Back pain is one of the most common causes of pain and disability as over 10% of all primary care doctor visits relate to spine pain, unsurprisingly there are hundreds of treatment options. More recently, guidelines for back pain management are moving away from more aggressive treatments like surgery and prescription opioid medication and recommending more natural strategies like acupuncture, yoga, physiotherapy, spinal manipulation, exercise, and more. In the absence of a serious underlying condition, non-specific low back pain is likely to resolve from these conservative treatments within 3 months (1). 

When it comes to exercise, the source of your back pain is very important in determining which exercise may be best for you. However, there are a handful of exercises that have been found to be excellent at improving back pain, function, and reducing the likelihood of re-injury. This article will detail a few of the BEST exercises to improve and prevent symptoms of low back pain.

It is extremely important to remember that if any of these exercises cause pain, stop the activity and move on to something that you can perform completely pain-free. 

The McGill Big 3:

Dr. Stuart McGill developed these exercises to strengthen the core muscles and improve function of muscles and joints with the goal of stabilizing the spine. These exercises have been very effective and are one of the most popular treatments for patients with non-specific low-back pain. 

1. Bird Dog

The bird dog may be the single best exercise for preventing low back pain. The goal is to train the body to activate certain neuromuscular pathways that improve coordination and stability of the spinal joints. It can also strengthen the intrinsic muscles of the spine as well as the supporting musculature. 

How to Do It:

1. Begin on all fours (hands and knees)

2. Slowly extend arm in front while simultaneously extending the opposite leg back to ensure they are pointing directly in opposite directions

3. Bring arm and leg back together under the body without touching the table.

4. Repeat exercise 10-15 times and perform on both sides. 

2. Side Bridge

This exercise is commonly used to increase the strength of the core abdominal muscles, which stabilize the spine and upper body. Weak core muscles are commonly a source of back injury due to an imbalance in musculature between the abdomen, lower back, hips, and legs. Strengthening these core muscles can reduce the frequency of back pain while improving symptoms.  

How to Do It:

1. Lie on side and forearm with shoulders, hips, ankles in line with the floor

2. Lift up lower torso by pushing through forearm. 

3. Keep torso parallel to table and hold for 30 seconds - 1 minute

3. Curl Up

Strengthening the core muscles is a common theme in low back pain management and prevention due to their relationship with spinal support. The curl up is another exercise to strengthen these muscles and provide a foundation to stabilize the spine

How to Do It:

1. Lie flat on your back with hands under the lower back

2. Bend knees with feet flat on the floor. You may extend one leg while keeping one bent to increase difficulty. 

3. Without moving anything but your upper torso, contract your core muscles to lift your head and shoulder blades off of the floor. 

4. Repeat this exercise 10-20 times (both sides if keeping one leg straight).

These three exercises may be performed on their own each day to improve symptoms and function associated with low back pain. 

Here are some additional exercises/stretches that may be added to your routine To prevent and improve the symptoms of low back pain: 

Child's Pose:

This yoga position is excellent for certain types of back pain caused by tight back muscles by slowly stretching these muscles. It is also a great stretch for muscles in the hip and legs, which can commonly contribute to low back pain when tight and over-contracted. 

How to Do It:

1. Start on all fours (hands and knees)

2. Extend hips back and attempt to sit buttocks on the ankles while pushing and extending arms forward

3. Hold this position for 15 seconds - 1 minute. (You should feel a stretch through the hips, low back, shoulders, and legs- depending on where tight musculature is)

Prone Cobra:

Another common yoga position that can be used for low back pain( side note: yoga is GREAT for back pain). The prone cobra is a position that is great for many intervertebral disc injuries causing back pain, but also may make some types of low back pain worse. It is important to only do this exercise if it improves your symptoms and to discontinue if there is any pain associated. 

How to Do It:

1. Lie face down with palms flat on the floor

2. Push upper body off of the floor with hands, extending the back with a reverse arch

3. Hold this position for 15 seconds - 1 minute.

Hip Circles:

Similar to the bird dog exercise, hip circles are great at activating neuromuscular pathways which improve coordination and prevent injury. These are great for improving back pain located in the sacroiliac joints of the pelvis. Hip circles may also improve flexibility in the hip joint and release muscles that become tight and over-contracted. 

How to Do It:

1. Start on all fours hands and knees

2. Circle hips forward beginning by kicking the leg directly back and following with a circular motion around the hip joint axis. Continue this motion without your leg or knee touching back down. 

3. Repeat this motion in the opposite direction, rolling the hip backward around the joint axis.

4. Perform forward and backward circles on both hips. 10-20 repetitions each direction, 10-20 repetitions each side. 

Hip Flexor Stretch:

This is an excellent stretch for a muscle that can pull the pelvis forward leading to postural imbalance and back pain. By stretching this muscle, the position of our pelvis becomes more neutral and our biomechanics may normalize if tight hip flexors are the culprit.

How To Do It:

1. Begin kneeling on one knee with the opposite foot flat on the floor and a 90 degree bend in the opposite knee. 

2. Slowly push the hips forward, leaning more on the knee on the ground, while pushing the opposite knee forward. 

3. Hold this position for 10-20 seconds each side, and repeat 2-3 times. 

It is important to remember to visit a healthcare provider before beginning an exercise routine and to rule out any serious underlying conditions. Overall, these exercise have been shown to be extremely effective at improving low back pain symptoms but are not ideal for everyone. Use good judgement and physician consent prior to performing these and do not push it past the point of pain as they are meant to provide therapeutic relief while strengthening/stretching structures of the body.