Best Prehab Exercises for Your Lower Back

Low back pain is the leading cause of activity limitation and work absence throughout much of the world and is associated with an enormous economic burden. This called for Preventative measures! Here are 10 exercises from the leading Rehab and Fitness professionals that may help reduce your risk of injuring your lower back!

Bear Crawl

The bear crawl is a primitive movement exercise to challenge dynamic core stability while simultaneously loading the upper and lower extremity. When we say core stability, we are talking about the ability to support and stabilize the torso. With any movement, we want to limit the spine from excessive, uncontrolled movement. Whether it’s flexion, extension, or rotation under a load, too much unwanted spinal movement results in compensation! Compensatory mechanisms may lead to tissue overuse, which can lead to injury. Building a stable core is a fundamental prerequisite to lifting heavy weights safely and effectively. 

Demonstrated here is how to appropriately progress into a 2-point contact bear crawl. Once you find a position that is an appropriate challenge for you, maintain that position for 3-5 seconds per side. 

The bear crawl is also great because it helps with body awareness. Having a good sense of body awareness–also known as proprioception–will help maintain proper form during lifts and various other exercises. If you are unsure that you are maintaining a neutral spine, you may place a weighted ball on the lumbar spine region as a cue to prevent excessive rotation at the trunk. Make sure to not compensate with lumbar lordosis to keep the ball still on the back!

Stir The Pot

We can argue all day long about if maintaining core stiffness during lifting prevents injury but it certainly helps move more weight in the gym. My favorite for really teaching an athlete how to brace is Stir The Pot popularized by Dr. Stu McGill.

Many athletes will have to start on their knees versus toes as shown in the video but either way have a neutral spine and extended hips and the athlete will maintain this positioning as they make small, controlled circles as if stirring a pot. This exercise is much harder than it looks and very often results in improved lifting form immediately as it provides great feedback to the athlete on proper bracing.

Zach Long, DPT, SCS, PES

TheBarbellPhysio | Instagram | Facebook | Twitter

Deadlift

My favorite prehab exercise for the low back is a little counterintuitive. The deadlift, executed properly, is by far my favorite exercise to aid in preventing future bouts of low back pain. The deadlift is the king of posterior chain strengthening exercises. It strengthens the lats, lumbar extensors, glutes, hamstrings, and everything in between. When executed properly the movement teaches one to hip-hinge and have adequate control over their hips and low back. Progressively loaded deadlifts increase full body strength and tissue load capacity. Improved tissue load capacity subsequently develops improved “functional reserve” and resilience to imposed stresses of daily life. The deadlift is incredibly versatile. It can be performed with barbells, dumbbells, kettlebells, bands, a baby, or nothing at all. It can be performed double leg, single leg, stiff leg, elevated, deficit, sumo, and standard.

Furthermore, when looking deeper into pain and realizing possible psychological components that could drive pain, the deadlift yet again demonstrates utility. Regularly performing the deadlift motion trains the brain to be “not so scared” of lifting items from the floor, a common fear avoidance behavior that could subsequently elicit hyper painful response to a minor lifting injury in the future.

Additionally, if people are dead lifting, it likely means that they are routinely performing general exercise. Staying active and exercising is far and above the most powerful low back protector we know of.  
Finally, the dead lift is incredibly functional. It carries over into ADLs for people of all ages and walks of life. Comfort, strength, and resilience with lifting objects from the floor is in my humble opinion the pinnacle of low back prehab.

Jarod Hall, PT, DPT, CSCS

Drjarodhalldpt.blogspot| Facebook | Twitter

Barbell Squat

When it comes to low back prehab, the barbell squat is a must! The squat itself is a fundamental human movement pattern that we perform everyday. If you have to stand up from a chair, you have to squat! What better way to maximize function, build tissue resiliency, and reduce the risk of injury than to load this pattern? From increasing your ease with activities of daily living, to maximizing athletic performance, the barbell squat can benefit nearly every population. A stronger back is a back that is less likely to be injured. Now go out there and build your resilient spine with barbell squats!

Michael Mash, DPT, Cert. TMM, CSCS, FMS

BarbellRehab | Facebook | Instagram | Twitter

Eccentric Isometric RDL

The number one reason for low back injuries is improper spinal alignment associated with faulty hip hinge mechanics.   Simply put, most individuals lack the ability to hinge at the hips with a neutral or naturally arched spine.  In fact a majority of the population including many so called advanced lifters and athletes rely primarily on spinal flexion to lift and bend over rather than hinging properly at the hips.  As a result they end up placing excessive tension on their low back and lumbar region.  Overtime, this has a direct impact on posture and ultimately structurally integrity of the entire spine.

Unfortunately once the spine goes, both quality of movement and quality of life degrade rapidly.   Just ask anyone who’s ever had a back injury and they’ll tell you just how debilitating this can be. To alleviate this issue my go-to exercise is the Romanian Deadlift or RDL.  However, were’ not talking just any RDL.  The RDL I prescribe to my athletes and clients regardless of their low back history is a very precisely executed eccentric isometric hip hinge.  This can be done with a barbell, dumbbells or kettlebells.

Eccentric isometrics involve performing the eccentric or negative portion of the lift in a controlled manner (3-5 seconds) and holding the stretched position for a given duration (2-7 seconds) before completing the concentric or lifting phase of the movement in an explosive fashion.  

Here’s what it would look like applied to an RDL.

By emphasizing the eccentric component of the lift, this allows the lifter to spend more time in a loaded stretched position.  When the muscles are stretched and under tension this produces greater sensory feedback and kinesthetic awareness from muscle spindles and other proprioceptive mechanisms.  As a result the athlete can make subtle adjustments to their positioning and fine-tune their body mechanics. This has a tremendous impact on hip hinge technique when applied to the Romanian Deadlift.  In fact the lifter should be able to feel their form gradually improve without the use of a coach as eccentric isometrics allow the lifter to master their own mechanics. In addition, the eccentric isometric RDL eliminates momentum taking stress of the spine and placing all of the tension on the surrounding musculature. The proper form for an RDL involves slightly more knee bend than most individuals have been led to believe.  Keeping an overly straight leg position is one of the most damaging cues not only for the low back but also for causing hamstrings tears and sciatic issues.  Maintain soft knees and push the knees slightly apart laterally to place more weight on the outside of the foot (while keeping the whole foot in contact with the floor).

Finally, avoid an excessive stretch and overly large range of motion.  When you use eccentric isometrics you’re body will feel where the optimal stopping point is on RDL’s or any other movement.  Rather than trying to increase mobility and flexibility by using an exaggerated stretch, find the natural stopping point which is slightly above parallel.  This represents the optimal range of motion for any hip hinge and places the least amount of tension on the spine while targeting the large hip muscles.  Going deeper may seem beneficial at the time.  However using an exaggerated stretch will simply be reinforcing a dysfunctional hip hinge position that will inevitably cause low back issues rather than cure it.  So yes the RDL can both cause and cure low back pain depending on how it’s performed.

Learn to apply this eccentric isometric RDL technique to your training program and watch your low back healthy markedly improve.

Dr. Joel Seedman, PhD, CSCS, ACSM, FMS,

http://www.AdvancedHumanPerformance.com | Facebook | Twitter | Instagram | Youtube | Linkedin

The Crossfire

This is an excellent movement to activate the extensor chain for stabilization and neurological patterning. Rounded shoulders and forward flexion postures of modern day society from increased sitting causes the posterior part of the body to become weak. Lower back stabilization muscles become inhibited and joints begin to lose mobility in an effort to regain control of movement.

When the brain feels threatened and vulnerable it inhibits motion. The secret is to go back to the environment where all movement began; the floor. Integrate  the entire body together in a safe environment prime the brain and nervous system to learn a new habit. The Crossfire is extremely powerful because it taps into how we developed our arms and legs embryologically. The arms and legs are called limb buds in utero. They elongate and develop via rotation. However they rotate the opposite way from each other.

The arms develop in external rotation and the legs develop via internal rotation. The Crossfire Resets the neural switch to ignite dormant movement patterns. That’s why this movement can make an instantaneous improvement in how you feel.

https://vimeo.com/201349703/e2f23fcb83

Highlights:

  1. Go slow. Speed hides need. Take at least 4 seconds in each direction.
  2. Always keep breathing
  3. Never stop trying to move the arms and legs at end range
  4. Start arms with palms flat
  5. Start legs with feet turned out
  6. Do at least 8-10 repetitions
  7. If you can’t bring the arms out fully to the sides take them to what’s comfortable
  8. There should now be Zero pain anywhere
  9. Turn your head to both sides and repeat 2 more times each
  10. Initiate movement from the shoulder and hip joints not the hands and feet

Perry Nickelston, DC, NKT, SFMA

http://www.stopchasingpain.com | Twitter | Instagram | Facebook | Youtube | Podcast

 

The Quadratus Lumborum Door Stretch

Episode 57: Is your low back feeling #tight? The quadratus lumborum muscle (QL) is often overlooked when it comes to low back pain. We believe this is one of the best stretches out there for the QL muscle. Hold for up to 2 minutes per side. The QL muscle becomes tight due to the excessive sitting in our daily lives. A tight QL muscle presents with achy/dull low back pain when sitting or standing for long periods of time. People with QL tightness also have trouble straightening from the sitting to standing position. A tight QL muscle goes hand in hand with an excessive anterior pelvic tilt brought about by a lack of core and glute strength. #CaliSpine #chiropractic #sport #therapy #lol #backpain #backday #backmuscles #fitness #fitfam #fit #strength #stability #mobility #muscle #shirtlessguys #enjoy #abs #wellness #painrelief #lowback #carlsbad #encinitas #oceanside #sandiego #lift #DPT #abs #QL

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Core Bracing and breathing are by far one of our favorite exercises for Prehab, rehab, and LIFE in general. Since many other people in this article have mentioned bracing and covered one of the most important motions of our life (deadlifting), we will instead share our favorite flexibility exercise for the lower back. When combined with the other exercises on this list, stretching a deep muscle called the quadratus lumborum (QL) will help to reduce your back aches and improve your ability to tilt the pelvis and brace your core.

Due to poor posture, improper lifting techniques, and our terrible “sitting society,” the QL muscles become chronically tight for many people. The QL door stretch is a simple way to open up the lower back and provide  an immediate increase in pelvic and lumbar range of motion. A knotted and tight QL muscle will often be achy, throbbing, and nagging when standing or sitting for long periods. Tight QL muscles, along with tight hip flexors(psoas), will compress the discs and contribute to joint and disc pain in the lower back. After doing a stretch like this, it is important to follow it up with the glute, hamstring, and core strengthening exercises that are provided in this article.

MoveU |The Back Pain Guys – Dr. Mike Wasilisin and Andrew Dettelbach

https://moveu.com | Instagram | Facebook

Suitcase Carry

How frequent are you performing heavy carries in your training? As a great implement to building core strength and robustness, the heavy suitcase carry is an excellent movement. ▪️▪️▪️ By loading the boy heavily unilaterally, we're forced to stabilize in the frontal plane and preface the Quadratus Lumborum and Obliques and challenge the system in a varied direction. ▪️▪️▪️ By adding heavy carries in your training, you will help develop a strong and complete core, strengthen the often cranky QL, and become a better and more robust athlete. Try them out! . . . @fitnesstx #fitness #rehab #prehab #backpain #carries #crossfit #training #exercise #performance #stability #physio #fitnesstx #aidingelitefitness #physicaltherapy #pt

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Building a strong and robust midline is not only important in the prevention of low back pain but also for any athlete seeking increased performance.  To do so requires training the midline in multiple planes and variations under both high repetitions and heavy loads. One way to both challenge the midline in a varied plane with heavy loads is with the suitcase carry. Heavy carries have been a staple in classic strength and conditioning programs for years and for good reason. The suitcase carry is one of my personal favorites because it puts tremendous stress on the body to stabilize in the frontal plane, heavily prefacing the quadratus lumborum (QL) and obliques. The QL is a common nagging point on many individuals due to its overuse helping to control forward flexion. By loading it with the suitcase carry, we can influence a long, isometric contraction of the QL and help build tissue capacity and strength.

Highlights:

  1. Select a heavy kettlebell or dumbbell that challenges your grip for 50-100’.
  2. Pick up the weight from the floor as if there were one in each hand, helping to stabilize off the floor.
  3. Walk slowly and consciously, working to maintain an upright torso position throughout the movement.
  4. For added challenge, perform immediately following hard sprint or rowing intervals to challenge your stability under fatigue and respiratory demand.  

Mitch Babcock, PT, DPT, SFMA

www.fitnesstx.physio | Facebook | Instagram Unchained | Instagram Fitnesstx | Twitter

Cat/Camel + Quadruped Neutral Spine Rocking

The estimated cost of low back pain in the United States is $100 billion a year!  People spend so much time tuned into their screens and stuck in chairs that they have become out of tune with their own bodies.  This is manifested in limited mobility, decreased strength and most importantly, poor quality in movement.  

One of the things we frequently see in low back patients is their inability to dissociate their femurs and pelvis.  We see this most frequently in a squat, or going from standing to sitting, but this manifests in so many daily tasks, like picking something up from the ground or putting groceries in the trunk of your car.  

The ideal movement pattern we hope to see at the trunk is the pelvis tilting forward and the spine moving with it.  The lumbar spine/low back, should not bend or round at all.  For this to happen, the femurs need to be able to move independently from the pelvis.  

This is not an easy thing to teach people or to learn.  Countless therapists and personal trainers around the world bang their heads into the wall trying to correct people’s squat mechanics, only to give up and hope their clients aren’t working with them when their backs go out:(  

We have found a pretty fool proof combination of motor control exercises to make proper squat mechanics stick.  We love these 2 drills in combination because they build upon each other, can be modified as necessary, and because they work!  The first drill teaches people how to move their pelvis on their femurs.  This is the easier of the drills.  Once successful with this, move on to the the second drill which teaches movement of the femurs on the pelvis.  This is a little tricker, but is more similar to what happens with a squat.  The initial drills give you 6 points of contact (feet, knees, hands).  The progression on the wall is 4 points of contact (feet and hands), and eventually you move to your squat with only 2 points of contact (feet).

**Remember to check hip flexion range of motion first so that you know how far you can expect to be able to rock back before the pelvis starts to dip.

Dr. Santo Riva, DPT, OCS, NASM-CPT

Instagram | Facebook | Twitter | Youtube

Hip Hinge

This single universal movement is vital for load management & sparing of the knee below & spine above. It also, helps create a more upright posture so can help with cephalad issues. Finally, it is a key to performance since most power is generating from the hips and lower extremity.

One of my favorite quotes is “A natural athlete moves from his hips, never from his back or knees. The hips-first movement is safest for your back and knees – and the most powerful.” –Pavel Tsatsouline. This is a basic principle which echoes Pr Janda’s work on gait as well as his Hip Extension movement stereotype. He suggested that prolonged sitting led to loss of normal  hip extension mobility  and typical substitution patterns during gait. Since gait requires 10 deg hip hyperextension during high gear push off restrictions in hip mobility would automatically be compensated for by an anterior pelvic tilt and overactivity of the lumbar erector spine muscles.

It is also a basic tenet of Dr. McGill’s work that we should have core stability and distal mobility. Echoing PNF’s signature phrase but putting biomechancial science to the arguments. Hip hinge can be taught in many ways – Waiter’s or Japanese bow, windowpane wall slide, box squat, dead lift and many more.

A benefit of this skill is also it’s transference to enhanced frontal plane agility for basketball, tennis, soccer and other athletes. In order to gain access to high quality frontal plane power & stability hip extension is a key potentiator. This is in contrast to jumping athletes who require more knee dominant squat patterning.

Craig Liebenson, D.C.
www.lasportsandspine.com | Blog

9 thoughts on “Best Prehab Exercises for Your Lower Back

  • I am a big fan of yours that is the reason I am writing this comment (feedback) in the future I don’t think great pts would have included barbell back squat (axial loading of the spine) as prehab treatment for lbp, some of the videos are great the one with LE internal rotation, and UE external rotation, or the cat camel one such simple great explanation, or the suit case one sure I get it, but the squat one I don’t think its good, and here is why: In my humble opinion I think you should squat with your toes in many different directions but I have seen the pt you guys posted and Im not a fan of his work or form, I believe regular athletes should “prioritize” squatting with toes forward and avoid axial loading as much as possible, also there are so many better ways to squat, and better exercises to put on your article such as SFT squatting, (include some variations adding a Sp press, Tp press) or a retro lunge into an elevated surface where one limb is doing a hf stretch in different dimensions (SFT) and the other limb is strengthening in different dimensions, keep up the great work good luck in pt school I want to become a pt one day, and I work with usc graduate pt, she also went to ucla for masters degree, you guys would love her, she also likes to rep ucla

    • Hey there Alex I see what you are saying. Just wanted to add that there is no idea form for squatting, the truth is everyone has a different anatomical structure! At the end of the day, you have to think to yourself what is my intent with this exercise, and then work backward and change foot position, trunk angle, foot width to allow you to optimally achieve your intent. Thanks for reaching out and showing your appreciation! Let us know if you have any questions moving forward with your quest! Boo UCLA lol.

  • Hi, I’m from chile and I had a surgery in L5-S1, I had a Hernia, they also made me a Rysolizis and they put me Stem Cells.
    This surgery was 9 months ago and I still have some pain and irradiation on the rigth gluteus.
    I follow you instagram and i try to do the excercises you recomend.

    I will be very grateful if you can recomend me some excercises and how I cand return to run.

    I’m writing to you because I’m worried about this injury…and I dont find solution.

    Thank you very much

    Felipe Brain

    • Hi there Felipe,
      Have you seen a been seeing a Physiotherapist within the last 9 months?
      It would be a disservice to you if we gave you recommendations without fully looking at why you are having this discomfort.
      These exercises shown in this article show different ways to strengthen, improve control, and range of motion of muscles surrounding your lower back which may help with your issue.

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