What exercise is best for low back pain

Low back pain in Australia

Do you experience low back pain? If you do, you’re not alone. Low back pain will affect most people at some point in their lives. As well as pain, it often leads to psychological distress and poorer quality of life, and is the leading cause of disability worldwide.

In Australia, back problems are the number one cause of lost productivity and early retirement. In 2018-19 more money was spent on managing musculoskeletal disorders, including back problems, than any other category of disease, condition or injury in Australia.

The vast majority of low back pain is described as Non-specific back pain.  In these cases, treatment should focus on improving spinal function (rather than just addressing pain) to achieve the best long-term results.

The impact of chiropractic care

Chiropractic care is a great place to start if you have back pain. The nature of back pain is often complex, so an experienced practitioner will not only need a range of different treatment options, but will also address other factors, such as physical activity, exercise, lifestyle and psychological factors.

If you’re after the best results, you need a practitioner who takes a wholistic approach to your health.

Acute vs Chronic low back pain

These terms describe how long pain has been present, and not the severity of the pain. Acute Low Back Pain (ALBP) is pain for a duration of less than 6 weeks, and Chronic Low Back Pain (CLBP) is pain that has been present for longer than 12 weeks.

This is important because the type of exercise used for ALBP will often need be different than for CLBP. Early on, restricting movement or using simple ‘pain free’ movements are usually best. For long standing back pain, a greater focus on building strength and motor control is critical.

In reality, most LBP is episodic and recurrent. In other words, it comes and goes, with bouts of pain over time.

The different types of exercise

A systematic review of the impact of exercise on LBP was published in the journal Healthcare in 2016. It looked at the impact of 1) Aerobic 2) Strength and Core Stability, and 3) Flexibility exercise on LBP outcomes.

Aerobic Exercise

This provides cardiovascular conditioning. The term aerobic actually means “with oxygen,” which means that breathing controls the amount of oxygen that can make it to the muscles to help them burn fuel and move. Examples of aerobic exercise include brisk walking, running, swimming, dancing and cycling.

One study showed improving your fitness with a 12-week high intensity aerobic exercise program can improve outcomes by 41%. The catch here is working out the activity that best suits you. For example, if you have CLBP, running might not be the right exercise for you.

Strength and Core Stability

There is a strong link between poor core stability and LBP. Your core muscles are most situated deep in your body and help control and guide movement. When the core is weak and we don’t have good control of movement, this increases shear forces on joints and strain on soft tissues, leading to inflammation, degeneration and pain.

You can reduce your CLBP by 39-77% with a combination of strength and core stability training. Of interest though, was that general exercise that was not specific to the individual, still showed good outcomes. Walking speed and other activities of daily living may improve with core and strength based exercises.

One study showed that lying on your back and curling your feet up improved the ability to activate on your core muscles.


Stretching the tissues of the low back, legs and buttocks can help mobilise the spine, however, CLBP patients must be careful not to perform exercises that result in pain, especially when stretching the flexors and extensors of the trunk and hips.

Studies have shown stretching may reduce LBP by 18-44%.

Take home messages

People with CLBP are likely to get the best results with a combination of aerobic, strength/core and flexibility exercise. While an individualised program is likely to be best, some general exercise will almost always be better than none.

The research suggests the benefits of exercise wane when we stop exercising….no surprise really. So this is about developing habits to keep your body strong over a lifetime. Regular chiropractic and physiotherapy care may also be a habit worth keeping!

If you have not attended for a Clinical Exercise visit at our practice, you can book in and we will provide you with your individualised home exercise program.