Research indicates that back pain is the leading cause of disability worldwide, even more than heart disease and diabetes. It’s estimated that about 80% of adults will experience an episode of low back pain during their lifetime. Additionally, more than half of those who develop back pain will either have another episode within the year or their back pain will persist and become a chronic issue. Because of these facts, a key aspect of chiropractic treatment for low back pain is to reduce the risk for both chronicity and recurrence. While maintenance or wellness chiropractic visits following the conclusion of care have proven to help in this regard, exercises performed at home by patients are especially useful. But what type of exercises are best in the goal of preventing a future low back pain episode, stretching or strengthening?

To find out, researchers recruited 90 patients with non-specific low back pain—the most common type of low back pain, which occurs in the absence of specific pathology like a herniated disk, spinal stenosis, infection, or fracture—and divided them into three groups: stretching only, strengthening only, or both. After three months, outcome questionnaires revealed the strengthening only group experienced the greatest improvements with respect to pain and disability followed by the combo group and lastly, the stretching only group. A similar study published a month later concluded that strengthening exercises are more efficacious than stretching alone. However, each patient’s condition is unique, and the specific exercises they perform should be informed by their examination findings, response to in-office treatment, personal preferences, and their chiropractor’s training and clinical experience.

One aspect to consider before starting an exercise routine is that musculoskeletal disorders elsewhere can affect the patient’s biomechanics and contribute to (or cause) their present low back pain. For example, if one foot pronates or rolls inward more than the other when standing and walking, the entire kinetic chain reacts and has to compensate for this as follows: the knee “knocks” inward, the hip outward, the pelvis drops excessively, the lumbar spine curves further (convex to the short side), the mid-upper back leans to the opposite side while the occiput or head tries to maintain a horizontal for balance purposes. The consequences of this biomechanical fault could first be experienced as low back pain and over time, they can lead to excessive wear and tear on the joints, ligaments, disks, and may lead to premature osteoarthritis and degenerative disk disease. If these issues aren’t addressed, not only could the patient’s low back pain be more likely to return, but it may make proper form during exercise more difficult and elevate their risk for injury.

The good news is that chiropractic is well-supported as an effective intervention for managing low back pain, especially if you follow your doctor’s advice to perform exercises between visits and stay active following the conclusion of care.