Best Physiotherapy Exercises for Lower Back Pain

First, find your direction

Back pain isn't one thing, and exercise works best when it matches the pattern. Some people feel better bending forward and worse arching back. Others are the opposite. Pain that eases when you lie on your front and prop up on your elbows often responds to extension work such as McKenzie press-ups. Pain that eases when you sit or curl up tends to prefer flexion, like the knee to chest stretch.

If you're not sure which you are, notice what the last flare-up liked. That's usually a better guide than any list.

The core set

These five cover most non-specific lower back pain. Start gently and build.

1. Pelvic tilts. Lying on your back, flatten the lower back into the floor, then let it arch slightly. It's movement without load, useful in the first painful days.
2. Cat cow. On hands and knees, round and then arch the spine slowly. It loosens the whole back with the weight taken off.
3. Glute bridges. Lift the hips from lying and squeeze the buttocks. Strong glutes take strain off the lower back during lifting and walking.
4. Bird dog. Opposite arm and leg reach from hands and knees, holding the trunk still. This trains the kind of control the back needs for daily tasks.
5. Dead bug. Lying on your back, lower opposite arm and leg while keeping the lower back steady.

Each has a full step-by-step guide in our back exercises section.

How much, and how hard

Two to three sets of 8 to 12 repetitions, most days of the week, is a reasonable start. Mild discomfort during exercise is acceptable. A useful rule: if symptoms are no worse the next morning than before you started, the dose was fine.

Progress by adding holds, then repetitions, then difficulty. A bridge becomes a single-leg bridge. A bird dog gets a longer hold. What you are building is capacity, and capacity needs gradual overload.

What to avoid early

Sit-ups and toe-touch stretches aren't forbidden, but they're poor choices during a flare because they load the discs in flexion repeatedly. Heavy deadlifts can come back later. Aggressive twisting stretches rarely add much.

Bed rest is the biggest mistake. Walking, even short and slow, is one of the best early treatments for back pain.

When exercises aren't enough

If pain travels below the knee, or you notice numbness or weakness in the leg, the problem may involve a nerve. That calls for assessment rather than more of the same routine. Our comparison of sciatica and lower back pain explains the difference.

Exercise treats most back pain well. It works better when someone has checked which exercises suit your back, how hard to push and when to move on.