When patients present with low back pain (LBP), they usually move slowly, and they often can’t stand up straight. Even a simple task such as bending over may cause them to grimace and even require the use of their hands pushing on their thighs to return upright.

These are classic signs of lumbar instability to movement coordination impairment. Over time, the patient will adapt and adopt new movement patterns to perform their everyday tasks, which can lead to some muscles weakening while others become overworked and prone to injury. Once acute inflammatory pain is managed—primarily with the application of manual therapies like spinal manipulation and mobilization, ice therapy, nutritional/supplement recommendations, work modifications, etc.— patients may receive instruction on the “BIG 3” core strengthening exercises:

• Abdominal muscle strengthening (AMS) starts with abdominal bracing (tighten up your abs as if bracing for a punch to the midsection). This simple exercise can be done ANYWHERE (while driving, sitting, standing, lying, etc.) A great AMS exercise includes crossing one leg over the other (ankle near the knee) and using the opposite hand, PUSH your knee and hand against each other. Start with ten reps holding each rep for two seconds and increase hold time as your ab muscle become stronger.
• Lateral trunk muscle strengthening is best accomplished with a side plank or side bridge. Start from your knees first. If it’s too hard, alter and adjust the hold time and reps for your abilities.
• Low back and glut muscle strengthening includes front planks (starting from the knees) and the four-point kneeling quadruped or “bird-dog” (raising opposite arm/leg). Squats, lunges, and supine bridges help strengthen the gluts.

Patients may also be advised to add in balance challenges, such as standing on one foot with both eyes closed, as they not only stimulate the core muscles but also improve proprioception—the body’s ability to sense where its various parts are in relation to one another for purposes of movement and balance.

In addition to in-office treatment, these at-home exercises will not only help you get out of pain and back to your everyday activities as soon as possible, but also reduce the risk for a future episode of low back pain.