A guide to strength training for chronic low back pain

Suffering with chronic low back pain? You’re not alone. In 2020, low back pain affected 619 million people around the world, and these numbers are only set to increase (1). In fact, low back pain is the single leading cause of disability worldwide, and the cause of 12 million sick days a year. When you’re struggling with low back pain, exercise is often the last thing on your mind. But it shouldn’t be…..in fact exercise and strength training can help to relieve your chronic low back pain and get you back to your daily activities and more! Have a read of our article to find out more.

What causes low back pain?

Low back pain can be classified as specific, or non-specific. Specific low back pain is when the low back pain is caused by a specific structure or disease, such as a broken bone, a disc bulge, inflammatory arthropathies or cancer. However, these make up a very small number of low back pain cases. In fact, 90% of low back pain is non-specific low back pain (1). This is where the exact causes of the pain cannot be identified, but can include injuries to the muscles, ligaments or joints. Risk factors for specific low back pain include a sedentary lifestyle, stress, obesity and smoking but, as a chiropractor, I know that it can affect people from all walks of life.

What is chronic low back pain?

Most episodes of low back pain will resolve within a few weeks. However, low back pain that continues past the 3 month mark is classified as chronic low back pain. It can persist even after the initial injury has been treated and often has a huge impact on health and wellbeing (2). Chronic low back pain is complex as it is often affected by psychosocial factors such as fear of movement, catastrophising, stress and anxiety.

How can exercise help chronic low back pain?

Evidence suggests that exercise reduces pain and disability in people with chronic low back pain (3). In long term back pain, muscles in the back can get weaker and stiff as they get used less, which makes the pain worse. Exercise helps because it improves the strength and movement in your muscles and joints, which can reduce pain and speed up recovery. It is also useful in addressing some of the psychosocial factors associated with chronic low back pain, as participating in exercise helps reduce your fear of movement, as well as improving mood and helping to relieve stress and anxiety (4). There is also evidence that exercise can actual reduce pain perception through changes in the nervous system (4).

Why is weight training particularly good for chronic low back pain?

Whilst all movement and exercise is good for back pain, strength exercises, such as weights and core, can be particularly beneficial. This is because weight training leads to a big improvement in muscle mass and strength, which can help to stabilise and protect the back. You can also gradually increase the load you put your back under which can help prepare you for returning to day to day activities: for example, lifting children up or gardening.

As we get older, strength training becomes even more important for lower back pain because we naturally lose muscle mass. This is even more relevant for women going through the menopause. You can find out more about this on our menopause pages.

Full length portrait of a strong muscular adult sportswoman lifting heavy barbell isolated over gray background
Image by drobotdean on Freepik

How can I do weights safely when I have low back pain?

  1. Make sure your low back pain is not serious in nature.

It is important to see you GP, physiotherapist or Chiropractor to make sure you are suitable to start training. For example, disc bulges, particularly those with nerve pain (sciatica) need more specific rehabilitation.

2. Start off small and build up

You don’t need to lift heavy weights right from the start! Even if you have trained weights before, remember that after a period of time off, you will need to build yourself back up to where you are before. It is better to use lower weights but keep good form throughout your programme.

3. Start off with machine weights first

If you are new to weights, it may be an idea to start off using exercise machines at the gym first, before progressing to free weights. This is because the exercise machines help you to perform an exercise correctly and safely, thereby reducing the risk of injury.

4. If in doubt, get a personal trainer!

If you are unsure, it is always great to get a few sessions with a qualified personal trainer who can give you a programme and make sure you are doing the exercises correctly. Although it may seem like a big cost, it may save you problems in the future.

4 Key Strength Exercises to help with your chronic low back pain

  1. Bridge
  • Lie on back with knees bent
  • squeeze bottom muscles and lift bottom off the floor until your back is in a straight line.
  • Do not over extend the back
  • hold for 3 s and relax. Aim to build up to 3 x 10 times

2. Dead Bug

  • Lie on back with legs bent
  • Slightly flatten back into the floor- this will help to protect your low back
  • Keeping the back flat on the floor, slowly straighten out opposite arm ang leg. If your back starts to arch off the floor, don’t extend them out any further.
  • Repeat with each side, aim to get to 3 x 10 reps

3. Clam

  • Lie on side with knees bent.
  • Keep ankles together and open up knees like a clam.
  • Ensure you keep hips still.
  • Repeat 3 x 10 reps

4. Bird Dog

  • Start on hands and knees
  • Gently engage core and straighten out opposite arm and leg.
  • Try to keep the back level as much as possible.
  • Repeat 3 x 10 reps

You can download the PDF here

You can have a look at our other programmes here.

How often should I do the exercises?

To maximise benefit, strength exercises should be done three times a week. These exercises are easy to slip in after another exercise, such as a run. Or during a lunch break when working from home. However, if you are time pushed, remember anytime you can do the strength exercises is better than none.

You can get more ideas for our strength workouts on our programme page.

(1) GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023: 5: e316-29.

(2) https://www.who.int/news-room/fact-sheets/detail/low-back-pain#:~:text=LBP%20can%20be%20specific%20or,reason%20to%20explain%20the%20pain.

(3) https://www.who.int/news-room/fact-sheets/detail/low-back-pain#:~:text=LBP%20can%20be%20specific%20or,reason%20to%20explain%20the%20pain.

(4) Bement and Sluka, 2016

Image by Racool_studio on Freepik

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