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CONTENTS
Introduction ............................................................................................................................................ 2
Purpose of the Low Back exercise guide............................................................................................. 2
Prognosis – How long will it take to get better................................................................................... 2
Do I need a scan? ................................................................................................................................ 2
Target muscles .................................................................................................................................... 3
Length of the program ........................................................................................................................ 4
A note on sciatica ................................................................................................................................ 4
Disclaimer................................................................................................................................................ 5
Physio Rehab Exercises ........................................................................................................................... 6
Stage 1: Stretch it out and get it moving ............................................................................................ 6
Heat it up ............................................................................................................................................ 8
Stage 2: Strengthening time ................................................................................................................... 9
Stretches ........................................................................................................................................... 10
Stage 3: Get back to normal and keep it that way................................................................................ 11
Exercise ............................................................................................................................................. 11
Stretch ............................................................................................................................................... 11
Maintain strength and control .......................................................................................................... 12
Final word ............................................................................................................................................. 12
References ............................................................................................................................................ 13

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INTRODUCTION

Purpose of the Low Back exercise guide

This guide is for those that want to ease pain and improve their function, mobility and strength.
Whether you have had back pain for three days, 3 months or three years, the advice and
rehab in this guide will help you gain more movement, better function and less pain by taking
your treatment into your own hands.

Prognosis – How long will it take to get better

The great news?

Low back pain is a self-limiting condition. This means that it will resolve by itself without treatment or
intervention.
90% of people with LBP will recover in 3-4 months with no treatment.

70% of people with LBP will recover in 1 month with no treatment.

50% of people with LBP will recover in 2 weeks with no treatment.

The bad news?

The above figures are a bit deceptive as the recurrence rate is quite high. At least 1/3 of those
have another episode of low back pain within a year. To top that off, having more than 2
previous episodes of low back pain triples your odds.
Much too high and that is why following a rehab guide and making your back improve is so
important. It not only speeds up recovery times but most importantly means you are less
likely to get it again.
The answer?
Follow through with Physio Rehab Exercises to:

• Speed up your recovery

• Improve back muscle strength, flexibility and conditioning
• Reduce risk of reinjury
• Ultimately enjoy the things you love more!

Do I need a scan?
That is case by case and is up to your doctor but as I have said above, in 85% of cases, scans
have no benefit and often just show things that aren’t relevant such as degeneration.

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Key inclusions for a good recovery
A good rehab guide to help resolve back pain well needs to cover the lot. It can’t just be the
odd stretch here or there or relying on pills while it sorts itself
Our body responds the forces we put through it. With the right stimulus your back can
respond by getting stronger, more mobile and less painful.

Movement
Strength Full
Regain good
movement and Control recovery
Improve muscle
function while activation and
decreasing pain Last but not lease
strength in regain strength
comfortable through full range
positions for long lasting
improvements

Target muscles
These can be generalised as your core muscles and are demonstrated here:

The two main muscle groups we need cooperating and working together are:

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 • Your extensors: These are your gluteal muscles and low back paraspinals, the muscles
that help hold you upright, straighten you up when getting out of a chair or bed and
much more
• Your “abs”: These muscles through the front held you bend and flex and act like a
natural corset
And then there are two muscle groups that need good flexibility to unload your spine

• The back of your hips: Your glutes and hamstrings tend to be a bit protective and
“muscle guard” which means less movement in your hips and more load on your back,
so it is important to stretch out these muscles to de-load the back
• Your hip flexors: The opposite muscles also often need a good stretch to make sure
we can stand up straight and aren’t being held stuck forward.
Main thing to remember: None of your muscles work in isolation and then is no single or
individual core muscle

Length of the program

To gain lasting, long term results, we need you working at this for 6 weeks minimum which
will take you through:
1. Regaining range and comfort
2. Improving core strength
3. And regaining functional strength and control
Ideal though is 12 weeks which allows adequate time for your body to adapt and condition to
a “new normal”
And then, once you are improved it is best to maintain improvements with regular stretches
and exercises each week as prevention is always better than a cure!

A note on sciatica
Sciatica is a well-known issue but not actually as common as you think but when you do have
sciatica then your rehab is a little different.
Sciatica is pain down the leg along the path of the sciatic nerve and is caused by compression
or irritation of the nerve by one of several causes.
Sciatica is a symptom and not a diagnosis because of this and you may or may not have it.

If you have pain referring down one of your legs, pain that is worse down the leg than in the
back or pain the is ongoing, sharp, searing etc as well as at times numbness and pins and
needles then you may have sciatica. If you have any loss of strength in your legs, change in your
bladder or bowel function or any concerns about your back pain, go and see you GP.

For those with sciatic symptoms, I have placed a big red X on the exercises that you should
avoid as we don’t want to tug at the nerve.

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DISCLAIMER
This guide does not intend to replace or replicate a health or medical professional and
information provided in this document is not intended to serve as medical advice or used for
the purpose of medical diagnosis or treatment. Anyone seeking specific advice regarding pain
or injury should consult his or her Physiotherapist or Doctor.

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PHYSIO REHAB EXERCISES

Stage 1: Stretch it out and get it moving

Aim to do stage 1 exercises1-3 times per day

Back extensions
To reduce disc injury and regain extension
Level 1
- Lie on your front
- Prop up onto your elbows
- Fully relax your hips and back
- Lie for 1-2minutes
Note: A ache in your back is expected but if painful, you can start lower such as lying with your
forehead resting on your hands.

Level 2
- Put your hands under your shoulders
- Push your upper body upwards
- Keep your hips and back relaxed (hanging
down)
- Go to the point of discomfort
- Hold for one relaxed breath in and out
- Repeat, up and down 10 times.

Knee rockers
Maintains and improves spinal rotation and muscle activation
Level 1
- Lie on your back, knees together
- Gently rock your knees form side to
side, rotating your low back
- Do not push into pain
- Repeat from sided to side 20 times

Gluteal stretch
Regains hip flexion, improving sitting and forward
bending range. Keep in mind that a lot of people look
at this stretch and think, I can’t do that. Most can
though! Give it a go as it can be very beneficial.
- Start on your hands and knees on
the floor or bed
- Bring one knee up between your
hands

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 - Rotate that leg under your body as shown
- Slide your other leg out backwards
- Then relax down onto your elbows
Tip: Make sure your chest is over your knee
Tip #2: If you cannot get down onto your
elbows, keep your arms straight and slide
your hands out forwards until your feel a
gentle stretch
This stretch is one of the most important for easing your back pain and regaining more
mobility in order to be able to sit comfortably, put socks on and do shoes up etc so to
ensure you are doing it right, here is a quick demo video HERE or YouTube “Pigeon
pose”

Bird-dogs
Improves low back and gluteal muscle strength and control
- Start on your hands and knees on the floor or
a firm bed
- Keep your back in neutral (straight)
- Straighten one arm out in front and the
opposite leg out behind at the same time and
then lower down again
- Do this nice and slowly and in control
- Do 3 sets of 10 reps

Bridges
This exercise is great for waking up your butt and back muscles while keeping your back in neutral to
start with
Level 1
- Lie on your back with your knees bent up and
feet on the ground
- Keep your back straight
- Lift your backside off the ground
- Aim to make a straight line between your
knees and shoulder as shown
- Repeat for 3 sets of 10 if able

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Level 2
- Lie on your back and straighten one leg out
in the air
- Keep that leg parallel to your other thigh
- Lift your bottom up, again aiming for a
straight line between knee and shoulder

Heat it up
Heat can really help relieve back pain effectively and reduce the
need for pain medication.

A large aspect of back pain is muscle spasm and heat helps to

relax muscle and improve blood flow.

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STAGE 2: STRENGTHENING TIME
Aim to do stage 2 exercises once a day

The Dead Bug

A Pilates based exercises that is great for improving abdominal control and strength
Level 1: Heel touch downs
- Lie on your back and bring both legs up into
Table-Top position (Thighs straight vertical
and shins horizontal)
- Place your hands under your low back and tilt
your pelvic back so that there is more
pressure on your hands
- Then lower one leg down and lightly touch
your heel down before returning to starting
position. Then do it with your other leg, all the while, not letting the pressure
come off your hands.
- Do 3 sets of ten, alternating legs
Level 2: Single leg pikes
- Similar to level 1 but instead of keeping your
knee bent at 90degree, you straighten your leg
out to JUST above the ground and then back to
the starting point
- Alternate legs
- 3 sets of 10
Level 3: Full Dead Bugs
- Start with your legs in the same starting position but also have your arms straight
out above you
- Now as you do a single leg pike, you also lower your opposite arm down over your
head at the same time
- Bring back to the start position and alternate
- 3 sets of 10

A demo video of level 3 can be found HERE or by googling dead bug exercise.

Single leg bridges

Move onto the level 2 bridges from stage on if you haven’t already and keep working on them. If you
can do 3 sets of 10 easily, add a 5 second hold at the top of each rep.

Side planks
This one is often missed but is important as it strengthens laterally through your obliques,
quadratus lumborum (QL) and gluteus medius

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Level 1
- Lie on your side, propped up on your elbow
- Have both knees bent and aim to have you body straight between your
shoulders and knees (don’t stick your butt out!)
- Lift your pelvis off the ground (so just your bottom knee and elbow are on
the ground) until body is straight
- Hold until your muscles fatigue and build up to 1 minute
- Once you can do that, move on to level 2

Level 2
- Lie on your side with straight legs, feet on
top of each other and elbow under your
shoulder
- Lift your pelvis and hold
- Don’t stick your but out or look at your
toes
- Build up to at least 1-minute hold

Level 3
- Once you can do level 2 for 1 minute, you can add in leg raises
- Left your top leg up and down while maintaining control/form
- Instead of holding for time, just aim for 3 sets of ten reps – you may need to build
up to this!

Chair squats
Great functional strengthening
- Stand in front or a chair and squat down
until your backside JUST TOUCHES the chair
then straighten up again
- Remember: Chest up, lean forward and stick
your butt out as shown
- Aim for 3 sets of 10
- If you cannot get down that far initially, find
a higher chair, put a cushion on it or use the
back of a couch

If it gets easy and comfortable – try is while holding some weights on anything heavy

Stretches

Continue doing these two stretches form stage one, at least

1. Gluteal stretch
2. Back extension

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STAGE 3: GET BACK TO NORMAL AND KEEP IT THAT WAY

Exercise
Set a fitness goal and work towards it.

Exercise helps lose weight, which goes a long way towards reducing load on your low back. Upright
exercise (walking, running etc) and swimming also helps your back muscles (erector spinae) get better
conditioned and normalised,
Whether your goal is walking around the block or running 10km, set it, start with what is doable and
steadily build up.

Walk, Run, Bike, Swim, Skip, Dance – anything, just move

Stretch
After exercise or a long day at work or in the garden etc, it is great to do a bit of recovery.
Have a stretch out 2-3 times per week that stretches the hips, front and back and maintains mobility
in the back. Here are some great examples

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Maintain strength and control

Continue working on the stage two exercises and challenging yourself

Aim to do strength and conditioning 2-3 times a week and remember – Just like our cars, we should
look after our bodies and not just wait for them to break down!

FINAL WORD

Remember that our spines are strong, resilient structures.

Often, we forget to treat them just like any other sore or injured part of our body. Too often
people rest back pain and avoid aggravating activity.
But really, the best thing you could do is keep moving, regain range of motion and build
strength and load capacity back up.
Just like any other injury – don’t cotton wool your back.

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REFERENCES
Machado, G., Maher, C., Ferreira, P., Latimer, J., Koes, B., Steffens, D., & Ferreira, M. (2017). Can
Recurrence After an Acute Episode of Low Back Pain Be Predicted? Physical Therapy, 889-895.

Maher, C., Underwood, M., & Buchbinder, R. (2016). Non-specific low back pain. The Lancet, 736-747.

The guidelines on low back pain are clear: drugs and surgery should be the last resort. (2018, May 16).
Retrieved from The Conversation: https://theconversation.com/the-guidelines-on-low-back-
pain-are-clear-drugs-and-surgery-should-be-the-last-resort-
94746?utm_source=twitter&utm_medium=twitterbutton

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