A patient recently wrote a letter of thanks to me and the Director of Physical Therapy at the Non-Surgical Center of Texas, Julie Barnett, DPT. He had been suffering from back pain, so after a series of steroid shots we instructed him to follow a regimen of home, core-strengthening exercises that he was to do “forever.”

“The purpose of this letter is to thank you . . . for the excellent care I received from you and your staff,” patient Bernard Harris wrote. “I have followed your ‘forever prescription of exercises’ and I have not missed a single day of doing the designated exercises. The results have been excellent and I am so grateful that even at my advanced age, I am able to do all of the normal things I desire to do.”

The idea of exercising to help with lower back pain may sound, well, painful. But in fact, exercise is the best way to relieve pain.

Physical therapists working with someone who suffers from chronic back pain will demonstrate exercises that strengthen and train core muscles. This, according to guidelines from the Orthopaedic Section of the American Physical Therapy Association (APTA), can help reduce chronic lower back pain and the debilitating condition that can result from it.

The APTA guidelines for treating lower back pain were formulated from current research about back pain and exercise.  Examples of the type of research considered includes a 2009 study in the journal Spine that compared the results of a treatment plan including an exercise program focused on stabilizing the core with the results of a treatment plan that included a general walking program. The study showed that core exercises were more effective than the walking program at meeting treatment goals, not only at the end of the treatment period but also at follow-up surveys done one year and three years later.

Another study published in Spine involving 39 patients compared a core exercise treatment plan versus a no-exercise plan. The core-exercise group had about one-third of its members report recurring episodes of lower back pain over the next three years, versus three-fourths of the no-exercise group. Using these and other similar studies, APTA concluded that core exercise was an effective treatment for improving lower back pain as well as preventing recurrent episodes.

Research is continuing. A 2014 study in the Journal of Physical Therapy Science compared treatment including core training to routine care without exercise. Adding core training not only had a greater effect on pain, but also made a significant difference in restoring range of motion.

Here are a few examples of everyday and weekly stretches and exercises that we have prescribed at the Non-Surgical Center of Texas for people with back pain.

Everyday stretches (to be done daily)

  • Pelvic tilts Lift your hips off the floor using your lower abdominal and buttocks muscles. Lift each foot a small amount in tiny, marching steps. Use your buttocks muscles to hold your pelvis while your legs move independently from your trunk.
  • Knee to chest – Lie on your back with your knees bent and your feet flat on the floor. Leaving one foot in place, bring one knee toward your chest while pressing your lower back into the floor. Hold the raised knee with both hands and then hug it toward your chest. Hold the leg in place for between 15 and 20 seconds, and then reset and repeat with your other leg. You can intensify the stretch by beginning with both legs extended on the floor instead of bending them at the knees.
  • Hamstring stretch – Place the heel of one foot on a stair or step with the toes pointed up. Lean forward bending only at the hips. The stretch will be felt in the back of the thigh. A PT may prescribe holding this stretch for 20-30 seconds, or more. Repeat with the other leg. The number of times you do this stretch also would be prescribed depending on various factors, including the severity of your back pain.


Core-strengthening exercises (prescribed for 2-3 times weekly)

  • Dying bug – Lie on your back in a neutral position while you firmly contract your abdominal muscles. Bend both hips and knees to 90 degrees while your arms are straight up in the air above your chest.  Slowly bring one arm overhead and lower to the floor while straightening out the opposite leg and lowering to the floor.  Then return to starting position and repeat the move with the other arm and leg. Use your abdominal muscles to hold you firmly in position while you breathe freely and move your arms and legs in a smooth, controlled movement.  Repeat 10 times.
  • Wall slides – Stand with your back against the wall. Slide your bottom down until the knees are bent halfway. Your PT may prescribe that you hold this for 10 seconds, and repeat 3-4 times.
  • Forward Lunges – Stand in a stabilized posture. Take a step forward and bend at your knee. Return to starting position. Now repeat with the other leg.

Of course, sometimes back pain may require more than exercise. A just-released study in Pain Practice found that for patients with chronic low back pain, ultrasound-guided sacroiliac joint (SIJ) injection with platelet-rich plasma (PRP) was effective for reducing pain. The study compared two groups who received either a steroid solution or a PRP injection. The groups reported that the effectiveness of the steroid injection was reduced to 25 percent in three months, versus 90 percent of PRP patients reporting positive results from that treatment three months later. We’ll examine how injection therapies like Prolotherapy, Stem Cell Therapy and PRP Injection Therapy are making strides in helping people deal with musculoskeletal and joint injuries in a future column.

As always, if you aren’t currently exercising, talk to your physician about what physical activity you should or should not attempt.

Dr. Annette “Dr. Z” Zaharoff heads the Non-Surgical Center of Texas, focusing on non-surgical treatments to relieve pain and repair injuries. A former professional tennis player who competed on the WTA circuit, Dr. Zaharoff remains actively involved with the US Tennis Association. Learn more about her at www.drzmd.com. You can follow her on Facebook at www.Facebook.com/DrZaharoff.