Core strengthening for lower back pain is an effective evidence based treatment to reduce and even eliminate lower back pain. Exercise can seem counterintuitive because it may hurt to move your back. This is a common complaint I hear and while it is not easy, there are ways to adapt. An important concept to consider with core strengthening is tissue irritability. That is, how much can you do before things start to feel painful?

Core strengthening to improve lower back pain doesn't have to be hard. In fact, I find once people dial in their form and dosage, they notice that the exercises not only improve their lower back pain but they notice improved strength, flexibility, and overall confidence in their body. We even wrote a whole book on this topic based on our knowledge and experience in the clinic! If you’re looking for a quicker taste, below are 3 easy lower back pain core strengthening exercises that can be done in your home.

How to strengthen core with lower back pain

Lower back pain can respond very well to core strengthening exercises. The key is to listen to your body and to start slow. Explore the ranges of motion while keeping a close eye on your discomfort. If you don't have discomfort but want to improve your core strength this is a great place to start as well.

Strengthening your core with lower back pain is a necessary part of recovery but timing can be everything. In general, if you can do things throughout your day but have some residual achiness or discomfort then you are most likely ready to start strengthening. If you want to be very sure you are ready to start strengthening then reach out to a local physical therapist.

Disclaimer

3 fundamental core and lower back strengthening exercises for lower back pain

1. Thread the needle
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Starting with mobility is a an essential tool to help you gain range of motion of your back. When I treat lower back pain I almost always start with mobility exercises to loosen things up and prime your body to move.
Start with completing 10 on each side.

Woman lumbar spine mobility exercise — Thread the needle exercise

Start on your hands and knees then reach underneath your body trying to extend your shoulder so you feel a pull in your upper back. Make sure you reach underneath the other arm while keeping the arm fairly straight. This will allow you to improve stiffness in your upper and lower back. A tip is to breathe out so you can release all the air in your lungs. This will allow you get achieve more range of motion from your thoracic spine.

2. Bird dog

The bird dog is a great core and lower back strengthening exercise. Some don't think of it as a core strengthening exercise but just give it a try. You want to stay slow and controlled as you complete the movement. Try completing 30 total.

Female bird dog exercise — Bird dog exercise

Start on your hands and knees and then slowly reach out in front of you with one arm then extend a leg towards the wall behind you. If you are reaching with your right arm then you should extend the left leg. The trick her eis to reach so that you feel your but and core muscles fire while keeping your trunk stable. You want to limit the amount of rocking side to side.

3. Squat

The squat is a necessary exercise for core strengthening. Your core has to activate when we squat. The increase in intraabdominal pressure requires your core to engage. You need your core in order to complete necessary movements throughout the day such as a squat. The squat amount other exercises need to be apart of fundamental core strengthening for lower back pain.

Female performing a squat — Squat core exercise

Why can you have lower back pain from core exercises?

Lower back pain from core exercises isn’t uncommon, but it’s best to understand what pain is! Without its ability to warn us from the dangers around us, we wouldn’t survive very long. However, it can be quite annoying to down right debilitating sometimes. Pain is quite a complex topic and is actually a construct of our brains! Asking why something, such as core exercises, is rather person dependent. Let’s dive in a bit deeper to see what reason resonates with you the most.

At the most basic, acute level, pain can be from tissue damage. AKA, you did it wrong. Just like when you get a papercut, you see the tiny bit of blood, and end up with a sensitive finger for days. If you’re lucky, maybe you get out of dish duty in your household for a bit too! If you were doing exercises and felt pain, it could very well be that you “got a paper cut”.

You could have damaged a bit of tissue. If this is the case, check in on your form next time, try to lessen the resistance or weight, or decrease the amount you’re doing. Maybe you just did it wrong, or too much of it. Just like the paper cut on your finger, our tissues on our insides heal pretty darn quick too. This is by far the most common reason for lower back pain from core exercises.

"On a more involved level, given that pain is a construct of our brains, it can be evoked from a memory."

On a more involved level, given that pain is a construct of our brains, it can be evoked from a memory. I was chopping garlic 5 years ago for my brother-in-law. I sliced a chunk off of my finger which proceeded to squirt blood when I grabbed it so tightly. I think I threw up, just about passed out, and cried for like 30 minutes! As time went on, my finger healed. Now, I have a tiny scar (and a garlic press) and don't even think about it. However, whenever I tell this story, I become hyper aware of that scar and it actually starts to feel sensitive.

If you hurt your back doing a certain task, such as bending over, your brain remembers that! It’s job is to keep you alive and well so when you go back to do that activity or something remotely related, it can send you a “warning”. You might feel your same pain IN THE ABSENCE of actual tissue damage because your brain is proactively reminding of what happened before. Stay cool, calm and collected here. Ease back into that activity. It will take the brain several times of doing the activity without it causing that papercut to start to form new memories.

On the most involved, chronic level, pain can be from a sensitized system. If your paper cut is all healed up, but you have a large amount of pain every time you put on a glove over that finger, you could say that the tissue sensitivity is heightened. The threshold of stimulus that the brain requires in order to set off the alarm bells is now much lower. This same thing can happen with the rest of our bodies. You used to do medicine ball throws without a problem until it hurt your back one day (here is your paper cut!). It kind of got a little better…but not really. Now, we're a year down the line, and your back feels sore even to the touch! What gives? Is your tissue still injured? Should I think about an MRI?

Remembering that your tissue on the inside heals just as quickly as your tissue on the outside, we start to wonder if the tissue itself is a bit sensitized. ‍Treating this type of pain is more complex and requires help from a few different disciplines! It does not have to mean that there is repetitive tissue damage occurring. It can still be safe for your tissues to feel this discomfort, and usually requires a higher level of guidance from a team of providers to work through.

Does core strengthening help lower back pain?

Yes core strengthening does help with lower back pain. It may depend on what type of lower back pain you have.

Acute lower back pain or pain that is less than 2-3 months old responds well to gentle range of motion and progressive strengthening. Now, if you are having numbness, tingling, or burning pain down your leg then exercise is still important but the type of exercise can vary greatly person to person. Most people with acute lower back pain improve on their own and focusing on resuming your normal activity as soon as possible is best.

Once you start feeling some improvement, it is recommended you resume your daily activities and normal exercise routines gradually. You may be sore after first but that doesn't mean damage has been done. It just means you are waking things up again!

Chronic lower back pain does respond very well to core strengthening. Pain longer than 3 months can greatly improve after specific core strengthening exercises. I have seen it many times and the evidence supports it. The key here is dosage. Just like medication, exercise, especially those in pain, requires a certain dosage. You want to do enough to make change but not more than what your body can handle right now.

This is the tricky part and often requires the skill of a physical therapist. Too often, I have seen people give up on core strengthening for lower back pain because it hurts but in reality it's more related to the dosage. They often complete room much too soon.

The effect of core strengthening exercise for lower back pain

The relationship between improving lower back pain with core strengthening exercises is complex because our bodies are complex. But it does not have to be complicated. Building a stronger core is going to build an overall stronger body. Building a stronger body is going to build a more resilient body. More resilient bodies are more likely to thrive and less likely to die.

Core strengthening exercises engage a variety of muscles, including the transverse abdominals, rectus abdominis, internal and external obliques, erector spinae, multifidi, pelvic floor, gluteal muscles and even some shoulder muscles like our latissimus dorsi. Our body works via a beautifully orchestrated interplay of multiple systems, muscles, ligaments, nerves, and bones to get the task at hand done. Because of this, doing core exercises strengthens multiple muscles at the same time.

It also gets our heart rate up which helps our cardiovascular system and increases the amount of oxygenated blood our hurting tissues in our back get. Our body is relearning how to engage muscles in new positions that don't cause your same lower back discomfort. All while gently reminding you that your body is strong, movement is safe, and you CAN do this.

In conclusion, core strengthening exercises can help to reduce or resolve lower back pain. However, we need to keep the bigger picture in mind here. We are building a stronger core through these exercises, but we are also building a stronger, more resilient human! If you found this information helpful and are looking for a deeper dive, check out our book specifically on core strengthening!

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References:

George SZ, Fritz JM, Silfies SP, Schneider MJ, Beneciuk JM, Lentz TA, Gilliam JR, Hendren S, Norman KS. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. J Orthop Sports Phys Ther. 2021 Nov;51(11):CPG1-CPG60. doi: 10.2519/jospt.2021.0304. PMID: 34719942.

Dr. Michael Derry is a Doctor of Physical Therapy and board certified in orthopedics. He is very passionate about treating lower back pain and helping people build their resiliency. He has spent time assisting at universities as well as managing large clinics before starting his own practice in Jacksonville, FL.