How to Identify and Treat Chronic Low Back Pain with Exercise $0.00

How to Identify and Treat Chronic Low Back Pain with Exercise

By: Rebecca Moore | Aug 10, 2018
How to Identify and Treat Chronic Low Back Pain with Exercise

Low back pain is one of the most common ailments experienced by the population today, and in return. Clinicians are experiencing an influx of these pain sufferers into their clinics every day. Because of the role the lower back plays in movement and support, identifying the root of the pain is a dynamic task even for the most seasoned of healthcare professionals. However, in a situation that can be as physically and mentally debilitating as chronic low back pain, quality assessments are extremely important. Before you can treat the pain, you have to find what’s causing it!

What Causes Chronic Low Back Pain?

There are four main causes of low back pain that clinicians should take into consideration when assessing their patients:

Back Injury/Post-Surgical

The most obvious to identify, patients who have sustained a back injury or undergone surgical procedures are undoubtedly going to experience some level of pain.


Often found in athletes, manual laborers or people who are on their feet for the majority of the day, low back pain commonly presents itself in those who are constantly on the go. More specifically, those who are moving in incorrect or compensatory patterns.

Poor Ergonomics/Sedentary Lifestyle

On the opposite end of the spectrum, a great deal of the population spends almost their entire day sitting; time spent driving, working and watching television adds up quickly. To make matters worse, if this sitting isn’t done in a proper ergonomic position, back pain is even more likely to occur. Regardless, pain is seemingly inevitable for those leading a sedentary lifestyles, as compression on the lumbar spine and decreased disc height are bound to develop overtime.

Lower-Crossed Syndrome

This muscle imbalance syndrome is characterized by tight thoracolumbar extensors on the dorsal side cross with tight iliopsoas and rectus femoris, as well as weak deep abdominal muscles cross with weak gluteus maximus and medius. The longer patients are experiencing these postural compensations, the more likely it is to experience chronic low back pain.

Lower-Crossed Syndrome

Even if you identify the root of the pain, everyone experiences and tolerates pain differently. Lindsay Becker PT, DPT, SCS, CSCS, CGFI-M3, a physical therapist working primarily with golfers, deals with low back pain on a regular basis and is constantly faced with this conundrum.

“Not all back pain presents itself the same,” says Becker. “Even if we find that two people have, for example, a disc bulge, one person may prefer more flexion-based movements while another may prefer more extension-based movements. It’s really taking that person as an individual; when does it hurt, what movements hurt, what can they do, not do, looking at the joints above and below and seeing if there’s range of motion deficits or strength deficits elsewhere that can be placing increased stress on the spine and then trying to go from there. There’s just so much going on in that area that really trying to figure out from an evaluation standpoint is really the biggest thing in helping us treat this."

So many causes, so many avenues of rehabilitation to explore. However, the most utilized method by Dr. Becker in most scenarios is corrective exercise. While the use of pain medication, topical analgesics and other methods may temporarily relieve low back pain, using therapeutic exercises actually addresses the root of the problem, resulting in lasting results.

How to Prescribe Exercises for Chronic Low Back Pain Relief

No matter what and where the pain stems from, exercise prescription for patients with lower back pain should be a delicate, methodical process. The goal should be appropriately challenging the muscles in the core, hips and glutes to rebuild proper movement patterns and correct posture.

“When I prescribe different exercises, I like to use a variety of postures to challenge or decrease the challenge of the stability of the spine,” said Becker. “I start off with exercises that are in non-weight bearing positions like supine, just focusing on the activation of some of the muscles around the core, but not having to stabilize the spine against gravity. Then we start to move up through our different postures like quadruped, kneeling and finally standing to continually and progressively load the spine against gravity to get us back to more of a functional posture."

Using the 4x4 Matrix to Position Exercises Appropriately

This method Dr. Becker follows is outlined completely in the 4x4 Matrix for Functional Exercise Progression. Commonly used in Selective Functional Movement Assessment (SFMA) protocol, this method utilizes two factors to determine the correct class of exercises to use in rehabilitation based on the patient's pain and ability:

  1. The Positional Side (left) - based on the neurodevelopmental process and represents the posture the patient will be performing the exercise in (supported, suspended, stacked or standing)

  2. The Resistance Side (right) - the type of resistance that the patient will be using while performing the exercise (feedback, no load, load with feedback and load alone)

4x4 Matrix

Not pushing patients past their limits is the key to all exercise, but even moreso for something as delicate as lower back rehabilitation. For more detail on the 4x4 Matrix, check out an article we did earlier this year.

Low Back Pain Relief Exercise Protocol

Lower back pain exercises don’t have to be complicated or equipment-heavy; all you need is a TheraBand CLX Elastic Resistance Band and a TheraBand Pro-Series Exercise Ball to create real relief. In this section of the Injury Management Series, Dr. Becker introduces you to the rehabilitative exercises she uses in her practice every day.

Hear from Dr. Becker herself while you check out the full playlist of her exercises

Save and use this PDF to incorporate them into your practice for patients of all ages!

Lower Back Pain Exercises