Back Exercises

Back exercises are a necessary part of preventing back pain. Using the exercise ball 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.

CONTENTS back exercises

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 stabilizers 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 program on the floor first.

If you are experiencing back pain, consult your physical therapist prior to attempting ANY of these exercises.

Why it's important to achieve control

Before beginning any back exercise program it is important to learn how to control and maintain lumbar neutral position, pelvic positioning, and maintain transversus abdominus activity through abdominal hollowing. 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:

Test of lumbar control in standing

  1. Stand with your back against a wall with your heels, butt, and upper back touching the wall.
  2. 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.
  3. 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 can cause injury - because you lose your ability to maintain neutral position and end up loading your joints in weak positions.

This test in itself can be used as an exercise:
  1. Stand against the wall as you did above with your hand behind your lower back.
  2. Tighten your abdominal muscles by abdominal hollowing technique.
  3. Concentrate on maintaining the distance between the wall and your lower back that you can feel with your hand.
  4. 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.
  5. 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.

A test of lumbar control in lying

If you find the test and back exercise above too difficult you can try the following in lying:
  1. Lie flat on your back with your knees bent. (with or without a pillow under your head)
  2. Slide your left hand under your lower back. You should feel 1 to 2 inches of space between your lower back and the floor.
  3. Tighten your abdominal muscles by drawing your belly button in and up.
  4. 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.

This test too can be modified as an exercise:
  1. Lie flat on your back as above with your hand under your lower back and knees bent, feet flat on the floor.
  2. 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.
  3. 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.
       Repeat 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 following:

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 leg raises in standing as above.

Lumbar stability is the result of the coordination of the deep stabilizing muscles and larger global movers.

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 was best achieved through the use of exercises that minimized use of the rectus abdominus. (3,4) Use of the abdominal hollowing 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.

Back exercises on the exercise ball recruit different muscles.

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 exercises.
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.

Back exercises done on and off the ball - a comparison

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 erector spinae.
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 the individual.

Back exercises are most beneficial when done daily.

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.

No Pain No Gain?

Under no circumstances should a strengthening exercise cause lower back pain. 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 side bridging exercise

Endurance may be more important than strength.

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.

1. 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 muscle recruitment in patients with chronic back pain following a specific exercise intervention. J Orthop Sports Phys Ther 1998;27:114-24.
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.

4.  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 May;30(5):465-75.