bad posture; any posture held for long periods of time can become sensitive or uncomfortable.
The key to reducing the chances of a posture causing or exacerbating your pain is to get up and move regularly, for example, taking a phone call standing up, going for a walk at lunchtime or changing up your work environment.
If you do find yourself in an uncomfortable posture, try modifying it. For example, a more upright posture may temporarily alleviate your discomfort.
How can Physiotherapy help me?
The National Clinical Guidelines for Low Back Pain in Clinical Care outlines Physiotherapy as an effective option for the management of low back pain. Specifically, Physiotherapy interventions can help with the following:
Pain reduction
When your symptoms are at their worst, we focus on getting you pain-free and comfortable. This can involve noninvasive treatments such as hands-on work, stretching exercises, specific exercises for pain relief, spinal manipulation, education about what movements will help and which you should avoid, taping and gentle exercise (exercise helps with pain, even when you’re sore)
Restore normal range of motion
Once we have your pain under control, the focus shifts to regaining your normal range of motion and providing your back with the strength it needs to move freely.
Once you’re moving freely again, we’ll look to slowly resume your normal activities and build your strength with a graded and progressive exercise program. This could be a home program, gym program, pilates or a whole host of other exercise options.
It comes down to personal preference for the type of exercise, as the type of exercise that you enjoy is the one you’re more likely to stick with. Consistency is key to getting long-lasting results.
Prevent recurrence of low back pain
Think of exercise in this stage of treatment as adding layers of armour to your painful region. The stronger you can get it, the more protection it has and the less likely it is to become sore again.
Education about why the problem occurred in the first place and self-management strategies to prevent recurrence are also staple parts of our treatment journey for lower back pain. This could include a discussion about the common contributing factors to pain, such as sleep quality, stress management, posture, work habits, and activity levels.
Again, addressing all of your contributors to pain is key to achieving long-lasting relief from your low back pain.
To give you an idea of the process of rehabilitating a lower back injury or pain, below is a snippet of what a typical treatment journey for lower back pain looks like:
When to get help?
This depends on your symptoms and how much your pain is limiting you. Generally, if you’ve had a moment of injury or woken up with an acute bout of lower back pain, it is worth seeing your physiotherapist for a physiotherapy examination in the first couple of days.
Alongside ruling out serious or sinister pathologies and red flags, reassurance, education, and advice are KEY in the early treatment of lower back pain to get you back to doing the things you enjoy sooner.
With chronic lower back pain, any time is a good time to see a physiotherapist to start your journey to reducing your pain and increasing your quality of life.
Persistent back pain is influenced by a multitude of contributing factors, so to ensure a sustainable long-term outcome, our team implements a holistic approach. This includes examining areas that commonly contribute to the persistence of low back pain, such as posture, sleep, mental stressors, work ergonomics, and current sports or exercise routines.
If you want to know how we can provide you with pain relief and reach your physical best, book a time online or call our friendly team clinic on 8490 0777 to start your journey to a pain-free lower back today.
Alternatively, fill out the enquiry form below, and we’ll get one of our experienced Physiotherapists to give you a call.
