What exercises for my core can help prevent lower back pain?

Brian Yee
Physical Medicine & Rehabilitation

First - generally there are different roles of muscles in your trunk. Typically the smaller ones closest to your spine are considered ‘local’ muscles. Such muscles as the transversus abdominis, diaphragm, pelvic floor, and lumbar multifidus provide segmental control of your lumbar vertebra. Real-time ultrasound imaging can be used to visualize the proper contraction of these muscles as we cannot see these muscles from the superficial skin. So first step in core stability is to ensure that the smaller muscles are engaging properly. Then you have ‘global’ muscles which are the larger muscles - such as rectus abdominis, obliques, paraspinal muscles. These muscles are designed for power and stability at higher loads. Core stability exercises should integrate the function of the ‘local’ and ‘global’ muscles in proper sequence.


Once that is established, any asymmetries of the muscles should be determined. In back pain patients, it is very common to have one side of the oblique muscles contracting properly while the other side does not. This causes an imbalance of forces on your trunk and can cause increased torque to your spine - eventually leading to back pain due to excessive torsional stresses in your daily function or sport.

Once the asymmetry is addressed, integration of muscles from above and below the core need to be assessed.  The old saying ‘the knee bone is connected to the hip bone’ goes too with the muscles in your body. Such lower leg muscles as the gluteal muscles in your hip or the latissimus dorsi in the mid back affect the way your core muscles in daily function and sport. People with back pain, typically have an improper tone and sequence of these muscles working together. Over time this places increased stress on the back - regardless of how strong your core is.


As you can tell, there is a lot to consider when training your core. To recommend a standard protocol of exercises to help your back is not specific enough. A proper assessment of your muscle control and movement patterns should be assessed by a qualified movement specialist - such as a Physical Therapist - to determine what the appropriate level and progression of exercises for proper stability and prevent back injury.

Most patients with low back pain seem to display many similarities in lifestyles and movement patterns.  Experts agree that individuals who sit for more than 4 hours per day and in enclosed workspaces are up to 300% more likely to suffer from low back pain.  
Being seated for long periods of time allows our bodies to adapt to this position, so the muscles in the buttocks (glutes) and the muscles which stabilize the spine do not perform correctly. There is also a pair of muscles which take on an opposite role, the Psoas.  While seated the Psoas is put into a shortened position which further contributes to the poor performance of the muscles mentioned previously. In order to treat this correctly, we must approach it in an integrated manner, which will include stretching the psoas, activating the core and then teaching the nervous system to move properly.
Begin by dropping down to one knee to stretch the Psoas, flex the buttock on that side and work to tilt the pelvis up underneath you, like a "scared dog". Once in this position take the arm on the same side and reach as high as you can and add a bend away from the side being stretched. Hold this stretch for a minimum of 30 seconds.
To work the glutes, start by performing a bridge. Take a seat on a ball and roll down to where you can rest your shoulders and head on the ball. Squeeze the glutes and press your hips up. Hold this position for up to a minute. There should be no discomfort in the low back. To progress, set a light weight on the hips which will require some extra effort from the glutes.  After this, perform an exercise which will work the stabilizers of the spine. The drawing in maneuver. Get down on all fours and draw the naval into the spine during an exhale, then allow the stomach to relax while inhaling.  Perform this 12-20 times. We now need to train the nervous system to move in a better pattern.
If you have access to cable machine perform a squat with a row.  Put the cables in the lowest possible position and add a minimal amount of weight.  Slowly squat down, ensuring that you are maintaing perfect form and keeping the naval drawn into the spine.  At the bottom of the squat press up through the legs and pull back on the handles.  Perform 10-15 repetitions.  Repeat this routine for 1-3 sets, anywhere from 2-4 weeks depending on the low back pain.

If you have low back pain, the first thing you need to do is get a proper diagnosis from a qualified medical professional.  Your exercise program should be specific to your individual condition.  In my sports medicine clinic, I have found coordination exercises to be more important than strengthening exercises in rehabilitating patients with low back pain. Usually a combination of coordination, flexibility and strength exercises provide the most success.

If you are experiencing low back pain and want to strengthen your core start with the prone iso ab hold. Lie faced down with your elbows on the floor and your torso off the ground supported by your forearms with your spine straight and core engaged, head looking down.  Hold the position for 8-10 seconds, then rest. Repeat for 8-10 repetitions. Perform these exercise 3-5 days a week until you can hold it using a perfect form with ease. Once you can do that move on the stomach crunch. To perform a stomach crunch lie flat on the floor with your knees bent so that the soles of your feet are flat on the floor. Lie flat on your back with your head flat on the floor arms on your side palms down.  To initiate the crunch, use your stomach muscles to pull your upper torso off the floor, continue to look straight up at the ceiling and pull your torso up far enough that your hands move 2-3 inches, then return back to your beginning position.  Perform 10-15 repetitions, and repeat for 2-3 sets. Combine core strengthening with foam rolling of the affected area to help decrease low back pain. 
Dr. Vonda Wright, MD
Orthopedic Surgery
Core exercises that can help prevent lower back pain include:

McGill Curl: core stability, lower back pain prevention
1. Lay flat on the floor with your left knee bent and right knee straight.
2. Support your lower back with your palms under the small of your back.
3. Keep your chin pointing forward and raise your head and shoulders off the floor without flexing your lower spine.
4. Remember to exhale when you raise your shoulders and inhale as your lower them.
5. Do 20-30 reps.

Russian Twist: oblique core stabilization, hips, lower back pain prevention
1. Engage your core and sit with your trunk 45 degrees off the floor. Keep your knees bent and feet flat.
2. Extend your arms, palms together, in front of your body.
3. Rotate to the right with your arms and trunk as far as you can.
4. Switch and rotate to the left as far as you can. This is one rep.
5. Do 20 reps.

Increase the difficulty of this move by holding toning balls or a kettle bell in your arms.
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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.