Top Exercises for Low Back Pain

Low back pain is one of the most common musculoskeletal conditions and a leading cause of disability worldwide, with an estimated 840 million people projected to be affected by 2050.¹ This condition significantly impacts patients’ quality of life, influencing their ability to work, engage in physical activities, and perform daily tasks. While low back pain can be complex and influenced by various factors, evidence consistently shows that patient education and targeted exercises for low back pain are critical for managing symptoms and restoring function in both acute and chronic cases.

In this article, we’ll explore Phase 1 exercises from Medbridge’s evidence-based low back pain protocol in Pathways. These foundational movements reduce stiffness, improve mobility, and empower patients to actively participate in their recovery.

To help you streamline care and empower patients to stay consistent with their recovery plan, we’ve created an easy-to-access resource: a free low back pain exercises handout PDF. Download it below to keep on hand for your practice or share directly with patients.

Understanding low back pain and recovery

Anatomy and causes

The lumbar spine is a resilient structure designed to respond to and dissipate forces put on the body through daily movement.  It has components designed to provide both stability and flexibility, including vertebrae, intervertebral discs, facet joints and ligaments. Low back pain can arise when the external load or force on the spine outweighs its capacity to respond. This can include things like muscle strains, joint dysfunction, or nerve irritation.

Low back pain is extremely complex and often results from a combination of biological, psychological, and social factors unique to each individual. It is also often labeled as non-specific, meaning no single anatomical cause can be identified. This uncertainty can be frustrating and unsettling for patients, as they may feel they lack a clear explanation for their discomfort, which can lead to anxiety or fear of movement.

Education as a foundation for recovery

As physical therapists, athletic trainers, and other healthcare professionals working in rehabilitation settings, you have the opportunity to clarify the mechanisms of low back pain in simple, accessible terms. By breaking down the anatomy of the lumbar spine and explaining common mechanisms of pain, you can correct misconceptions and ease fears of structural damage.

Patient education should emphasize the anatomical strength inherent in the human spine and the neuroscience of pain perception, reassuring patients that recovery is highly likely and their condition often has a favorable prognosis. These strategies help decrease fear and catastrophizing, enabling patients to approach recovery with greater confidence.²

Reassuring patients about safe recovery

Fear and misinformation can amplify the experience of pain, leaving patients feeling overwhelmed and hesitant to move. It is important to debunk common misconceptions, such as the belief that imaging is required to diagnose pain or that complete bed rest is necessary for healing. By providing education, you can help patients feel more in control of their recovery.

Use simple, patient-friendly language, and encourage patients to see movement as safe and necessary for recovery, framing their journey in a positive light. This reduces fear and promotes engagement, allowing patients to take an active role in their rehabilitation.

Why movement matters

Encouraging movement is one of the most impactful interventions you can provide for patients with low back pain. Physical activity promotes healing by improving circulation, reducing stiffness, and enhancing well-being. Gentle, purposeful exercise builds strength and resilience, decreases fear of movement, and reduces the risk of future pain episodes.

Here’s how you can explain to patients that movement directly supports recovery:

• Reduces stiffness and restores mobility: Controlled, targeted movements keep joints and muscles active, preventing stiffness that can develop from prolonged inactivity. Exercises that enhance flexibility can also relieve pressure on surrounding structures.
• Strengthens supporting muscles: Rehabilitation exercises target key muscle groups, such as the core, hips, and lumbar extensors, to provide stability and reduce strain on the spine. This creates a solid foundation for everyday activities.
• Builds confidence in movement: Patients often avoid activity due to fear of worsening pain (kinesiophobia). By gradually reintroducing movement, you help them rebuild trust in their bodies and reduce fear-avoidance behaviors.
• Engages natural pain modulation pathways: Physical activity triggers the release of endorphins and improves neural pathways that modulate the perception of pain. This helps patients experience a sense of relief and control over their condition.

Exercises for low back pain

After your initial evaluation has ruled out any red flags or treatments to avoid, the acute phase of treatment generally focuses on gentle movements designed to alleviate stiffness and reduce pain. These exercises serve as a foundation, helping patients regain mobility and confidence in their ability to move safely. Encourage them to perform these exercises four to five times weekly, gradually progressing as tolerated.

1. Supine lower trunk rotation

This exercise is an excellent way to improve spinal mobility and reduce stiffness in the lumbar region.

• How to perform: Instruct your patients to start by lying on their back with their knees bent and feet resting on the floor. Tell them to keep their back flat against the surface as they slowly rotate their knees down toward the floor on one side until they feel a gentle stretch in their trunk. Ask them to pause briefly, return to the center, and repeat on the other side.
• Tip: Remind patients to keep their back and shoulders in contact with the floor throughout the movement.

2. Pelvic tilt

This exercise engages the core muscles and promotes mobility in the lumbar spine.

• How to perform: Guide your patients to begin by lying on their back with their knees bent, feet resting on the floor or bed, and hands on their hips. Tell them to slowly tilt their pelvis to flatten their back against the floor or bed, then return to neutral. Next, have them tilt their pelvis in the opposite direction to gently arch their back. Encourage them to repeat these movements in a controlled and fluid manner.
• Tip: Encourage patients to focus the movement solely on their pelvis and use this exercise to build awareness of core engagement and spinal positioning.

3. Supine march

This movement is ideal for introducing controlled, low-impact engagement of abdominal muscles.

• How to perform: Ask your patients to begin by lying on their back with their arms resting at their sides, knees bent, and feet flat on the ground. Instruct them to tighten their abdominal muscles and slowly lift one leg off the floor, keeping the knee bent. Once they lower the leg back to the starting position, have them repeat the movement with the other leg.
• Tip: Advise patients to keep their trunk stable during the exercise and avoid letting their lower back arch.

4. Supine single knee-to-chest stretch

This stretch relieves tension in the lower back and gluteal muscles.

• How to perform: Tell your patients to start by lying on their back with their legs straight. Instruct them to use their hands to slowly pull one knee toward their chest until they feel a gentle stretch in their lower back. Encourage them to hold the position for 20 to 30 seconds before switching to the other leg.
• Tip: Instruct patients to keep their back relaxed and flat on the ground during the stretch for maximum benefit.

Empowering patients for a successful recovery

A successful recovery from low back pain involves more than just prescribing exercises—it’s about equipping your patients with the tools and confidence they need. Each session is an opportunity to reinforce positive habits, address concerns, and adjust the plan to suit their unique needs.

Here are some practical tips on how you can improve patient recovery:

• Consistency is key: Explain to patients that regular practice is essential for building strength, improving mobility, and reducing pain. Skipping sessions may delay progress and make it harder to regain momentum, so patients should incorporate exercises into their daily routine. To make it easier, suggest practical strategies, such as setting reminders on their phone or pairing exercises with existing habits—like performing stretches after brushing their teeth or completing a routine after a morning walk.
• Focus on form: Stress the importance of proper technique for both safety and effectiveness. Use clear, patient-friendly instructions, and provide visual demonstrations, such as the videos in our exercise library. Encourage patients to take their time with movements and avoid rushing. If they struggle with form, consider modifying the exercise or offering tactile cues to guide them.
• Listen to the body: Teach patients to differentiate between normal and mild discomfort, as well as signals that may indicate they need to adjust their approach (sharp pain, numbness, or significant swelling). Let them know it’s okay to feel some muscle activation or slight soreness, but sharp or worsening pain is a sign to stop and reassess. Maintaining an open line of communication will help patients feel comfortable sharing concerns about their pain levels, allowing you to work together to address any issues and adapt their plan as needed.
• Seek guidance when needed: Remind patients they don’t have to navigate recovery alone. Your role is to provide ongoing support, whether that’s through modifying exercises, addressing setbacks, or celebrating milestones together. Adjustments to the program are a normal part of tailoring care to their needs, and these changes help keep their recovery on track. To build trust and confidence, reassure patients that you’re there to guide them every step of the way, even through challenges.

Pathways to stronger, healthier patients

Low back pain affects millions worldwide, disrupting work, daily activities, and overall well-being. Through a thoughtful, evidence-based approach, you can help patients regain function and confidence, enabling them to take control of their health and well-being.

When you combine evidence-based exercises for low back pain with a patient-centered program, you create a foundation for improved outcomes and patient empowerment. That’s what Pathways delivers—a well-structured musculoskeletal (MSK) care solution featuring phased progression and tailored care programs designed to address the unique needs of each MSK patient. By integrating the personalized benefits of in-person care with the flexibility of virtual care, Pathways offers a hybrid solution that enhances access, improves engagement, and boosts adherence.

Learn more about how Pathways provides a comprehensive solution for managing musculoskeletal conditions. Ask your organization to request a demo and discover how Pathways can elevate your practice and enhance patient care.

References

1. World Health Organization. (2023, June 19). Low back pain. Retrieved December 3, 2024, from https://www.who.int/news-room/fact-sheets/detail/low-back-pain
2. George, S. Z., Fritz, J. M., Silfies, S. P., Schneider, M. J., Beneciuk, J. M., Lentz, T. A., Gilliam, J. R., Hendren, S., & Norman, K. S. (2021). Interventions for the management of acute and chronic low back pain: Revision 2021. The Journal of Orthopaedic and Sports Physical Therapy, 51(11), CPG1–CPG60. https://doi.org/10.2519/jospt.2021.0304