Low Back Strengthening Exercises For Chronic Low Back Pain.

Best Exercises To Increase Low Back Muscle Size with low back pain. 

Strengthening the low back while dealing with chronic or recurrent low back pain can very difficult.  Pain, abnormal muscle activation patterns, and muscle guarding can all make it difficult to create a training effect needed to grow muscle.  With that said, there is excellent support that strengthening exercise can be very beneficial in improving pain and reducing disability related to low back pain. So how do you choose the right exercises to build that size and strength back? 

One recent study (1)  showed that replacing traditional stabilization exercise with hip abduction strength exercises increased muscle thickness in women age 20-45.  The hip is closely linked to the low back, in both proximity and nerve connection.  If this research holds true and we can increase lumbar muscle size with hip strengthening this may be a way to avoid fearful or guarded patterns that come with back pain.  Hip Exercises may be something we can do to build strength without fear of irritating the back. 

The reverse hyperextension is another commonly used exercise for low back pain, and is very popular amongst weightlifters.  With modifications, when needed this is one that can also be used to increased muscle size.  The beauty of the reverse hyper is that you can really work the hip through a full range of motion, while generating good activation of the erector spinea without undue stress on the spine.  Lawrence et al. demonstrated increased activation of the lumbar paraspinals compared to the traditional back hyperextension exercises (2).  

In the rehab world, the reverse hyper may be too intense to start with.   So you can start with the bird dog exercise which is a similar hip extension exercise but has a shorter range of motion and by nature is more horizontal making it a little easier.  The bird dog is an extremely popular lumbar strengthening exercise and is a part of the McGill Big 3 Exercise routine for low back pain.  If that goes well, you can move to a single leg RDL with one leg still on the ground.  This provides stability while increasing range of motion. If that still goes well and is pain free, Finally, you will move to the full reverse hyperextension exercise.  

Sets and Reps.  This is a little more debated topic.  Most pain has some component of altered blood flow. I am a big proponent of adding a metabolic demand to the exercises when working on rehabilitation.  Caution: If you have a new onset of low back pain none of this applies.  Get the pain reduced first. Rules are no pain or a pain level of 1-2/10 throughout and after performing the exercise.  Reps are  performed until you get just shy of technical failure.  Technical failure means your form starts to break down, not that you can’t possibly do another rep.  Are target is to be around 20 reps  Plus or minus 5 before this occurs.  If you get to 15 and you’re done, you need an easier exercise.  If you get to 30 probably a little too easy.   Do two rounds of this. That should be enough to get some metabolic stress and target rep ranges related to muscle growth.  Again, make adjustments and modifications so there is no pain. 

1. Hip Abduction Exercise. 
2. Bird-Dog. 
3. Single Leg Reverse Hyper. 
4. Reverse Hyper. 

Disclaimer: This is intended for educational purposes only. Do not take this as medical advice we do not have a doctor / client relationship established.  All low back pain should be evaluated by a qualified medical professional before beginning an exercise program. 

Aboufazeli M, Afshar-Mohajer N, Jafarpisheh MS, Heidari M, Akbari M. Recovery of the lumbar multifidus muscle size in chronic low back pain patients by strengthening hip abductors: A randomized clinical trial. J Bodyw Mov Ther. 2021 Apr;26:147-152. doi: 10.1016/j.jbmt.2020.12.035. Epub 2020 Dec 30. PMID: 33992236. 

Lawrence MA, Chin A, Swanson BT. Biomechanical Comparison of the Reverse Hyperextension Machine and the Hyperextension Exercise. J Strength Cond Res. 2019 Aug;33(8):2053-2056. doi: 10.1519/JSC.0000000000003146. PMID: 30946266.