Physiotherapy Exercises for Lower Back Pain

Should I rest or keep moving with back pain?

You should definitely keep moving, but with guidance from a licensed professional physical therapist. Rest and medications are not the first steps in treating back pain, but they are the first steps taken by many people who suffer from it. Learn physiotherapy exercises for lower back pain from a licensed physical therapist in your area.

What can a physiotherapist do for lower back pain? 

Physical therapists are trained to evaluate lower back conditions and develop a plan of care depending on the findings of the exam, along with past medical history and current goals. 

A physical therapist may choose to perform manual therapy like myofascial release, soft tissue mobilizations, or joint mobilization or manipulation to assist with pain relief and to restore normal function. Corrective exercises to improve posture, core stability, and day to-day functional strength are the bread and butter of how physical therapists can help those suffering with back pain. 

Trigger-point dry needling, myofascial cupping, and kinesiotaping are other modalities used in therapy to help with improving circulation and decreasing inflammation.

What are three therapeutic exercises for the back?

My go-to exercise for back pain is two-fold. First, it is important to release and stretch the tight hip flexors, the iliacus, and psoas in particular. 

The hip flexors: the psoas and iliacus pic

The hip flexors are tight due to our excessive sitting in today's society. We spend years in school sitting at the desk, and many continue to sit at the job for many years.

This causes the hip flexors to get extremely tight and leads to weakness in the core. Let’s release the iliacus and psoas first, the locked short and tight muscles.

These are the first two exercises, but they are more release work than actual exercises.

1. Lay on your stomach and place a tennis ball just inside your pelvic bone. 
2. This will bring your iliacus into contact with the tennis ball.
3. This will be painful and tight for most.
4. Breathe deeply into the ball for 2–3 minutes to let it sink in. 
5. Now bend and straighten your knee on the same side that you have the ball for 20–30 reps to increase the tension on the muscle and cause a deeper release. 

The psoas is next and a little trickier to get to. It is deep under the intestines and abdominal layers, so we need a ball a little bigger than a tennis ball. We use a 4" inflatable ball at the studio, and it is about the size of a softball, but it is much softer than a softball.

1. Lay on your stomach and place the 4-inch inflatable ball next to your belly button, about 1-2 inches away. 
2. Take some deep breaths for 2–3 minutes, just like for the iliacus release.
3. Repeat the knee movements with the heel toward your bottom.

Now we want to strengthen the lumbar multifidus muscle, located deep in the back of the spine.

This is one of the core muscles and is neglected the most, in my opinion. Focus on the abdominals overshadows the multifidus. Let’s strengthen the weak core muscle that most people have never heard of.

The long bridge multifidus:

1. Lay on your back with your legs extended. 
2. Flex your toes and ankles towards your nose, dig your heels into the ground, and bend your knees about 6 inches off the floor.
3. Hold this position for the entire exercise.
4. Push into the heels, and you will feel your hamstrings and gluteals engage.
5. Consider lifting your pelvis off the ground and into a bridge, but do not actually lift it.
6. Do not tilt the pelvis back or forward with this exercise.
7. Push into the heels and hold for 5 seconds, engaging the lumbar multifidus.
8. Repeat for 20 reps.

Which exercise is best to relieve back pain?

After releasing the hip flexors and strengthening the multifidus as described above, it is now important to strengthen the deep abdominals, called the transverse abdominus (TA).

This is the deepest of the three abdominal muscles and is the most important when it comes to helping relieve back pain.

The obliques are certainly important, but the six-pack, the rectus abdominus, is by far the least important of the abdominal layers.

Once you strengthen the TA, you can use this TA strength with activities that normally cause you pain, like going from sitting to standing, standing on one leg to put on pants, pushing a grocery cart, or lifting a box or weights. 

1. Lay on your back with your knees bent and your feet flat on the floor. 
2. Take a big breath and push your belly button to the ceiling on the inhale.
3. On the exhale, pull your belly button in towards the spine or floor.

This is a challenge to find at first and is best understood under the direct supervision of a physical therapist. Tactile and verbal cues are often required to find this muscle, which is why it is so important to get help from someone in person and not just from a YouTube video.

Does back pain go away with exercise?

If you are doing the correct exercise for your condition, then there is a very good chance that exercise will help your back pain.

If you are doing the wrong exercises, using poor form, or over-recruiting your hip flexors instead of your core muscles, then exercises may make your back pain worse.

That is why it is so important to see an outpatient physical therapist to evaluate your back pain and establish an appropriate plan of care to address it. 

How do you get rid of back pain naturally?

Be consistent with getting your back and core strong with the help of a physical therapist. Keep those hip flexors loose and flexible. Strengthen your multifidus and TA. Use your core stability in everyday activities and sports.

Do not take pain medications and rest when you have back pain. Get an evaluation by a physical therapist and stay moving. 

Check out our blog on the lumbar multifidus at to watch the long bridge exercise. 

Learn more from Spine Health at Specific Low Back Pain Exercises.  

Call 512-215-4227 if you live in the Austin | Westlake area and would like to learn the best physiotherapy exercises for lower back pain.