Best exercises and stretches for lower back pain

Estimated reading time: 5 minutesI became interested in learning more about the mechanics of back pain after my initial Pilates training. So many people who attend Pilates classes start because they have pain, often back pain. I trained to become a back care specialist in 2009 and started running weekly back pain classes. 

I have seen many clients over the years with back pain due to spinal instability, muscle imbalances, or over reliance on ligaments and joints – in what I call hanging postures, rather than relying on strong muscular connections for support.

It was through this early work into back pain that I went onto study neuroscience and developed the Integral Movement Method. I recognized that people in pain could not start with strengthening exercises that are typically prescribed for back pain.

I adopted a gentle approach that initially focused on controlled, mindful movements rather than diving straight in with pure strengthening work.

I wanted to make my method more widely available since I was seeing so much success with my clients. Moovlite focuses on chronic pain not associated with hypermobility. The Zebra Club focuses on hypermobility, EDS, and chronic pain.

The biopsychosocial model and back pain

My recent MSc in Pain Management focused on the importance of the biopsychosocial model of healthcare as opposed to the biomedical approach.

The biopsychosocial model of chronic pain is a framework that explains pain as a complex interaction between biological, psychological, and social factors rather than just a physical issue. This model is particularly relevant for chronic pain patients and people with EDS or HSD, where pain tends to be a persistent factor.

Traditional models often focus on the biomedical approach – looking purely for structural problems and prescribing medication or surgeries. As a movement therapist with 16 years experience, I have found the biopsychosocial model really helpful in addressing my clients in a whole-person, holistic way.

Through addressing these interconnected factors, I offer a comprehensive strategy for managing chronic pain, which targets both the physical, emotional, and social dimensions.

Movement plays an essential role in addressing chronic pain. Through safe, gentle movement, we can hydrate the fascia and begin the process of pain relief. Finding exercise approaches that don’t exacerbate pain is crucial for those of us with chronic or persistent pain.

It’s worth noting that exercise is actually the first-line treatment recommended for chronic lower back pain (1). By incorporating movement strategically, we can break the cycle of pain and start building a foundation for long-term relief and improved function.

How to warm up safely

With my IMM, we take a different approach to “warming up.” I always start any movement session with the first phase of the IMM called Unwind.

This phase is where we allow the body to take a few moments to let go of tension and stress, normally lying supine for best results.

If we are in pain, we are more likely to have been tensing back muscles for protection or fear of movement. The Unwind phase is particularly helpful in creating a sense of safety before we start to exercise.

Try some supine breathwork, allowing the body to soften into the mat or treatment table.

• Initiate movement with the breath – a pelvic tilt is a great way to start softly moving the lower back muscles. Try not to push or force any movements, keep it soft.
• Hug one knee into the chest and breathe. These can help relieve tension in the lower back. Repeat on the other side.

Effective stretches for back pain relief

Here are some of my favorite moves for back pain relief.

Knees to chest knee circles

Lying supine, hug both knees into the chest and breathe.  Place hands on top of knees and gently circle the legs in opposite directions. Repeat in the reverse direction.

Cat stretch

Cats can be modified if you don’t like weight bearing through the wrists by placing forearms on some books, or hands on a chair. Try not to push into the flexion as this could cause strain. Keep it a soft CAT.

Windscreen wipers

Gentle rotation for the lower back is particularly good if you have been sedentary driving or at your desk. Windscreen wipers supine are a great way to introduce a gentle spinal twist. Try not to let the legs collapse to the floor when doing this one – keep the movement flowing from side to side.

Great exercises for back pain relief

Pelvic lift into Bridge

A great strengthening exercise for the posterior chain.

Knee rolls

A great stability exercise for lumbar stability. Keeping the pelvis heavy, float one leg up into the air.  Try to keep the pelvis heavy as you return the leg to the floor.

Leg slide

Opening up the hip without arching the back. Slide one leg along the floor whilst the pelvis stays heavy. Draw it back gently.

Starfish

A progression of the leg slide – add an opposite arm overhead as the leg slides out.

Tabletop / Bird Dog

I often leave this for a while. It is often prescribed very early on for back pain patients, but it is important to have some degree of awareness and stability before doing it otherwise, you could just brace and guard your way through the movement, creating more pain and restriction. You may need to work up to it.

Baby prone extension

Start low with this because you should not experience pain in the lower back. These can be good to start targeting the back muscles like the erector spinae, which supports the spine.

Movements to avoid with back pain

This really depends on each individual person. We should not do any exercises that increase or make our pain worse. It’s important to consult with a physical therapist or physiotherapist if exercise is making your pain worse.

Certain conditions will mean that some exercises may not be suitable for your back pain. For example:

• Back extension exercises may not be suitable for people with spinal stenosis or spondylolisthesis. Extension may make symptoms worse. Always check with your physio or movement therapist.
• Loaded spinal flexion and rotation exercises may not be suitable for people with osteoporosis. Movements need to be modified if you have back pain and this diagnosis.
• Contact sports with sudden movements or the risk of being hit could increase pain and further injury.
• Running and jumping activities, especially on a hard surface could place more stress of the back.
• Heavy weights when they are performed without proper form or control, leading to hinging on certain joints. The path of least resistance needs to be avoided.

Safety considerations for back exercises

• It’s always prudent to check with your healthcare professional if you are having back pain and exercise seems to make it worse. It may simply come down to technique, or guarding patterns and these can be addressed by a movement therapist.
• Make sure the exercises prescribed are suitable for your type of back pain and condition. It is worth getting some 1:1 guidance or attending a class designed especially for back pain.
• Start low, go slow. Be mindful of your movements so that you don’t overextend or strain certain muscles
• Work on exercises focused on alignment and body awareness.
• Correct techniques can really help avoid back pain.
• Listen to your body. If you need to stop, then take a break. If pain increases, stop and check with your PT or movement professional.
• Be gradual in your progression. Build up tolerance slowly and safely.
• Don’t jump straight in with stability and strength work. Let the tight muscles relax first.

Here’s a video for lower back and hip pain that may help!

FAQ

What is the best exercise class for lower back pain?

A class that is designed for back pain is best when you are starting out. Learn the techniques and build up confidence in moving safely. Pilates is often recommended by doctors for a safe exercise solution.

Should you stretch your lower back if it hurts?

Gentle stretching can improve flexibility and reduce tension. But check your technique, make sure you are not hanging into stretches passively, as this could create more strain. I am a big fan of dynamic stretching.

Why won’t my lower back pain go away?

It’s always important to check if exercise has not helped. We want to rule out any underlying medical conditions, assess lifestyle habits and psychological influences. Pain is complex and can require a comprehensive approach to figure out the cause of your pain.

Jeannie Di Bon

Jeannie Di Bon is a movement therapist, educator and author specializing in hypermobility, Ehlers-Danlos Syndrome and chronic pain. She is the founder of The Zebra Club app and the creator of the Integral Movement Method.