It’s not uncommon for low back pain patients to reduce their activities in an effort to avoid their pain. Unfortunately, it’s likely their core muscles—the muscles that help support their midsection—will become deconditioned over time due to inactivity, which may only increase the risk of further injury. Therefore, to effectively improve one’s low back pain status, he or she must first strengthen and keep their core muscles strong! Think in terms of one to three sets of ten reps for ease of application and ALWAYS release the exercise SLOWLY—don’t just drop back from the end-range of the exercise.

The ABDOMINAL muscles include four groups: the rectus abdominis (they attach our rib cage to our pelvic area, and the fibers run straight up and down), overlapping on the sides are the internal obliques (fibers run down and inward), the external obliques (fibers run down and out), and lastly, the transverse abdominis (the fibers run horizontal and attach to the fascia in the low back).

If we think of three levels of exercise difficulty, an easy (or Level 1) sit-up can include a “crunch” or simply lifting the head and shoulders off the floor. A more difficult (Level 2) ab exercise would be to bend the knees and hips at 90 degree angles while performing a sit-up, while a more difficult (level 3) ab exercise could be a double straight leg raise during the sit-up. The rectus is stimulated by coming straight up and down while the overlapping obliques require a trunk twist. You can employ an “abdominal brace”, or holding the stomach muscles firmly as if someone is going to punch you in the stomach, in any position or activity during the day.

You can strengthen the LOW BACK extensor muscles using a number of effective exercises including (but not limited to) the “bird-dog” (kneeling on “all-fours”) straightening the opposite arm and leg separately (Level 1) and then simultaneously and switching back and forth (Level 2). Level 3 could be longer hold times, drawing a square with the hand and foot, or increasing the repetitions.

Another low back strengthener is called the “Superman”, which requires laying on the stomach (prone) initially lifting one arm and then the opposite leg separately (Level I); then opposite limbs at the same time (Level 2); and finally raising both arms and legs simultaneously (Level 3). Placing a roll under the pelvis/abdomen can make it more comfortable.

You can strengthen the SIDES OF THE CORE, or lateral trunk stabilizers, using a side-bridge or plank (laying on the side propped up between the elbow and feet, with the hips up and off the floor). Level 1 could be a six-second hold from the knees, Level 2 a six-second hold from the feet, and Level 3 could be a twelve-second hold between the elbow/forearm and feet. A modification could include slow repetitions of lowering the pelvis to the floor and back up. Mix it up!

There are MANY more exercises, but these should keep you going for a while! Remember, stay within “reasonable pain boundaries” that you define, release each exercise SLOWLY, and most importantly, have fun!