Back pain - Overview and recommended exercise interventions

By: Tom Cloyd - 9 min. read (Reviewed: 2025-02-24:0910 Pacific Time (USA))

Page contents…

• The basic anatomical problem with the human back
• Lower back pain is common in the USA and the world
• Back pain is disabling and costly to individuals and the economies of entire countries
• Risk factors - summary
• Exercise is an affordable and accessible intervention that reduces risk and can help reduce or eliminate pain
  • About these specific exercises
  • Essential advice
  • Brief focused breathing: do this before exercise
  • Begin with stretches
    • 1. Knee to chest stretch
    • 2. Lower back rotational stretch
  • Finish with strengthening exercises
    • 3. Glute bridge
    • 4. Bird dog
    • 5. Walking
• Appendix I - connective tissue
• Notes ^

The basic anatomical problem with the human back

Two central facts dominate the function of our back:

1. It is the center of our body, to which all other parts attach.

2. It is a complex network of bones, muscles, and connective tissue, the foundation of strength and support for our legs, arms, and neck and head, yet it has no principal rigid bone to support it.

Pause a moment to look carefully at the image below. Notice how many separate muscles there are. They are attached to each other and to bone by connective tissue. The complexity of our back’s structure means that there are many points of potential injury or failure - many ways that pain can originate from the back - when we experience excessive physical or mental stress.

Lower back pain is common in the USA and the world

In 2020, the world population was close to 8 billion people (7,887,001,292¹). That same year, an estimated 619 million people were affected by lower back pain² - about one person in 12, or 8% of the population (619/7954 = 0.0778).

Lower back pain is more common in women, and overall is most common in the 50-55 age range. It can occur at any age, and “most people experience lower back pain at least once in their life”.²

“A survey from 2022 found that around 28 percent of adults in the United States report having chronic low back/sciatic pain. Those aged 50 to 59 years were most likely to report suffering from chronic low back/sciatic pain.” The prevalence increases with age, with 35% of adults aged 50-59 reporting chronic low back pain³

“It is predicted that the overall prevalence of low back pain will not change significantly over the next few decades and that in 2050 just over seven percent of the global population will suffer from such pain.”⁴

“It is worth noting that the prevalence of low back pain varies across different countries. Developed countries like Canada, the United States, Sweden, China, and Japan have higher prevalence rates compared to other regions.”⁵ (Why are there higher rates in the US than in the world? One factor is that more people work while sitting for long periods of time - a risk factor.)

Worldwide estimates of prevalence indicate that about 87% of adults will at one time or another in their life have lower back pain.⁵

The point prevalence (prevalence on a single day) in adolescents increases from about 1% of the population at age 12 to 5% at age 15. By age 18 for girls and 20 for boys, 50% will have experienced at least one episode of back pain. The peak number of cases occurs at ages 50-55. Women experience low back pain more frequently than men. The prevalence and disability impact is greatest among older individuals aged 80-85.⁶

Back pain is disabling and costly to individuals and the economies of entire countries

Lower back pain has a unique distinction: It is “the single leading cause of disability worldwide and the condition for which the greatest number of people may benefit from rehabilitation….Lower back pain is often associated with loss of work productivity and thus produces huge economic burden on individuals and on societies.” ²

Risk factors - summary

Anyone can develop back pain, but factors that increase one’s risk include age, a lack of exercise, being overweight, or working a job that requires heavy lifting or long periods of sitting.⁴

Exercise is an affordable and accessible intervention that reduces risk and can help reduce or eliminate pain

Exercise reduces risk. “Research indicates that exercise alone can reduce the risk of low back pain by about 33%. Additionally, the severity of low back pain and associated disability tend to be lower in groups that exercise regularly.”⁷

Before starting an exercise program, a healthcare professional should be consulted to eliminate possible serious causes of pain such as tumors or serious physical injuries.⁷

Research supports the use of these types of exercises:⁷

• Strengthening exercises focused on lower back and abdominal muscles - exercises like planks and bridges.
• Stretching exercises such as pelvic tilts and knee-to-chest stretches can relieve tension and pain.
• Combining both types of exercise are most effective.

Aerobic exercise such as walking, with added strengthening exercises, has been shown to reduce pain and improve function.⁷

“Exercise programs that combine strengthening with either stretching or aerobic exercises, performed 2-3 times per week, are recommended for prevention and treatment of low back pain. A combination of exercises targeting the back, abdominal, buttock, and upper leg muscles is most effective.”⁷

Crucial to success in exercise programs to reduce or eliminate lower back pain is proper form and consistent work, ideally 2 to 3 times a week. Start slowly - with only a few repetitions of an exercise - to avoid risk of further injury. Sharp pain at any point, or increased pain that persists hours after the exercise is over, indicate that one should stop immediately and rest (not do the exercise) for 2 or more days.

About these specific exercises

Excellent descriptions and demonstrations of back exercises are available on multiple trustworthy websites. I provide here links to the best descriptions I have found. I have selected these exercises based on a review of these trustworthy sources (see footnotes for details), informed by my own experience with the exercises.

I urge everyone to do back exercises, since this part of our body is in nearly constant use and injuries or dysfunctions here can be quite serious in their effect. Fortunately, for many of those experiencing such injuries, careful inclusion of these exercises in their ongoing self-care can have remarkable results.

The only way to know how helpful these exercises may be for an individual is to try them out for a few weeks. They do not take long to do and are not difficult.

Essential advice

Learn to “listen to your body”. What this means is that you will usually get valuable information about how to do these exercises simply by paying attention to what it feels like to do them. Do this in two ways:

• Pay attention to what you’re feeling while doing the exercise. You should NOT feel “acute” (sudden, sharp) pain at any point. If you do, stop. See if you can understand the cause. It could be due to a muscle cramp, an existing injury, or a weakness that last suddenly allowed an injury to happen.
  • Respond to muscle cramps by gently stretching out the muscle, until it relaxes. One of the best ways to do this is to tighten the opposing muscle. (Muscles usually come in pairs which cause movement in opposite directions. When one tightens the other usually automatically relaxes.) Also, try gentle pressure or massage.
  • Acute pain that is not a cramp indicates injury to a joint or connective tissue around or attached to the joint. If an injury already exists in this area, the risk is re-injury or increased injury. In any case, immediate ceasing of the exercise or stretch is necessary. In serious cases, compression bandages or alternating heat and cold applied to the area can reduce pain and speed healing. Do not resume any exercise where acute pain is felt for at least several days, although gentle movement of the area is almost always a good idea - it relaxes muscles and promotes circulation of blood and reduction of inflammation.
• Mild to moderate pain, usually associated with stretching of muscles and connective tissue, is normal and not a reason for concern. But, beware the familiar saying: “no pain, no gain”. While there is limited truth to this, it can definitely be dangerous to allow too much pain. (See this note⁸ and Appendix I below to learn more about connective tissue.)
• Pay attention to what you feel in the hours and the day after you do an exercise. Sometimes sharp pain develops AFTER doing an exercise. If you feel much soreness a day or two after doing an exercise or hours later on the same day, that indicates that you did too much! Reduce the exercise repetitions you are currently doing, and slowly work your way up to more.

Brief focused breathing: do this before exercise

This simple practice has one goal: calming your mind and body. It will do this because it focuses on activation of the calming half of your “autonomic” (intentional) nervous system. This system has two parts:

• sympathetic nervous system - this takes an impulse from your brain and amplifies it so that it can make muscles tense, in order to get movement.
• parasympathetic nervous system - this sends impulses to relax tense muscles.

Do this:

• sit comfortably, in a quiet place if possible;
• breath in, slightly more deeply than normal, for about 2-3 seconds;
• breathe out gently, and hold it, for a total of about 4-6 seconds.

Breathing in activates your sympathetic nervous system; breathing out activates your parasympathetic nervous system. Emphasis on the breathing-out causes relaxation and calming to slowly increase in your body.

Do this exercise for 2-3 minutes.

Begin with stretches

Gentle stretches at the beginning of an exercise session can make strengthening exercises more comfortable, while also reducing the risk of injury.

1. Knee to chest stretch

Instructions: https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/back-pain/art-20546859 - the first exercise on this page

2. Lower back rotational stretch

Instructions: https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/back-pain/art-20546859 - the second exercise on this page

Finish with strengthening exercises

3. Glute bridge

Instructions: https://www.medicalnewstoday.com/articles/323204#strengthening-exercises - the first exercise on this page.

4. Bird dog

Instructions: https://www.medicalnewstoday.com/articles/323204#strengthening-exercises - the second exercise on this page.

5. Walking

Walking combines stretching and strengthening. For example, when you tense the muscles on the front of your leg, certain muscles on the back of your leg relax. But it does more than this. It coordinates a wide range of muscles that stabilize your body and make it possible for you to not fall, and this has the overall effect of creating strength, fatigue, relaxation, and greater stability in a wide range of positions. It is a remarkably valuable, yet easy, exercise.

We can walk at almost any time. I like to do it very early in my day, and also right before sleep. In both cases, it relaxes my body and mind, and the effect of this is entirely positive.

Almost universally recommended by the knowledgeable sources I consulted, it may not be obvious why this exercise is likely to help with back pain, so here are three reasons I know and have experienced:

1. Walking activates established movement patterns which act to reorder the pattern of tension and relaxation in your large muscles. Any time we are still for long periods muscle tension tends to increase. This is why we are stiff after sleeping. You see cats and dogs stretch after sleep or a nap - they are working to loosen up muscles that have tightened during rest. A more thorough way to do this is to walk, at first slowly, but then quickly, for 10 to 20 minutes.

2. Walking creates legitimate fatigue in your large muscles, and this leads to relaxed muscles after the exercise if finished.

3. Walking involves a change of environment. This does two things: it separates you mentally from thoughts and images in your mind that you may have been focused on that were creating anxiety and then muscle tension, and it gives you fresh, new, and often interesting things to react to - this tends to be energizing and relaxing.

Walking is simple, refreshing, relaxing, and reliably helpful. Do remember however that it is not a slow walk we want, but a brisk walk. It is done as an exercise!

Appendix I - connective tissue

This excellent brief summary says it all:

• Ligaments connect two bones and stabilize organs;
• Tendons connect muscle to the bone;
• Fasciae connect muscle to another muscle.⁸

Notes ^{^}

 

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