Back exercises are a necessary part of preventing back pain. Using the exercise
with its inherently labile
surface has always been popular in physical therapy clinics and is now
popular in gyms for use by people who want to keep their back strong.
80 percent of people with back injuries will go on to have
reoccurrences so it is absolutely necessary to maintain a strong and
flexible back if one is to maintain a pain free status. Seeing your
physical therapist or ergonomist about lifting and sitting mechanics is
also important in maintaining back health.
I'm not going to list all the gym exercises like rowing, and
pull-downs, deadlifts and chin-ups. There are plenty of other websites
that describe those. I would like to present the evidence showing what
the more effective back exercises are that will recruit the back
and help prevent
back injuries. Of course, the goals of your back exercise program will
dictate which exercises are most appropriate for you.
If you are new to back exercises, start with a
on the floor
If you are experiencing
back pain, consult your physical therapist prior to attempting ANY of
Before beginning any back exercise program it is important to learn how
to control and maintain lumbar neutral
, pelvic positioning,
and maintain transversus abdominus activity through abdominal
. If you have no idea
where your spinal joints are when lifting a load you may be putting
joints at risk of injury without realizing it. if you are lifting and
realize your posture
isn't the greatest or feel strain in your back you must be able to
correct this voluntarily by repositioning your spine and pelvis.
The ability to stabilize
your back, or any other body part, is dependent on your ability to
isolate movements, or recognize the movement that is occurring at your
pelvis versus your lower back. You can perform a test to see how good
you are at this:
- Stand with your back
against a wall with your heels, butt, and upper back touching the wall.
- Slide your left hand
inbetween your lower back and the wall. You will probably feel a
distance between your back and the wall of about 1.5 to 3 inches.
- Lift your right knee
up so that your thigh is parallel to the floor, hip at 90 degrees, knee
at 90 degrees.
If you feel the distance between your back and the wall changing, you
are not controlling spinal stability. Of course your ability to perform
these movements also depends on flexibility. If your hips are tight you
will have to achieve this movement with some lower back flexion. That
is why a loss in hip
or back flexibility
injury - because you lose your ability to maintain neutral position and
end up loading your joints in weak positions.
test in itself can be used as an exercise:
Stand against the wall as you did above with your hand behind your
- Tighten your abdominal
muscles by abdominal hollowing technique.
- Concentrate on
maintaining the distance between the wall and your lower back that you
can feel with your hand.
- Lift your knee up so
that your foot is only a few inches off the ground. Perform this slowly
over a period of about 3 or 4 seconds.
Hold this for 5 to 10 seconds and repeat 10 times.
If at any time you feel your lower back pressing against your hand
you've lost it. Take a break and try again in a minute. When you get
good at this you can progress this exercise by lifting your foot a
little higher and holding for a little longer. All the time during this
exercise you must be able to maintain a constant distance between your
lower back and the wall.
If you find the test and back exercise above too difficult you can try
the following in lying:
- Lie flat on your back
with your knees bent. (with or without a pillow under your head)
- Slide your left hand
under your lower back. You should feel 1 to 2 inches of space between
your lower back and the floor.
- Tighten your abdominal
muscles by drawing your belly button in and up.
- Lift your right foot
off the floor while keeping your knee bent.
If you feel your lower back
rise up off your hand or push down into your hand then you are not
controlling your lumbar spine. Controlling the lumbar spine is
imperative to performing any back exercise safely.
test too can be modified as an exercise:
- Lie flat on your back
as above with your hand under your lower back and knees bent, feet flat
on the floor.
- Perform the abdominal
hollowing exercise without moving your lower back. As your belly button
moves in and up, there should be no change in the amount of pressure
exerted on your hand by your lower back.
- As you hold this
position, lift your right foot up off the floor about 2 inches and hold
it there for 2-3 seconds and then lower it.
this 10 times.
If you can do this without moving your lower back then you know what it
feels like to maintain a stable spine while moving your leg. As this
exercise gets easy you can make it more difficult by trying the
1. performing more repetitions, 3 sets of 10 reps.
2. holding your foot up for a longer period, 5-10 seconds.
3. raising your foot up higher, 10-12 inches.
4. straightening your leg and lifting and lowering a straight leg.
5. putting a weight on your ankle, 1-2 pounds.
6. for those much more advanced you can try lifting both legs.
7. try the
raises in standing
Studies have been done to examine core stability exercises done on the
exercise ball versus a stable surface. The terms "core stability" used
on the web refers to training muscles of the lumbo-pelvic region and
abdominals, but we should identify them as the deep local stabilizers -
the transversus abdominus and multifidus. These tiny muscles are the
ones necessary for segmental stability of the spine during larger
movements when postural adjustments may be required.
Previous research has always emphasized that strengthening and
improving control of the transversus
abdominus and obliques
achieved through the use of exercises that minimized use of the rectus
abdominus. (3,4) Use of the abdominal
technique has also
been shown to facilitate transversus abdominus.
The abdominal hollowing exercise recruits the transversus abdominus
muscle; however, rarely do we use this muscle in isolation. When
designing a back exercise program one must take into account
the synergistic relationship between the large superficial muscles and
the deep segmental muscles. We use the large gluteal, quadriceps,
pectoral, and deltoid muscles to lift something, but without the
activity of the deep segmental stabilizers we cannot lift anything. At
the same time, great abdominal hollowing is not going to help you lift.
Our ultimate goal is to find back exercises that will elicit a training
effect while incorporating this synergistic relationship.
A study published in Electromyography and Neurophysiology used surface
electromyography (EMG) to examine the activity in various trunk muscles
during select exercise ball exercises. (1) Eleven health men without
back pain between the ages of 17 and 21 were fitted with electrodes on
their rectus abdominus, external obliques, and lower and upper back
extensors. EMG signals in these muscles were examined during seven back
Results showed that push ups with both hands on the ball, toes on the
floor resulted in the greatest activity in all of the abdominal muscles
tested. Lifting the exercise ball between both legs resulted in the
least amount of activity in the abdominal muscles. Reverse
bridging with the head on the ball, feet on the floor, lifting the
pelvis resulted in the greatest activity in the back extensors. Results
from this study show that different back exercises on the exercise ball
recruit different muscles to varying degrees. Depending on your
weaknesses, prior injuries, or preexisting conditions, your physical
therapist will prescribe different sets of back exercises.
A study done in in 2005 hypothesized that back
exercises performed on an exercise ball would result in greater levels
of muscle activation than the same exercises done on a stable
surface.(2) A relatively small sample size of 8 healthy
pain-free subjects in their 20's was used. Surface EMG was used on the
rectus abdominus, transversus abdominus and internal obliques, and the
Exercises that were performed in this study were as follows:
Upper body rollout (handwalking
Inclined press-up (pushups
on the ball)
Quadruped exercise (superman
Contralateral single leg hold (reverse
bridge leg raise
The quadruped exercise with arm and leg raises was the most effective
for recruiting the obliques and transversus abdominus. This exercise
also minimized recruitment of rectus abdominus. This ratio is
maintained when weights are applied to the arms and legs as well so to
make this exercise more challenging, just add weights.
Subjects rated the unstable press-up as the most difficult. The
quadruped exercise created a muscle activity pattern appropriate for
training local stabilizers while causing minimal contraction of rectus
abdominus. The exercises single leg hold and the press up using the
exercise ball resulted in the most rectus abdominus activity. So,
depending on your goal, whether it's to isolate the stabilizers or
maximize abdominal activity will determine which exercises are best for
Although a lot of trainers will advise you to do back exercises three
times a week there is evidence that suggests they may be most
beneficial when performed daily.(5) Activity in the deep stabilizers of
the spine is required over long periods during any activity so must be
trained for endurance.
Under no circumstances should a strengthening exercise cause lower
. Evidence shows that
repeated movements causing pain can cause serious tissue damage
especially when weighted as with weight lifting exercises.(6)
The side plank, whereby one is resting the upper body weight through
one forearm while on the knees has been shown to recruit the deep
stabilizers while minimizing compressive forces on the spine. This can
be made more challenging by moving the support to the feet from the
knees as in the
I will hear often about the patient that will "throw out their back" by
simply bending over to turn on the shower or doing some other simple
task. Evidence suggests that tissue loading changes with repetitive
movements, even under low or no load. Muscle fatigue can lead to errors
in adequate muscle contraction and control resulting in injurious joint
forces. Exercises should be designed to maximize endurance so as to
avoid this fatigue.
Jull G, Richardson C, Toppenberg R, Comerford M, Bui B.Towards a
measurement of active muscle control for lumbar
stabilization. Aust J Physiother 1993;39:187-93.
2. O’Sullivan PB, Twomey L, Allison GT. Altered abdominal
recruitment in patients with chronic back pain following a
specific exercise intervention. J Orthop Sports Phys Ther
3. Mori A. Electromyographic activity of selected trunk
muscles during stabilization exercises using a gym ball. Electromyogr
Clin Neurophysiol. 2004 Jan-Feb;44(1):57-64.
PW Marshall, PG Dip Sci, BA Murphy, PhD Core Stability Exercises On and
Off a Swiss Ball Arch Phys Med Rehabil 2005;86:242-9.
5. Mayer TG, Gatchel RJ, Kishino N, et al. Objective assessment of
spine function following industrial injury. A prospective study with
comparison group and one-year follow-up.
comparison group and one-year follow-up. Spine. 1985;10:482-493
6.McGill SM. The biomechanics of low back injury: implications on
current practice in industry and the clinic. J Biomech. 1997