The “Best” Low Back Pain Exercise


If you’re reading this, you probably have low back pain.  Or maybe a family member or a friend has low back pain.   So you want to find the BEST exercise(s) for low back pain.  All over the internet, there are hundreds of videos and articles and blogs on the best exercises for low back pain.  Heck, even we have done a few of those posts (here).  But this article is different.  This is to find the “best” exercise for your pain.

Let’s look at two recent patients I’ve had with low back pain.  Both had very similar low back pain.  It was located primarily in the center of their low back and occasionally radiated outward to their sides or down into the upper glutes.  (Both of these patients consented to video their exercises.  Fun fact, these two are also married to each other) 

Low Back Pain Patient #1: Ann

Here is a video of Ann doing the BEST exercise for HER low back pain

Low Back Pain Patient #2: Lance

Here is another video with Lance doing the BEST exercise for HIS low back pain.

As you can see, these exercises are pretty different.  From just a casual glance, they both might look to be nothing more than simple stretches. However, biomechanically there is a radical difference in the two exercises.

What is happening with these low back pain exercises?

Here is what is happening biomechanically with Ann’s lumbar flexion (bending forward exercise):

1. Stretch of spinal erector muscles
2. Gapping of lumbar facet joints
3. Compression of the anterior aspect of lumbar discs

And with Lance’s exercise lumbar extension (spine bending backward) the following things occur:

1. Stretching the anterior aspect of the spine
2. Compression the lumbar facet joints
3. Compression the posterior aspect of the lumbar discs

These two patients, despite living together, having the same general lifestyle and having very similar pain, require COMPLETELY different loading exercises.

When Ann does her exercises, her pain improves.  If she does Lance’s exercises, the pain worsens.  In between sets of exercises, we want her spine in more of a flexed position.   So when she sits, we actually want her to slouch!

Conversely, Lance gets better with his exercises and would worsen with Ann’s exercises.  For his condition to improve, we want him to sit up and stand tall in great posture at all times.

Why are different exercises needed?

Both Lance and Ann have low back pain due to lumbar derangement.  Research has shown that about 60-80% of low back pain is caused by lumbar derangements.  Basically, this issue arises when the discs and/or joints don’t function properly.  To correct these issues, end range loading in a SPECIFIC direction is needed.  If loading in the correct direction is used, the issue will improve.  However, when loading in the opposite direction is used, the condition will worsen.  What if a patient uses both directions? Generally, no change will then happen.

The great thing about lumbar derangements is that they rapidly change.  When the right exercise and progression is used, most of these conditions resolve in a month or two or even less. 

So what about your low back pain? What is “your perfect exercise”?

Here are the steps needed to figure that out:
1. Detailed evaluation to rule out anything sinister (bad things that need immediate referral to a specialist)
2. A thorough movement assessment to find out which movements are limited and/or painful.
3. Testing of repeated end range loading and then retesting movements to see if any changes occurred.
4. If no change occurred, further testing may be required. This could range from something simple like core stability testing to something like blood tests or advanced imaging.

Once those steps are completed, then and only then can you be given the “BEST” exercise for your low back.  If those steps aren’t completed, then any exercise is nothing more than a guess.

By now you’ve probably realized that the title of this article was a bit of clickbait. While I would love to be able to give you the best exercise for your pain without examining you, it’s just impossible.

So what happens if you try exercises you found online or one given to you by a trainer? Well, you might get lucky and your pain improves.  Or you get unlucky and your pain worsens.  Or nothing happens.  So if you get better, great!  But if your pain doesn’t improve or worsen, it might be time to get a specific exercise that is tailored for YOUR specific condition.

And that is where we come in. We pride ourselves on being spine pain specialists. So if your low back pain is not improving with your current treatment or exercises, give us a call or schedule online.

Jeff Remsburg, DC, MS, DACRB, Cert. MDT