Like many Americans, your clients may experience debilitating back pain on a regular basis, which can drastically limit their ability to enjoy their favorite activities. It is important for health coaches and exercise professionals to know which exercises can help and which can be counterproductive. This article examines some of the common causes of back pain and reviews the exercises that research suggests are most beneficial for addressing back pain.

First, if your client is experiencing acute back pain that is impacting their quality of life, it is essential they seek advice from a qualified medical professional who can help identify the cause of the pain as well as a specific course of treatment. However, if your client is like many individuals who experience occasional discomfort, they may be able to enhance back health with an exercise program designed to improve the mobility and strength of their hips while increasing the ability of your deep core muscles to stabilize the spine.

Causes of Back Pain

From a minor muscle strain to a rupture of an intervertebral disc that impacts surrounding nerves, there are many different mechanisms of injury that could result in back pain. Dr. Stuart McGill, Professor Emeritus at Waterloo University in Canada, has spent his career studying the mechanics of the spine. He has identified various types of back pain including injuries to the soft tissues like ligaments, tendons or muscles, damage to the bony structures of the vertebrae or the fibrous intervertebral discs that provide the cushion between each individual vertebra. In his book, Low Back Disorders, Dr. McGill explains that it is virtually impossible to develop a specific exercise plan without first conducting an assessment to identify the mechanism of the injury.

Various causes of back pain include muscle imbalances that restrict joint motion, repetitive motions or prolonged postures, including hours spent sedentary in a seated position, resulting in overuse of the muscle, or a poorly designed exercise program with movements that actually make the pain worse as opposed to offering a relief. Additionally, some individuals simply don’t know how to use their hips properly; specifically, knowing how to engage the large gluteal complex responsible for controlling the movement of the hips rather than bending from the spine when performing motions requiring forward flexion.

Exercises to Avoid

Before we identify the exercises that can help optimize back health, it’s important to first take a look at some exercises that, according to Dr. McGill’s research, could actually make back pain worse. This list includes traditional sit-ups, which activate the large psoas muscles responsible for flexing the hips; leg raises, which also use the psoas and compress the intervertebral discs; and the prone superman, in which both arms and legs are raised at the same time, resulting in excessive compressive forces on the lumbar spine.

Exercises for Optimizing Back Health

Here are two stretches and five muscular fitness exercises to incorporate into your clients’ programs to help develop a healthy back and potentially reduce back pain. These exercises focus on improving motion from the hips by targeting the gluteus maximus. Bending forward by rounding the spine could create compressive forces on the intervertebral discs causing an injury. However, being able to maintain a relatively straight, neutral spine while flexing forward from the hips makes it possible to use the strong gluteal muscles for the movement, which can significantly reduce the forces applied to the spine. Not only can these exercises help improve the muscular fitness of the back, but they may also help make the glutes work more efficiently, which is key to avoiding any future episodes of back pain. 

Stretches

Kneeling Hip Flexor Stretch

The largest hip flexor muscle is the psoas, which attaches from the lumbar spine to the lesser trochanter of the femur to flex and externally rotate the hip. In a seated position, the hips are flexed and the psoas is placed in a shortened position. If seated for too long, the psoas could become tight which is why moving back to a standing position can cause discomfort in the back. When the psoas is overly tight, it could reduce the ability of the gluteus maximus to effectively produce hip extension. This stretch helps to lengthen the psoas, which can improve hip motion as well as gluteal function.

Warrior I

This classic yoga move stretches the psoas from a standing position. The kneeling position used in the previous exercise emphasizes a “bottom-up” approach to stretching the psoas; raising the arms overhead while keeping a tall, straight spine can help lengthen and stretch the muscle from the top-down. To increase the effectiveness of the stretch, instruct the client to press their back heel into the floor as they shift their weight forward.

Exercises

Glute Bridge

Lying supine (face-up) is the safest position for the spine because the floor is supporting it and there are no compressive forces caused by gravity. This is the starting point to activate the gluteal muscles responsible for extending the hip. An additional benefit is that as the hips are moving upwards, which creates an active stretch of the psoas. This means the hip extensors are being activated while the hip flexors are being stretched. Once your client is able to perform two to three sets of 15 to 20 repetitions, feel free to add resistance and progress to the Hip Thrust. Loading weight on top of the hips can be an effective way to strengthen the glutes while reducing excessive forces on the spine, and strong glutes are the foundation for optimal back health. (Check out this article to learn more about the many benefits of the Hip Thrust.)

Quadruped Hip Extension

This exercise recruits the deep muscles of the core, which stabilize the spine while targeting the glutes. To increase activation of the hip extensors, cue your client to press their left knee down, into the ground as they raise their right hip in the air; this action creates something called the “cross-extensor” reflex, which can help to increase overall muscle activation. Another option is to place a miniband around the thighs, just above the knees; this additional resistance can help strengthen the glutes.

Standing Hip Hinge

Once your client has created a foundation of muscular fitness by performing floor-based exercises, it is time to move to a standing position, which makes it possible to recruit multiple muscles to increase overall strength. When teaching the hip hinge, hold a light dowel rod along your client’s spine (pictured) to help remind them to move from the hips as opposed to rounding from the spine. The dowel rod should remain in contact with the head, thoracic spine, and pelvis throughout the hinging movement. Again, once the client can perform 15 to 20 repetitions, increase strength by adding external resistance and progressing to a Barbell Romanian Deadlift. (Note: Kettlebells, dumbbells or a medicine ball may also be used for the load.)

Barbell Deadlift

The deadlift can help enhance the muscular fitness of the hip extensors and back muscles at the same time. During the lift, the back muscles activate isometrically to stabilize the spine, while the glutes contract to extend the hips. This move can also be done with a kettlebell, which allows the weight to be placed directly below the center of gravity.

Bent-over row

This is the ultimate back exercise, but it should be saved until your client no longer experiences any back discomfort. Holding the hip hinge while performing the row requires a tremendous amount of strength from the deep core muscles. To increase activation, cue the client to press their feet into the floor and squeeze the bar tight while pulling from the elbows to activate the large latissimus dorsi muscle. Start with a light weight to achieve optimal form; as the client’s strength improves, gradually increase the resistance.