If the lower back hurts, doing exercises is certainly not something that appeals to us instinctively. Because with pain, one likes to avoid anything that could worsen the pain.
But what causes back pain symptoms to improve: rest or exercise? What kind of exercises are promising? Do I have to worry about doing exercises despite my back pain?
We systematically investigated these questions and evaluated scientific articles and expert opinions. We then put together an exemplary selection of exercises together with experienced physiotherapists of a large pain center.
However, we would like to emphasize at the outset that most of the studies that are available refer to so-called nonspecific back pain. By this experts mean back pain which is not based on an urgent cause that should be urgently treated. For example, anyone who suffers from a recent herniated disc or spinal column injury should follow the advice of a physician or physiotherapist.
1. Movement or rest when in pain: what is better?
As already described above, we understandably want to rest if in pain, either temporarily or even permanently. Especially if we do not know pain in this form.
What happens if you yield to this impulse and just lie in bed or on the couch? Many medical examinations have already addressed this question. 1 They all come to unanimous results: rest, or even bed rest may be needed for a short time of course.
But as soon as one you can imagine to move again, you should do so because (bed) rest worsens the symptoms in the medium and long term. 2.3
Experts also point out that the more we avoid it, the more we will be afraid of pain. Avoiding pain-inducing situations in the longer term can not only lead to pain, but also to withdrawal from many areas of one’s private or professional life. 4
Therefore, experts in worldwide guidelines from Germany to the United States agree: resting when you have back pain does not improve the symptoms but can even lead to a gradual retreat from many areas of everyday life. 1, 5, 6
Therefore, the current German guideline for the treatment of low back pain advises the early resumption of the movements that were performed before the onset of pain. 7
2. Are exercises dangerous when I have back pain?
First, you have to know the following: Whether in individual cases a dangerous cause of back pain exists, which would speak against exercising, we certainly cannot decide in the context of an article.
But if there are no warning signs for a dangerous development in the medical history, such as a failure of the legs or a cancer (so-called red-flags), it is unlikely that the back pain has a threatening cause. 8, 9
So if one proceeds cautiously as an affected person, then a (at least long-term) worsening of the complaints by movement is not probable. This should be kept in mind, because fear of movement, as mentioned above, sometimes even worsens the course of the disease, as it can cause exaggerated protection – and it is also usually unjustified. 10
3. Which exercises are particularly helpful for back pain?
In principle, experts have proven that physical exercise in itself helps to treat back pain and relieve discomfort. First of all, it does not only seem to be decisive in which way one exercises physical activity. 11 However, the longer the person affected remains active, the better the effect becomes.
Is it worthwhile doing special back exercises at all? If you look at the causes for back pain, there are several reasons that support this:
- Our spine does not stabilize itself but instead relies permanently on the assistance of the back muscles. 12 Well-trained back muscles are better able to meet this challenge.
- In everyday life, we often move very one-sided due to our lifestyle. As a result, important stabilizing muscles on the spine are often poorly developed because they are not needed. A regression of the back muscles is often clearly observed especially in patients with longer existing back pain. 13, 14
- Unilateral movement not only leads to a regression of muscle function, but fascia may also play a role. Studies have observed a shortening of fascia of the back (i.e. the tissue that enclose muscles) in patients with back pain. 15 This is supported by the fact that stretching exercises also help against the symptoms of back pain. 16
4. Train the core and stabilize the skeletal muscles: an effective workout for back pain
The training of the stabilizing back muscles of the lower trunk with special back exercises is considered to be particularly effective by several studies – as one would expect according to the aspects listed above. 17
In fact, experts often recommend exercises to train the core muscles between the diaphragm and hip, sometimes in combination with stretching exercises as an effective treatment for back pain and as protection against the onset of further discomfort. 18
The so-called core tension chain consists of numerous muscles of different areas that connect the upper and lower body. Involved are the straight and oblique abdominal muscles, spinal extensors, long and short extensor muscles of the back, as well as hip extensors, glutes and hip rotators. 19
In return the complex structure of the stabilizing musculature of the body core also requires relatively complex exercises that train one or more of these areas simultaneously, at least always several muscles at the same time.
5. Effective training against back pain is also possible from home for most people
Effective back training can also be done well from home. When putting together an effective workout, however, there are some points to consider, such as a well-balanced training plan that includes the individual parts of the back and the entire body. However, complicated devices are certainly not necessary for effective training in back pain.
If the back pain has been clarified by a doctor and no cause in need of treatment has been found (so-called red flags), this side usually does not speak against back training in the home environment.
However, if you suffer from a cause in need of treatment, such as a (especially recent) herniated disc, an inflammation or injury of the spine or also changes in the shape of the spine, exercises should be performed only after medical clearance. In such cases, it certainly makes sense to perform the exercises at least initially under qualified supervision.
Those who train regularly form a routine after only a short time, such as two weeks, and miss the exercises if they skip a day (link to motivation tips).
Nevertheless, training at home is of course a challenge for motivation and personal timing. However, reminder functions and messages, such as an app, help many people to build up and maintain new habits, such as training. 21
6. What else should be considered when doing back exercises?
- Overall, our body is a functional entity. However, in the case of a problem of a certain part of the body we often only look at the spot that causes discomfort – like the back. For several reasons, it usually makes little sense to train just the muscles of the lower back alone and neglect the rest of the body. On the one hand, there are (painful) strains, especially on the lower back, partly due to poor posture or muscular weakness in other areas, such as the legs and pelvic girdle, the upper back and shoulders or the abdominal muscles. Therefore, a comprehensive training should also include these areas. On the other hand, many of the exercises that stabilize the lower back also strengthen the muscles of these other areas, thus ensuring an adequate state of fitness throughout the body.
- The training should be appropriate to your own level of performance. The exercises should match the level of difficulty as well as the duration of what the affected person can really do. Over-straining can permanently increase the pain and under-straining prevents a meaningful training effect.
The training should be as regular as possible. An individual session only needs to be 10-15 minutes. But the training should be done several times a week, with changing exercises to train different muscle groups.
Overall, back training has a positive effect on the course of the disease for many people with back pain.
Especially if a cause requiring treatment has been medically excluded (which is the case in over 90% of patients with back pain), nothing speaks against back training.
Back training requires neither special equipment nor a lot of time and can also be carried out at home. But even if you train alone at home, you should adjust the intensity to your own performance and train your body and back all-embracing.
If you are interested in back training at home, check out the Kaia app. It contains 150 back exercises, which were created in cooperation with the pain specialists of a large pain centre, and uses them to create an individual training plan.
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