What is the best exercise for prevention and treatment of lower back pain?

 Low-back pain is one of the most common medical complaints, and it accounts for more time lost from work than any other injury or disability. It can occur at any age in both men and women, and it is the most frequent cause of activity limitation in individuals under age 45. Exercise can be an important factor in decreasing the likelihood of ever experiencing low back pain, and it is often useful for restoring function in the individual who is already experiencing back problems. When planning an exercise program to prevent/treat low back pain, there are three major areas of consideration: 1) aerobic conditioning, 2) trunk muscular strength and endurance, and 3) flexibility of the musculature crossing the hip joint. Of course, anyone currently experiencing back pain should seek a medical diagnosis before embarking on an exercise program. Aerobic exercise has been recognized as having potential for decreasing the incidence of low back pain, and for the rehabilitation of individuals with low back pain and/or arthritis of the spine. Aerobic exercise is useful for overall physical conditioning, helping to control body weight, and for promoting nutritional maintenance of the spine. Aerobic exercises include activities that are continuous and rhythmic in nature, such as fast walking, jogging, swimming, cycling, rollerblading, etc. Optimally, these activities should be performed 3-4 days/week for 20-60 minutes/session.

Strengthening of the trunk musculature should include both abdominal and lower back muscles. The abdominal muscles brace and stabilize the trunk, and the muscles that need to be worked include the rectus abdominus, the transversus abdominus, and the internal and external obliques. All of these muscles can be worked with various "crunch" or posterior pelvic tilt exercises. The lower back muscles, particularly the extensor spinae and quadratus lumborum, should also be strengthened. This can best be accomplished with "hyperextension" or spine and hip extension exercises. These exercises should be performed for a total of 20-30 minutes/session, 2-3 days/week.

Flexibility of the muscles that cross the hip joint is one of the most important considerations in low back function. Because the pelvis is the foundation for the spine, tightness in the hip flexors (front of the thigh) or the hip extensors (back of the thigh) can upset the functional relationship between the lower extremities and the trunk. Therefore, stretching exercises to increase flexibility in these muscle groups should be added to the program. Stretching should be slow, controlled, and "static" in nature. Each stretch should be held for 20-30 seconds and performed 2-3 times with each leg. Stretching sessions should be performed 2-3 days/week.

These guidelines may sound overwhelming, but a basic program can be devised to fit the schedule and lifestyle of almost anyone.