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Finding Fitness With Lower Back Pain

The number of USA emergency room visits, pain medication orders, injections, imaging studies, and surgical interventions directed at lower back pain continue to rise.  I frequently meet people who report their fitness efforts have been hampered by low back pain.  I have five recommendations that can help fitness clients with lower back pain have more success in the gym.

#1 Do not exercise first thing in the morning:  Ergonomic experts have found that many more industrial lower back injuries happen in the morning.  The theory is that the discs in the lower back imbibe or gain fluid overnight and are more likely to deform with a physical challenge.  Give your lower back one or two hours of walking around time before starting an exercise session.

#2 Isometric strengthening of the spinal stabilizers:  The function of your “core” muscles is to limit movement of the lumbar spine and pelvis.  Stop all crunches, toes to bar, sidebends, sit ups, seated twisting, and learn how to perform bird dogs, side hovers, Pallof press, planks, and carries.  Compliance with this single hint would reduce USA expenditures on lower back pain dramatically.

#3 Enhance the function of your hip flexors and gluteal muscles: Please cease all the forward spine flexion, toe touching, spine twisting activities.  Greater lumbar spine range of motion is associated with more–not less, lower back pain problems.  Learn how to foam roll and mobilize the hip flexors and gluteal muscles.  Prolonged sitting and most popular “cardio training” deadens these muscles.  Properly functioning hip flexors and gluteal muscles keep the pelvis stable and take stress off the lower back.  Reawakening dormant gluteals and hip flexors is the magic that resolves long term lower back pain.

#4 Focus on single leg strength training:  Ditch the front loaded hip hinges–deadlifts, cleans, snatch, and drop the loaded squats.  Swear off the lower lumbar deranging leg press.  Reduce spinal compression and train the legs, one at a time.  Single leg training reveals the right / left side movement asymmetries that drive lower back pain.  Resolving these asymmetries and sparing the spine goes a long way to abolishing back pain.  You will need some guidance on exercise selection and execution- this brings me to #5.

#5 Get some help:  Exercise is the most powerful medication on the planet.  Nothing else comes close.  Take the proper dose of appropriate training and the results will be amazing.  Take the wrong dose of an inappropriate activity and the results can be devastating.  This is especially true for people with a history of lower back pain.  Find a qualified physical therapist to guide you through your fitness journey.  One way or the other, you are going to spend time and money on your health.  Proactive spending is always cheaper and more beneficial than reactive spending.

Michael S. O’Hara, PT, OCS, CSCS


We are beginning to win the battle against the myth that sit-ups and crunches are a worthwhile fitness activity. Take the time to read the December 21, 2015 Wall Street Journal article by Rachel Bachman, “Why You Can Stop Doing Sit-Ups.” In physical therapy, I treat the patients who in a valiant, but misguided, effort to regain fitness launch into a series of crunch/sit-up exercises only to wake the next morning with debilitating lower back or neck pain. The numerous reasons you should avoid crunches and sit-ups are listed below:


Most fitness clients are already spending too much time in a forward bent, slouched over posture. Their cervical, thoracic, and lumbar vertebrae are bent forwcrunchard for hours a day– sitting too much, driving too much, texting too much… Many are proud at how easily they can fold their thoracic and lumbar spine over and “palm the floor.” The last thing they need is to pull the ligaments, discs, and joints of their spine into further flexion with crunches and sit-ups.

Your Mother’s Eyes and Your Grandma’s Spine

As we age, our spines tend to fall into the flexed over, end-range alignment of a sit-up.   Why would you want to accelerate the pace of this degeneration by performing activities that accentuate the slumped over, forward flexed, spinal posture of old age?

The One True Belly Fat Reducing Exercise

Your abdominal muscles, or “six pack,” will not become more visible with lots of crunches, sit ups, rip twists, belly blasters, or any other targeted training. There is no such thing as spot reducing. The ‘table push away’ is the best exercise to improve the visibility of any muscle. Unfortunately, it is the least utilized exercise in America.

Abdominal Muscle Biomechanics

The function of your abdominal muscles is not to create movement but rather prevent movement. They work with a team of other muscles to act as anti-extensors, anti-rotators, and anti-flexor muscles. The six pack muscle, or rectus abdominus, makes up a portion of the cylinder of muscle that serves to support your spine in a tall and stable position. Think “movement preventers” and not “movement producers.” Crunches and sit-ups train your abdominal muscles to do the wrong thing.

The Pros Don’t Use Them

I cannot think of any athletic activity that emulates the motion of a crunch or sit up. It will not improve your ability to run, jump, throw, or compete. The strength and conditioning coaches who get paid big money to make athletes more successful and keep them injury-free do not use crunches, sit-ups, or other repeated trunk flexion exercises in their programming.

Maybe Not Now, but Soon and for the Rest of Your Life

Your lumbar spine hates repeated flexion. It really hates it if you throw in some rotation along with compression from an exterior load like a medicine ball, weight plate, or kettlebell. Lumbar spine injuries are cumulative. The stresses build up until one day you bend over to pick up a pencil and your back “goes out.” Crunches and sit-ups serve to accelerate the rate of accumulated spinal stress. I know you have a friend who does one hundred twisting, medicine ball crunches a day and has never had a problem. I have a friend who has smoked for twenty years and says he feels fine.

To read Rachel Bachman’s article, click on the link below:


-Michael O’Hara, P.T., OCS, CSCS