Exercise and back pain

Lower back pain is thought to affect up to 70% of adults. The majority of these cases are classified as non-specific as the mechanism of the pain is unknown. The spine is supported by a large number of muscles, the key groups being those of the glutes and core. These muscles, along with many others, work together to maintain posture and if one, or more, of these muscles are weak, it can lead to poor alignment of the spine and pain. In this post, we will discuss why muscle balance is important and what exercises can help activate and strengthen the key muscles of the back.

Glutes

The glute muscles are made up of three muscles; Gluteus Minimus, Medius and Maximus, and are located in your buttocks. They are important stabilisers and power generators. However, it is easy for the glutes to “switch-off” and become inactive, which can cause poor lower back posture and overactive, tight hamstrings. It is a common misconception that the only way to strengthen the glute muscles is to perform squat after squat. However, if the glute muscles are inactive, or inhibited, then your quads and hamstrings will dominate the movement without much benefit to the glutes.

At the start of any physical activity I always lead with glute activation exercises, whether for my 1-1 clients, football players, or in my own training sessions. Here are a few examples:

Glute Bridge – engages both the core and glute max. It is important to keep the lower back straight throughout the movement, avoid arching, and ensure you squeeze the muscles at the top of the movement. 

Single leg Glute Bridge – works the glute max more intensely. Again avoid arching the lower back and keep the hips level throughout the movement, don’t let one side dip.

Side-lying leg raises – Working the easily forgotten, but equally important, glute medius, there is no need to raise the leg too high and take care to prevent the lower back from side bending into the floor. If you feel it more down the leg, then bring the leg back slightly.

Glute bridge demonstration: Back straight, slow and controlled movement.

 Side-lying leg raise start position

Side-lying leg raise start position

 side-lying leg raise finish position

side-lying leg raise finish position

Core

The core muscles should be balanced to work with the glutes to keep a neutral spine and prevent poor posture. The deep transverse abdominis, the rectus abdominis and the oblique muscles all play different, but vital roles in maintaining this balance.  Similarly to the glutes, all of these muscles can become inactive and carrying out high numbers of crunches alone will not produce results.

Below are a few examples of core exercises aimed at each muscle group:

Pelvic Tilts – Works to engage the transverse abdominis; the initial movement which leads into a glute bridge. Focus on drawing the pelvis towards and away from you to flatten and arch the back, this should be a slow and controlled movement.

Deadbug – This is by far one of my favourite core exercises. It is perfect even for people with lower back pain as there is no extra strain on the back when performed correctly. For in-depth guidance on how to complete this exercise please see our Exercise of the week: Deadbug post.

Oblique twist – Again, this is a low-impact core exercise aimed at the oblique muscles. The movement should be slow and controlled and when performed correctly you will feel the muscles working in the first few reps

Oblique twist demonstration: Reach arm diagonally and lift one shoulder from floor. Should feel a pinch in the side you are reaching toward.

Take home:

There are many progressions of the exercises discussed in this blog, as well as a large range of alternate exercises which can help to improve the symptoms of, and resolve lower back pain. It is important to note that there is no “quick fix” which will keep the symptoms away for a sustained period of time. When performed correctly and appropriately, exercise is often the best medicine; the prognosis doesn’t always have to be negative or expensive!

If you do experience any pain completing the above exercises, please seek advice from a trained professional before continuing.