woman runner holding lower back in pain staying active with lower back pain
Injury Prevention

Lower Back Pain: Strategies to Stay Active

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Lower back pain is a real buzzkill. 

Left unchecked, it can wreak havoc on anyone’s quality of life. 

It’s estimated that as many as 60-85% of people will have lower back pain at some point in their life. 

Low back pain is also more common in those who do not have a regular exercise program, among other risk factors.

Not long ago, the treatment for almost any injury was rest. 

While in acute phases, this may be the case; at some point, you have to start moving again to resume a normal life full of activities you love.

This often brings about the age-old question: 

“I have lower back pain. What should I do?”

That seemingly casual, yet fishing for pro tips at a cocktail party (totally kidding, I don’t go to cocktail parties) is an incredibly loaded question. 

Sound the alarm. 

This unleashes an avalanche of follow up questions because there’s no way to adequately answer that in the absence of so many details. 

This article is dedicated to staying active with lower back pain and how to take an active role in your health and fitness. 

Disclaimer: Always seek proper instruction before initiating an exercise program. Not everything is great for everyone! Consult with your qualified health care practitioners for an exercise program tailored to your needs. Stay healthy and injury-free! Read the full disclaimer.

Back pain is more than just back pain (it’s complicated)

First things first, there are a lot of different kinds of lower back pain. 

Different diagnoses require different approaches, and the wrong treatment could leave you in more pain.

So when Joe-Schmoe tells you all about his back pain, including all his exercises and the late-night infomercial gimmick that changed his life, take it with a grain of salt. 

Because everyone knows a Joe-Schmoe with a story….

Sometimes, it seems like everybody’s a doctor (or a salesman) when you have back pain. 

Let’s take a look at the shortlist of common musculoskeletal issues that can cause lower back pain (and accompanying issues):

  • Strains and sprains
  • Compensation for lack of strength in another muscle group, e.g., glutes
  • Poor posture
  • Lumbar bulging or herniated discs
  • Sacroiliac (SI) joint issues
  • Facet joint issues
  • Arthritis
  • Stenosis
  • Scoliosis

Notice that I didn’t list sciatica here?

That’s because sciatica is a symptom of inflammation and pain along the sciatic nerve. It doesn’t tell you why the nerve is inflamed. Sciatica itself is not a diagnosis. 

There can be different sciatica causes, and it’s essential to be evaluated to get the proper treatment for your sciatica. 

Which brings me to my next point…

illustration of the spine
urfingus / bigstockphoto.com

Get evaluated 

Don’t try to cure your back pain with some generic catch-all advice.

For example: John has a disc bulge. Sally has an SI joint dysfunction. Both complain of “lower back pain.” Yet the treatment approaches will look different.

Get evaluated by your doctor and physical therapist to narrow down what you’re dealing with and get specific recommendations for you.

Get the scoop on your lower back pain. 

The sooner you address your pain, the sooner you can get on the right treatment path and start feeling better. 

Pro tip: When you see a physical therapist, be very specific about your goals. 

If your goal is to get back to Pilates, but your therapist isn’t that familiar with the movements required, show them.

If you’re in too much pain, show then a YouTube video of someone doing Pilates and point out what you need to be able to do.  

The more specific you can be, the more they can help tailor a rehab program to your needs. 

There’s a huge difference between: 

“I want to get back to the gym, a little cardio, a little weights, you know.” (No, I don’t know, everyone’s version of that will be different.)

Versus:

I want to be able to squat, do deadlifts, play basketball, or do Pilates roll-downs.

What kind of cardio? What kind of weights? What kind of activities?

Help me help you. 

Understand your lower back pain

We’ve already established that not all lower back pain is created equal. 

Take an active role in your health and take the time to understand your back pain. 

Pain seems random? Take notes and see if you can establish a pattern. 

When you go to a physical therapist, they’re going to ask this anyway, so you might as well be prepared.

Once you have a working diagnosis from a professional, do some research to understand the injury, including the dos and don’ts. 

Learning about your injury can help the rehab process. 

woman at home performing cobra pose
Mirage_studio / bigstockphoto.com

Find (the right) ways to move

Studies show exercise helps improve lower back pain.

When you avoid movement, problems multiply. 

Motion is lotion, shy of giving you an oil can like the Tin Man from the Wizard of Oz; it’s the best thing we have.

If you’re not sure what movement is safe for you, discuss it with a physical therapist.

A helpful question to consider is what positions or movements make the pain better and which make the pain worse.

This helps determine movements to promote and movements to avoid. In the beginning, the key is to find some range of motion that doesn’t exacerbate the pain.

If you continue to perform movements that aggravate your pain, you’re perpetuating the inflammatory cycle, working against your goal of feeling better. 

A physical therapist will help you determine healthy ways for you to move and start feeling better. 

Don’t work through the pain

This may sound like a no-brainer, but the no pain no gain mentality continues to be a myth that just won’t die. 

There will always be different sensations during exercise. Get in-tune with pain vs. sensation to avoid aggravating an already cranky area. 

Monitoring pain and noting subtle changes can help you stop or modify an activity before it gets too severe.

Improve your movement awareness

Everything is connected, and you may wonder how that overhead shoulder press left you clutching your back in pain.

“But, I didn’t even move my back!” Or so you think.

A heavy dose of stabilization was still required from your spine to allow you to perform that exercise. Couple that with a breakdown in form, and suddenly your back was invited to the party.

Whether you realize it or not, the body works as a whole. 

Even movements that appear only to involve one area require some level of stabilization from other parts.

How to improve movement awareness

  • Ask for help
  • Practice
  • Educate yourself about anatomy and movement
  • Practice following directional cues and mirroring movements
  • Keep it simple and use exercise modifications
  • Respect your limits
  • Work with a physical therapist or personal trainer
  • Use mirrors for feedback
  • Master fundamental fitness movements
  • Do activities that focus on fundamental movements
  • Do core and total body strengthening
  • Practice meditation
  • Practice deep breathing exercises
  • Try body scanning exercises
  • Perform contract/relax exercises
  • Work on balance exercises
  • Slow down and focus on what you’re doing

For a deeper look into these techniques, read Body Awareness for Injury Prevention.

man demonstrating proper squat form to protect the lower back
studioloco / depositphotos.com

Master fundamental fitness movements

There’s a theory that there are only seven basic fitness movements, and all other movements are some combination of these basics. 

The seven basic movements are:

  • Push
  • Pull
  • Squat
  • Lunge
  • Hinge
  • Rotation
  • Gait

Got goals of lifting weights again? 

Work toward performing bodyweight fundamental movements pain-free and make sure your form is top notch.

Take modifications

I get it if you’re used to working at a certain level, and all of a sudden, you can’t, it can be an ego blow.

It’s easy to think you’d be better off just staying home until this “blows over,” but movement is an integral part of the process.

If you don’t backtrack and build up some basics again, you won’t be able to get back to where you were. It’s kind of like saying you have to crawl before you can walk, and walk before you can run. 

Nothing is more frustrating than taking one step forward and two steps back. 

Modifications allow you to develop strength and mobility in safe ranges. Keep moving forward, no matter how slowly.

This may look like modifying your range of motion, weights, impact, or utilizing yoga props.

Once you can confidently perform these movements without pain, then you can think about progressing. 

Your back may not be the root cause of the issue

Again, why it’s essential to get evaluated and have a movement assessment, pain may land in the back from weakness or impaired movement mechanics from many other places.

A common issue is hip and glute muscle weakness or hip mobility issues, placing more demand on the low back. 

If this is the case, you can get all the massages you want, but until you address the root cause, that back pain is here to stay. 

It may be more than what goes on in the gym

If the pain doesn’t immediately show up after an activity, it can be challenging to pinpoint the cause.

It’s easy to blame your lower back pain on your workout, but the truth is how you move, stand, and sit the other 23 hours of the day matters too. 

Paying close attention to posture and other daily life movements can help you get ahead. You may need to pace yourself during the day and take breaks to stretch and move.

Again, movement awareness. 

cartoon woman working at a computer demonstrating poor posture and good posture.
lubenica / bigstockphoto.com

Sometimes it may be about management

Unfortunately, you can’t undo degenerative changes such as arthritis or trauma from accidents or surgery. Still, you can strive to maximize your mobility and strength to ensure you can keep moving for a very long time.

Sometimes it’s about moving to feel better, and sometimes it’s about moving not to feel worse.

Regular exercise can help keep you moving and delay the effects of degenerative wear and tear.

Don’t ignore flexibility and mobility work

Wouldn’t it be great if you could just get a massage and be magically cured? 

Yeah, me too, but it doesn’t work that way. 

Movement, flexibility, and mobility work are essential adjuncts to the whole picture.

This is where foam rollers and myofascial release balls come in.

Work out those kinks and keep your tissues mobile. Mobility helps strength, and strength improves mobility.

Don’t have a foam roller? Check out a great selection at ProSource Fit.

Incorporate new forms of exercise

Studies show that the following activities have proven beneficial in the treatment and management of generalized lower back pain:

  • Strengthening (core & total body)
  • Yoga
  • Pilates
  • Tai Chi
  • Low impact aerobic activities such as walking, elliptical, stair climber, swimming, stationary bike, and low impact cardio classes.

Varying your routine to include different activities can provide a more thorough approach to keeping your back (and the rest of you) healthy. It’s also the key to building a well-rounded fitness program for overall health benefits.

woman doing yoga at home in downward dog
Begelart / bigstockphoto.com

If the gym isn’t your scene, but you’re looking to try new activities, there are plenty of high-quality streaming options available.

Here are a few of my favorites that require minimal to no equipment and can be done at home:

Aaptiv 

All you need is headphones (or not) to follow along with the guided audio workouts on Aaptiv.

Pick from different types of workouts, including treadmill, stair climber, strength training, elliptical, indoor cycle, Yoga, Pilates, guided meditation, and more. There are even programs for guided outdoor walks.

Customize workouts by length of time, music genre, trainer, and fitness level. You can even schedule workouts, so you don’t forget.

Yoga Download

Bring the yoga studio to your home. Yoga Download has thousands of streaming classes for all levels at an affordable price. (There are even free classes!)

They have plenty of beginner-friendly resources including yoga classes, yoga pose videos, and printable pose guides to help you practice yoga safely and confidently.

Yoga Download also offers Pilates and meditation.

My Fitness

The My Fitness app allows you to customize workouts based on your level, area of focus, and what equipment you have.

If you’re trying to do more foam rolling, there’s a section for that too!

Modifications for all levels are offered.

Work with a physical therapist

Depending on the state, you may be able to see a physical therapist without a doctor’s prescription. Direct access can help get you the treatment you need, faster.

Check with your local PT office for the laws in your area.

A physical therapist will evaluate and analyze your movement to provide a treatment program tailored to you. 

Friendly PSA: To see success with physical therapy, you’re going to have to do exercises. Make sure you do them!

I’m going to spin it like this:

Let’s say you go to the doctor and you’re prescribed medication. If you don’t take the medication, it doesn’t work.

The same is true for physical therapy.

Except instead of medication, you’re prescribed exercises and stretches specific to your condition to regain strength and mobility.

If you don’t do the exercises, they don’t work. 

Remember, it’s your body! Take an active role in your care!

Work with a personal trainer

If you feel like you always get hurt exercising, a good personal trainer might be for you. They can assist with the right exercise for your fitness level as well as provide feedback on your form. 

Transitioning to a personal trainer after physical therapy can be a natural stepping stone when you’re finished with physical therapy, but don’t feel ready to be on your own.

Keep in mind that having someone watch you and provide feedback is extremely valuable – this is not a time to slack off and let information go in one ear and out the other.

At the risk of sounding like a broken record: Active role in your health!

The idea of paying someone to watch you, so you don’t have to think, won’t serve you well in the long run. Movement awareness only works if you actively tune in.

Stay ahead of lower back pain

Back pain can be a very frustrating experience, especially if you’re used to maintaining a certain level of activity. 

Reach out for help to the appropriate medical professionals to manage your pain and take out the guesswork.

Maintaining a healthy fitness program is the key to keep moving and decrease risk factors for injuries and other health issues. 

Learn everything you can. Don’t take a back seat to your health care.

featured image credit: Maridav / bigstockphoto.com

References

Dreisinger TE. Exercise in the management of chronic back pain. Ochsner J. 2014;14(1):101-107.

Gordon R, Bloxham S. A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare (Basel). 2016;4(2):22. Published 2016 Apr 25. doi:10.3390/healthcare4020022

InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Low back pain: Why movement is so important for back pain. 2012 Feb 9 [Updated 2019 Feb 14]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK284944/

NIH back pain fact sheet: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

Paolucci T, Attanasi C, Cecchini W, Marazzi A, Capobianco SV, Santilli V. Chronic low back pain and postural rehabilitation exercise: a literature review. J Pain Res. 2018;12:95-107. Published 2018 Dec 20. doi:10.2147/JPR.S171729

Thiese MS, Hegmann KT, Wood EM, et al. Prevalence of low back pain by anatomic location and intensity in an occupational population. BMC Musculoskelet Disord. 2014;15:283. Published 2014 Aug 21. doi:10.1186/1471-2474-15-283

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