Physical activity rehab for chronic lower back pain patients

Today, the good news is that if you suffer from chronic lower back pain you do not (and should not!) have to stop exercising. There are just so many inherent health benefits from a regular routine of physical activity. What’s more, many sports can still be a viable option if you are conscious of how you are using your back.


The most suitable exercises for lower back pain patients are ones that:


  • Provide protective movements for the lower back, for example partial crunches - these can help strengthen your back and stomach muscles
  • Engage the gluteal muscles properly and effectively - for example wall sits (performed by using a wall as a support and lowering yourself to sit on down on an imaginary dining chair)
  • Preserve joint flexibility
  • Maintain healthy posture and stability
  • Prevent muscular imbalances
  • Maintain optimal muscle length
  • Encourage weaker muscles to develop
  • Avoid unsupported forward flection (leaning forward from the waist without support)


Walking is the most easily accessible form of exercise for those experiencing chronic lower back pain and is also low impact. The results of a study by Taylor et al. showed that moderate levels of walking are also beneficial in the routine management of acute lower back pain. [Taylor NF, Evans OM, Goldie PA. The effect of walking faster on people with acute low back pain. Eur Spine J 2003;12:166–72] Walking strengthens muscles in the feet, legs, hips, and torso, which in turn increases the stability of the spine and conditions the muscles that keep the body upright.



The cardiovascular improvements gained from walking gives rise to strong circulation, pumping nutrients into soft tissues and draining toxins. Individuals also gain improvements in flexibility and posture. When combined with regular stretching, walking allows a greater range of motion; helps prevent awkward movements, and susceptibility to future injury.


Whilst regular walking at any pace will be of some benefit to an individual’s total wellness, walking briskly (at a pace where it is possible to maintain a breathy conversation) will result in the most gains. This level of exertion will push the body beyond its comfort zone, forcing the body to make adaptations so that it is able to cope better next time. As with any exercise, maintaining the correct body alignment and posture whilst walking is important.



Most people with lower back pain shy away from running because impact of the heel to the ground, and subsequent shock absorption, can cause back pain. However, with slight adaptations to equipment and execution, individuals with lower back pain are able to enjoy running without causing any further pain. Wearing padded shoes and running less intensely can reduce shock absorption to the lumbar.


A study by Turner et al observed that "regular, progressive training and the use of appropriate shoes and insoles that decrease shock transmission to the lumbar spine can be recommended for moderate running." [Which physical activities and sports can be recommended to chronic low back pain patients after rehabilitation? Annals of Physical and Rehabilitation Medicine 56 (2013) 576–594]


Using a treadmill, for example the Run Personal by Technogym, which has an engaging multimedia experience so you can have fun while you exercise, can enhance both the walking and running experience. Furthermore, running on a treadmill offers additional shock absorption. Run Personal’s large running surface has shock absorbers and a joystick for adjusting speed and incline to help maintain correct posture.



Recreational swimming is low impact and a good exercise for lower back pain due to the body being supported by the water. Swimming is a form of active stretching that ensures the full range of motion for many different body parts. It also provides just enough resistance from water for aerobic conditioning when sustained over the medium to long term.


Swimming backstroke is likely one of the best strokes for back injuries as it is performed in the supine position, allowing the water to support the back. By contrast, the other three strokes are performed in the prone position. However, in terms of biomechanics, the butterfly stroke is very taxing on the body and can result in the reoccurrence of lower back pain. [Nyska M, Constantini N, Cale ́-Benzoor M, Back Z, Mann G. Spondylo- lysis as a cause of low back pain in swimmers. Int J Sports Med 2000; 21:375–90]


Cycling is an activity often selected by people with lower back pain. Road cycling can be less jarring on the spine than many other forms of aerobic exercise, such as jogging and running. Exercise bikes, because they are not rolling over uneven road surfaces can be particularly gentle on the back. It is possible to have a vigorous aerobic workout on an exercise bike with minimal impact on the lower back.


Whilst for some people with lower back pain the forward leaning position of sitting on a bike holding the handle bars is more comfortable, a study by Burnett et al (2004) showed otherwise. It found that cycling has a greater chance of causing lower back pain due to the position that some cyclists take to streamline their bodies.


"In biomechanical terms, the cyclist’s seated posture implies the maintenance of lumbar kyphosis. The greater the proportion of bodyweight placed on the arms, the lower the total mechanical load on the spine. However, to reduce wind resistance, a cyclist must decrease his/her frontal surface area by flexing the thoracolumbar spine and the hips. This position increases the intradiscal pressure and thus accentuates the risk of LBP [42] related to repeated or excessive spinal loading." [Burnett A, Cornelius M, Dankaerts W, O’Sullivan P. Spinal kinematics and trunk muscle activity in cyclists: a comparison between healthy controls and non-specific chronic low back pain subjects a pilot investigation. Man Ther 2004; 9:211–9]


Again, modifications to both execution and equipment can make cycling a suitable exercise for people with lower back pain. Namely:


  • Selecting the right bike; a recumbent cycle such as Recline Personal may be preferable for those who feel more comfortable in the reclined position
  • Adjusting the bike to fit the user’s body properly
  • Reviewing your pedalling technique with a knowledgeable professional in order to get the most out of the exercise without putting undue pressure on joints
  • Ensuring that you have suitable accessories for shock absorption, e.g. padded seats


Exercise really is a great way to restore health and total wellness following the onset of chronic back pain. While some sports activities can cause back pain, with slight modifications, ensuring correct posture and using the right equipment, many are available to people with lower back pain to enjoy.