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physical therapy
Back pain

Once the acute phase of an injury has been passed, it’s usually a good idea to start trying to mobilize the area and eventually apply strengthening exercises. However it can be tough in the initial phases to find exercises that are gentle enough not to aggravate the injury and potentially take a step backwards, yet which provide a means of slowly and progressively overloading the muscles to return to a healthy state. This is especially true for the lower back.

The muscles of the lower back (the spinal erectors) help stabilize the lower 5 discs of the spine. They’re not really meant to be mobile or supple. They should be strong and sturdy. So to strengthen them most effectively, heavy loaded exercises are used where one must contract the lower back mostly isometrically to oppose any shearing forces.

However, this isn’t always feasible in the early stages of recovery and it may be preferable to perform exercises that don’t actually load (compress) the spine, or load it minimally while still providing stimulus to the muscles of the lower back.

The following are several exercises that don’t put any load on the spine but provide a way of strengthening the lower back.

The Back Extension

The load-vector in this movement doesn’t put any load on the spine, but provides maximal torque on the lower back’s erectors at the top of the movement where the muscles are in their strongest contracted position. This is mostly a hip extension exercise and the back is stimulated isometrically at the top of the movement. The spine is actually decompressed slightly at the bottom of the movement (where there is no load) and the torque and force needed to maintain a stable lumbar region increases as the movement progresses to the top. This can be considered a very safe and gentle movement for strengthening the lower back as it is mainly an isometric exercise if performed correctly. Make sure the edge of the pad is directly  underneath the crease of your hips and try and maintain a neutral spine as the movement is performed. This will recruit mostly the hamstrings and glutes and the back maintains its role as a stabilizer and is isometrically contracted most when it is in a safe position at the beginning of the movement.

Another way of performing this movement to actively work the spinal erectors is to position your hips further back on the supportive pad, so that the edge of the pad is under your stomach, encouraging you to fold in the lumbar region and stretch the spinal erectors. This will lead to trunk extension and much more active recruiting of the spinal erectors. However, this should only be performed with a very healthy lower back and is simply an alternative way of stimulating the spinal erectors in a stretched position. The former variation is much gentler and more useful for rehabbing the lower back.

Avoid hyperextending the back. To do this, just keep your neutral spine and finish the movement with your hips only. When you can’t go any further, you know you’re at the top of the movement, so don’t keep going by bending your back backwards – this is hyperextension.

Different angles of back extension machines are available, such as 45˚. You should keep in mind that as you increase the angle you increase the load on the spine and the load on the hamstring, glutes, and lower back while in the stretched position. Therefore it becomes much more intense on the muscles involved. However it can provide a good transition to movements such as the goodmorning which are great at bulletproofing the lower back and building the posterior chain when in a healthy state.

The Reverse Hyperextension

This is a great rehab and prehab exercise for the lower back. Much like the regular back extension, it doesn’t compress the spine, in fact it decompresses it. It is unique in that it allows the sacrum to rotate and consequently open up the discs in the spine so that they may refill with fluid. If a machine is used it provides loading throughout the entire range of motion, or if it is performed freely, it is loaded maximally at the top. This makes it great exercise for disc injuries because it provides nutrition to the tissues surrounding the discs.

If you don’t have a reverse hyperextension machine, you can still perform the movement on a sturdy surface with an edge and somewhere to grab with your hands to keep you stable. For example:

The Pull-Through

This movement is also useful in working the spinal erectors without any spinal loading. Make sure to initiate the movement at the hips and to squeeze the glutes through to finish the movement. Much like the other extension exercises, you generally do not want trunk extension or to hyperextend the lower back when you are not completely healthy and balanced in the lumbar region – however, rounding the lower back can be useful as an intensive lower back strengthening exercise when one is healthy.

This is a good way of strengthening the upper hamstrings at the hip joint and the glutes while your lower back may still be tender.