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When the muscles in your lower back ache or spasm, your first instinct may be to reach for a bottle of ibuprofen and head for the couch. But science says you may be better off heading to the gym.

Until the mid-1990s, a lower-back problem was considered a serious disability. Many physicians prescribed rest, painkillers and even surgery. Today, a collection of studies suggest that that’s not always the best treatment plan.

In a 1999 study conducted by the Physicians Neck and Back Clinics (PNBC) in Minnesota and by the University of California, San Diego, researchers found that exercise-only treatment plans were just as effective as traditional medicine for the majority of patients.

Similarly, a 1999 study published in Archives of Physical Medicine and Rehabilitation revealed that the majority of patients who had been told they needed back surgery were able to avoid the knife in the short-term by engaging in aggressive strengthening exercises under the supervision of their doctors.

“Studies revealed that people with lower-back pain have less flexibility of the spine and decreased strength of the muscles that are responsible for motion through the spine.”

Why the change in philosophy? “Studies revealed that people with lower-back pain have less flexibility of the spine and decreased strength of the muscles that are responsible for motion through the spine,” notes Mara Vucich, DO, a spine specialist at Mercy Medical Center in Baltimore, Md. In other words, it’s often weak or imbalanced muscles throughout the core, lower back and legs that contribute to the lower-back pain that now afflicts one in four Americans. If you spend long hours slumped before a computer screen, never strengthen your abs or are sedentary, your back will begin to feel the strain. “In time, lack of physical activity also may result in decreased bone density and predispose individuals to spinal compression fractures,” warns Robert G. Sheu, MD, director of the Pain Division at Beth Israel Medical Center in New York City.

Jeffrey Chow, 24, knows firsthand how a lack of physical activity can lead to back trouble. For several months in 2001, the avid hiker and outdoorsman was ill and uncharacteristically inactive. As a result, he began to suffer lower-back pain and sciatic-nerve inflammation, which sent shooting pain down the backs of his legs.

Upon the recommendation of a physical therapist, Chow underwent passive treatments, including massage and heat therapy. “While this was definitely relaxing, the pain relief was very temporary,” he recalls.

So he tried a regimen of core exercises another therapist suggested. “This was often painful,” he says. “But after a few weeks, I noticed fairly consistent improvement.”

Looking to further boost his flexibility, Chow joined a beginning yoga class. Early on, he struggled through the poses and contemplated quitting. “But by the end of the term, the pain had mostly subsided,” he says. “I could touch my toes and bend my back three times as much in cobra pose as I had during the most painful time.” (To learn the cobra pose, see below.)

Today, you would never know Chow ever suffered from back pain. He recently completed a 2,175-mile-long hike along the Appalachian Trail.

Before you dive into a back-boosting workout, your health professional should determine that you have no serious injuries. Then try this menu of exercises, designed by physical therapists to prevent and treat lower-back pain. For the most benefit, combine these moves with a workout routine that includes elements of yoga, Pilates or other core-strengthening techniques.

Start Slow: Basic Back Stretches

Best For: People who are just starting a workout routine or who are experiencing pain that is aggravated by higher-impact workouts.

The Move:

  1. Start by lying on your back and gently bringing one knee up toward the chest, grasping your knee with both hands. Hold this position for five seconds, and repeat with the opposite knee. “Don’t pull the knee up beyond the point at which you feel a gentle tightness within the back,” warns Sheu.
  2. Repeat the stretch three times on each leg.

If this stretch feels comfortable, try raising both knees to your chest at the same time. From there, progress to raising one knee at a time and gently rotating it toward the opposite side of your body, providing a gentle twist and stretch in your lower back. Repeat three times on each side.

Finally, Sheu suggests this stretch: “Continue to lie on your back on the floor, with your hands by your sides, palms down. Bend both knees while keeping your feet planted on the floor. Now lift the hips and buttocks gently off the floor for three to five seconds until you’re in a bridge position. Repeat five times.” (For more on the benefits of bridging, see “Office Imbalance“.)

Get Strong: Core Strengthening

Best For: Those who want to prevent back problems, prevent re-injury, and enjoy increased core strength and flexibility.

The Move: The cobra. Chow used this yoga pose as a yardstick to measure his increasing back strength and flexibility.

  1. Begin face down on a mat or carpet, with hands beside your shoulders, palms down.
  2. Slowly start to straighten your arms, pushing upward, and arch your back until you feel your lower back tighten. Keep your head in line with your neck and spine, and your shoulders pulled down, away from your ears.
  3. Slowly lower yourself to the start position.

If you’re just starting out, arch your back only as far as is comfortable (Chow could get only his shoulders off the ground when he first started). You should feel a pull, but it should not be painful. As your flexibility improves, you can try to arch farther.

Integrated Approach: The McKenzie Method

Best For: Patients who want to learn to actively manage their back pain using exercises under a physical therapist’s supervision.

The Move: Developed in New Zealand in the 1960s by physical therapist Robin McKenzie, the McKenzie Method combines physical therapy and exercise to extend the spine and centralize and treat the source of pain.

Though best taught by a licensed physical therapist, you can try this move, outlined in McKenzie’s book, Treat Your Own Back: Stand with your feet slightly apart.

  1. Place your hands in the small of your back with your thumbs just above your hipbones, pointing forward.
  2. Bend your trunk backward at the waist as far as is comfortable, using your hands for support. Keep your knees straight.
  3. Maintain this position for three seconds, and return to the starting position.
  4. Repeat the move three times, trying to bend backward a little farther each time.

What to Do for Back Pain … 

  • Do see a doctor if your back pain is due to an injury, the pain is intense, or you feel any tingling or numbness in your back or legs.
  • Do be aware of proper back maintenance throughout the day. Avoid slouching and lifting heavy objects (when you do lift heavy objects, lift with your legs instead of your back).
  • Do have your workstation evaluated by an ergonomics expert who can adjust your seat height and computer position to reduce back strain.
  • Do include core- and back-strengthening moves in your exercise routine at least three days per week.

What Not to Do for Back Pain …

  • Don’t bend too far forward when rising from a sitting position. Instead, use your hips and legs for support as you stand upright.
  • Don’t sleep on your stomach. It puts more strain on your lower back.
  • Don’t extend your legs out in front of you while sitting. Instead, keep feet planted on the floor and knees bent.
  • Don’t forget to take frequent breaks if your daily routine involves long hours of sitting or driving.

This article has been updated. It was originally published in the June 2007 issue of Experience Life.

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