Returning to Activity After Lower Back Pain

Your back is finally starting to feel better, but you’re worried it will go out again if you do too much too soon or you just don’t know where to start. Lower back pain tends to inhibit many key muscles in your lower back and hips. Waking these muscles back up is the key to a rapid and successful return to activity. If you don’t turn these muscles back on and restore some strength and endurance in them, getting back to the activities you love will be much more difficult. 

Two Areas of Focus

  1. The muscles that stabilize your spine (rectus abdominus, internal/external oblique, quadratus lumborum)
  2. The muscles that move and stabilize your hips (gluteus maximums, gluteus medius/minimus/hip external rotators)

Rectus abdominus, internal/external oblique and quadratus lumborum are involved in stabilizing your spine in a neutral position. This is this position where the structures in your spine can optimally accept load. We want theses muscles to be able to hold your spine in neutral and do this repeatedly. This will be reflected in the prescribed number of reps/sets/hold times for these exercises.

– insert photo of rectus abdominus, internal/external oblique, quadratus lumborum

Gluteus Maximus is the workhorse of the hip joint. It is one of the primary muscles involved in lifting things up from the floor or getting up from a chair. Gluteus medius/minimus and the hip external rotators play a stabilizing role, controlling laterally directed forces. Overall, both sets of gluteal muscles are more involved in creating movement than preventing it. This will be reflected in the number of rep/sets/hold times you do with these exercises.

Below are some starting exercises for each muscle group we have discussed along with some useful progressions for each.

Front Plank

This exercise targets rectus abdominus and your internal/external obliques. In particular, we are training these muscles to resist spine extension movement (backwards bending). It’s important that you feel this exercise on the front of your stomach and not in your lower back. If you feel your lower back, you are likely sagging down and hanging off the joints in your back, rather than holding yourself up with your abdominal muscles. 

  1. Lie on your stomach with elbows under shoulders
  2. Lift your body up so that your hips are in line with your shoulders (body should be in a straight line from shoulders to hips, but then your legs will angle down to your feet)
  3. Hold for 15 seconds per repetition
  4. Lower down to take a breath or two and repeat for all repetitions in your set
  5. Once you have completed your set, rest for 30-90 seconds and repeat all sets

Once the basic plank becomes easier to do, progress to the next variation

Front Plank with Elbows Forwards

– Insert video for front plank, elbows forwards

  1. Lie on stomach with elbows forwards relative to shoulders (start with a small distance) – the further forward your elbows move, the more difficult the exercise will become
  2. Lift your body up so that your hips are in line with your shoulders (body should be in a straight line from shoulders to hips, but then your legs will angle down to your feet)
  3. Hold for 15 seconds per repetition
  4. Lower down to take a breath or two and repeat for all repetitions in your set
  5. Once you have completed your set, rest for 30-90 seconds and repeat for subsequent sets.

Modified Side Plank

This exercise targets internal/external obliques and quadratus lumborum. Here the focus is on training these muscles to resist spine side bending. In the early days recovering from a back problem, it is important to focus on the set-up shown in the video to keep your spine in a good position throughout the exercise. You will move in/out of position by moving your hips, not your lower back.

  1. Lie on your side with your elbow directly under your shoulder and knees bent slightly in front of you
  2. Pre-engage the muscles on the bottom side of your trunk to straighten your spine
  3. Push hips forwards until your shoulders, hips and knees are in a straight line
  4. Hold for 15 seconds per repetition 
  5. Sit hips backwards to the ground and take a breath or two, then repeat this process for all reps in your set
  6. Once you have completed your set, switch to the other side.
  7. You can rest 30-90 seconds in between sides or after you’ve done one set on each side

Once the modified side plank becomes easier, you can progress to the full side plank below.

Full Side Plank

-insert video for full side plank

  1. Lie on your side with your elbow directly under your shoulder and feet on the floor slightly in front of you
  2. Pre-engage the muscles on the bottom side of your trunk to straighten your spine
  3. Push hips forwards until your shoulders, hips and knees are in a straight line
  4. Hold for 15 seconds per repetition
  5. Sit hips backwards to the ground and take a breath or two and repeat this process for all reps in your set
  6. Once you have completed your set, switch to the other side.
  7. You can rest 30-90 seconds in between sides or after you’ve done one set on each side

Glute Bridge

This exercise targets gluteus maximus. As you perform this exercise it is important to keep your spine in neutral and move only your hips. If you feel this in your lower back, you’re not keeping your spine neutral. On each repetition you must engage your abdominal muscles to resist spine extension and keep it in neutral. For further tips on this or to fix hamstrings cramping during this exercise, see this article (Hot link for fixing glute bridge article)

  1. Lie on back with knees bent, feet flat on the floor, hands by your hips
  2. Engage your abdominal muscles to stabilize your spine
  3. Start with gentle glute activation without moving, then gradually ramp this contraction up as you lift your hips up
  4. Hold 5 seconds
  5. Lower back down and repeat all repetitions in the set
  6. Rest 30-90 seconds between your sets

Once this exercise becomes easier, progress to single leg holds as in the video below.

Glute Bridge with Single Leg Holds

  1. Lie on back with knees bent, feet flat on the floor, hands by your hip
  2. Engage your abdominal muscles to stabilize your spine
  3. Start with gentle glute activation without moving, then gradually ramp this contraction up as you lift your hips up
  4. Once at the top, lift one leg off an hold 5 seconds, then repeat with the other leg
  5. With both feet back on the ground, lower back down and repeat all repetitions in the set
  6. Rest 30-90 seconds between your sets

Once this exercise becomes easier, progress to the single leg bridge.

Single Leg Glute Bridge

  1. Lie on back with knees bent, only one foot flat on the floor, hands by your hip
  2. Engage your abdominal muscles to stabilize your spine
  3. Start with gentle glute activation without moving, then gradually ramp this contraction up as you lift your hips up
  4. Hold 5 seconds
  5. Lower back down and repeat all repetitions in the set
  6. Rest 30-90 seconds between your sets

Clamshell

This exercise targets gluteus medius/minimus and the hip external rotators. When performing this exercise it’s very important to lie with your pelvis/back up against a wall to prevent your body/hips from rolling backwards. This helps to better isolate the target muscles.

  1. Lie on floor in front of couch or up against a wall
  2. Brings hips to about 45 degrees to your body, knees bent so your feet are in line with your hips

3.  Keep your feet together as you lift the top knee upwards as far as you can, focusing on squeezing/engaging gluteus medius

4.  Hold 5 seconds

5.  Lower back down and repeat all repetitions in your set

6.  Rest 30-90 seconds between your sets

Once this exercise becomes easier, you can perform the same exercise with a resistance band around your thighs.

Clamshell with Resistance Band

Programming for Front and Side Plank

As discussed earlier, we want these muscles to be able to hold your spine in neutral and have the ability to do this repeatedly. We also want them to be able to produce more force in order to stabilize your spine under heavier loads, rather than produce a low grade force for a long period of time. When you lift up a box from the floor or perform a repetition of a squat, your muscles need to produce a high amount of force for several seconds. So unless you are aiming to set the world record for a front plank (currently set at 8 hours, 15 minutes and 15 seconds!), we want to make these exercises harder, rather than hold them for longer. Once you are able to do the prescribed number of reps and sets, move on to the next progression rather than just holding them for longer and longer.

Sets: 3

Repetitions: 3 (take a breath or two between each repetition)

Hold: 15 seconds per repetition.

Rest Interval: 30-90 Seconds between sets

Programming for Glute Work

These muscles are involved in creating movement rather than preventing it. So the emphasis here is on more repetitions with a shorter hold. The hold here is used to help recruit/activate the target muscles more effectively.

Sets: 3

Repetitions: 10-15

Hold: 5 seconds per repetition

Rest Interval: 30-90 seconds between sets

All of these exercises should be done at least 3 times per week. They are all light enough that they could be done daily, provided you don’t have much in the way of muscle soreness or lower back pain/stiffness after doing them. If you experience this, take a rest day and return to them the following day. 

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