Section 1 will help explain the mechanisms and systems responsible for your pain. It will also help you understand the reasoning behind the exercises and other recommendations we will make.
Section 2 will help you determine your correct exercise “dosage”. Just like with medication, it’s not only about having the right pill but taking the right amount. This section will also help you adapt your program as your back pain changes and gets better.
Section 3 is your actual exercise program. With each exercise, you will find a text description of how to properly perform the motions involved as well as picture and video demonstrations.
Section 4 will include practical recommendations on how to avoid aggravating your back and how to better manage the pain in your day-to-day life.
Section 5 will explain the connection between your brain and back pain, as well as how you can disrupt the “Pain Cycle”.
These 5 sections are your roadmap to conquering your back pain. We have no doubt that you’ve got what it takes to make a positive change in your life, but your success still depends on your effort and commitment. With consistency and only about 10 minutes a day you can be the hero in your own journey.
Section 1: Why does my back hurt?
Before we begin, it is important to remember that there are many factors that contribute to back pain and that mechanical changes such as the ones described below do not define your back. Even an MRI or an X-ray would not be able to entirely capture what you are experiencing. Accordingly, they are NOT necessary in the vast majority of back pain cases.
With that said, understanding the anatomy and mechanisms of your back can be helpful in reducing pain-related fear and promoting healthier habits.
So here is what you need to know:
Your Sacroiliac Joint (SI joint) is an important connection between your spine and your hips. It’s the joint that links the triangular bone at the base of your spine, called the sacrum, to the pelvic bone, known as the ileum. This joint plays a crucial role in transferring the weight and motion of your body to your legs. The SI joint can become irritated if it experiences an increase in pressure or a reduction in stability.
Based on your answers to the quiz, it sounds as though you are experiencing a decrease in stability at your SI joint. When motion at this joint is interrupted, it can also irritate the lower nerve roots. Nerve root irritation would explain why you might feel pain a little lower down your leg. However, it is important to understand that this does not mean your spine is “permanently damaged”. Rather your back has entered a temporarily agitated state and just needs the right conditions to return to being pain-free.
Accordingly, you can overcome your back pain by reducing how much you challenge the stability of your SI joint. Your exercises and other recommendations are based on this principle.
However, many daily tasks will naturally challenge the stability of your SI joint. Does this mean these tasks and activities have to be avoided completely? While you should try and avoid challenging the stability of your SI joint until your pain subsides, loading the SI joint is thankfully not something to be afraid of.
By strengthening specific muscle groups such as your core and stretching others like your glutes, your SI joint will once again be able to tolerate the forces it was designed to handle.
The information above is intended to help you understand that what you are experiencing is capable of change and that you are not destined for a life of pain. You have a perfectly normal back that just needs a little bit of extra attention.
Section 2: Exercise Dosage
The recommended amount of exercise will be described using 3 main terms: Volume, Frequency, and Intensity.
Volume refers to how much of each individual exercise you should perform in a single session. Volume is measured in "repetitions" or "time". If an exercise is measured in repetitions you repeat the movement that many times. If an exercise is measured in time, you hold the position for that amount of time.
Repetitions and time are given in "sets". A set can be thought of as a group of repetitions. A set of repetitions should always be separated by a short break. We recommend starting with breaks that are 30-60 seconds long.
So for example, if you are doing 2 sets of 10 repetitions, you perform the exercise 10 times, rest for 1 minute, and then do another 10 repetitions for a total of 20 repetitions
Frequency refers to how many times you should complete an exercise at the recommended volume in a given amount of time. For example, you may be asked to perform the exercise at a frequency of 2 times per day, once in the morning and once before bed. If the recommended volume for this exercise was 2 sets of 10, you would do 2 sets of 10 in the morning and another 2 sets of 10 before bed.
Intensity describes what you should feel during an exercise. During some exercises you should feel your muscles get tired, in others you should feel more of a stretch. The intensity will help you know when you are doing the exercise right and how much you should be pushing yourself.
In order to get the most out of exercise you should challenge yourself, but more isn’t always better.
Before you are active or attempt an exercise you should ask yourself: “On a scale of 1-10, how much discomfort do I feel?”
A score of 10 means you are experiencing the most discomfort you can imagine and a score of 1 means you are experiencing very little discomfort. There is no right or wrong answer to this question, what 10/10 discomfort feels like is totally up to you.
The answer to this question will help you determine if you should be doing less, or doing more of the activity/ exercise in question.
Exercise and activity should not increase pain and or discomfort by more than 2 points. This increase should also not last longer than 1 minute after completing an exercise.
If your pain increases by more than 1-2 points and/ or lasts longer than 1 minute following the exercise or activity, you have pushed too far.
If you experience an increase in pain of more than 2 points or if the increase lasts longer than a minute you should rest or attempt an exercise you know makes your back pain feel better.
Once your pain has returned to the original level you may perform this exercise again but you should modify the painful exercise by reducing the number of repetitions to avoid a similar increase in pain.
If you cannot perform more than 3 repetitions without increasing your pain, reduce the exercise intensity. Most often this will mean not moving as far in each repetition.
If you cannot find a level that feels appropriate to you after modifying the volume, and intensity stop the exercise entirely and focus on the ones you can do. Avoid the exercise for 1 week, then attempt to reintroduce the painful exercise gradually still following the rules above.
If you get relief from your pain with one of the exercises, feel free to perform that exercise as many times a day with as much or as little rest in between as you see fit. It is very hard to "overdo it" with such an exercise, but if at some point an exercise that once felt good becomes painful, return to doing an amount that felt good.
If you are able to perform an exercise with ease at the recommended amount, you should attempt to advance to the second level of that exercise. But be sure to wait at least 24 hours before making any changes. Your pain may not increase until some time after an exercise is complete.
If you get to the third level of the exercise and still find it to be easy, you should increase the volume of this exercise by doing more repetitions or sets. If you are performing more than 20 repetitions or holding a position for longer than 2 minutes and you still do not feel like you are being challenged, you should now increase the frequency.
If you increase the volume and frequency at the hardest level of an exercise and still don't find the exercise challenging, you should continue to perform that exercise at the highest level you have the time and energy for as it will still be beneficial. However, focus on the exercises and activities that you find most helpful.
Other things to consider…
Each recommended exercise has 3 alternative versions of varying difficulty so you can increase the difficulty of your program as your back gets better. Level 1 will typically be the easiest version of the exercise. However, you may actually find it to be more challenging than the other levels. If this is the case, stick with the level you find most challenging at the time.
Do not feel the need to progress the exercises all at once, it is okay to be doing level 1 of a certain exercise and level 3 of another. You also do not have to do all of your exercises in a row. You can do exercise 1 in the morning, and exercise 3 at your lunch break. Fit them in whenever is convenient for you.
You may also need to perform a specific level due to a limitation other than your back. For example, if you cannot perform and exercise with proper form and without pain due to a shoulder injury, choose the version you can do properly without aggravating your shoulder.
Lastly, some exercises will involve only one side of your body. On occasion, you will need to repeat the exercise on both sides, other times you will only perform the exercise on one side. The side you should perform the exercise on will be explained in the exercise description.
At the end of the day, this is your exercise program. Our recommendations are a great place to start, but you should always do what feels best for your back.
Section 3: Exercise Program
We have recommended 4 different exercises for you. Each exercise comes with a text description of the proper technique, as well as a picture and video demonstration. To view the video demonstration, simply click the picture of the exercise and a new tab will open. You can switch between difficulty levels by clicking the buttons above the included picture. The recommended Frequency, Volume, and Intensity will be provided below each exercise.
Do not attempt the exercises before understanding section 2.
Exercise Description: To perform the "Clamshell" exercise, begin by lying on your side on a comfortable surface, this might be your bed or a yoga mat on the floor, whatever works best for you. Bend both your knees and hips to around 90 degrees. Lift the top knee off the bottom knee without separating your feet. Repeat this motion the recommended amount of times or for the number of repetitions you have determined to be optimal. Then do the same with the other leg.
Exercise Description: To perform the "Standing Hip abduction" exercise, begin by standing next to a stable surface. Holding this surface for balance, lift one leg out to the side and slightly behind you. Lift the leg as far as you can without triggering pain or tiling your torso. Repeat this motion the recommended amount of times or for the number of repetitions you have determined to be optimal. Then do the same with the other leg.
Exercise Description: To perform the "Side Lying Hip Abduction" exercise, begin by lying on your side on a comfortable surface, this might be your bed or a yoga mat on the floor, whatever works best for you. Bend your bottom knee to support you and then lift the top leg out to the side and slightly behind you. Go as high as you can without triggering pain or tiling your torso. Repeat this motion the recommended amount of times or for the number of repetitions you have determined to be optimal. Then do the same with the other leg.
Exercise Description: To perform the "Transverse Abdominis Activation" exercise begin by lying face up with your knees bent and feet flat on a comfortable surface, this might be your bed or a yoga mat on the floor, whatever works best for you. Squeeze your stomach muscles in a way that causes your lower back to flatten against the surface you are laying on. It may be helpful to think about pulling your belly button towards your spine or to think about bracing your stomach for impact. Practice holding this contraction while still taking normal controlled breaths. Once you feel you can do this, slowly straighten your legs while still maintaining the contraction of your stomach muscles. Hold this position for 3 seconds then return your legs to the starting position and relax. Repeat this sequence the recommended amount of times or for as many repetitions as you have determined to be optimal.
Exercise Description: To perform the "Plank" exercise, begin on a soft but firm surface like a yoga mat or carpeted floor. Prop yourself up onto your forearms with your elbows bent to 90 degrees. Lift your hips off the ground until your spine is in a neutral position. Be mindful to not let your back round in either direction. Hold this position for the recommended time or the amount of time you have determined to be optimal.
Exercise Description: To perform the "Superman" exercise begin by lying face down on a comfortable surface, this might be your bed or a yoga mat on the floor with your arms overhead. Lift your legs and outstretched arms off the ground. Hold this position for the recommended time or the amount of time you have determined to be optimal.
Exercise Description: To perform the "Sit to stand" exercise, sit at the edge of a heavy chair or one propped up against a wall so it won't slide out from under you. Place your hands out in front of you and use your leg muscles to lift yourself out of the chair. At the top of the movement squeeze your buttock muscles together. If you find it difficult to stand without the use of your hands, you may begin this exercise by holding onto a stable object for support. Repeat this motion for the recommended amount of repetitions or as many times as you have determined to be optimal.
Exercise Description: To perform the "Squat" exercise, stand with your feet about shoulder-width apart. Slowly lower your hips towards the ground as if sitting in an invisible chair. Only go as low as 90 degrees or as far as you can comfortably if this is too low. At the top of the movement squeeze your buttock muscles together. If you find it difficult to balance, you may begin this exercise by holding onto a stable object for support. Repeat this motion for the recommended amount of repetitions or as many times as you have determined to be optimal.
Exercise Description: To perform the "Lunge" exercise. Begin in a kneeling lunge position with both knees bent to 90 degrees. Slowly lift your knees off the ground while keeping your back upright. You may want to hold on to a stable object to help with balance. Hold this position for 3 seconds and then return to the starting position. Repeat this motion for the recommended amount of repetitions or as many times as you have determined to be optimal. Then switch legs and perform the exercise again.
Exercise Description: To perform the "Isometric Hip Abduction" exercise, sit in a chair with your feet flat on the floor about shoulder-width apart. Place your hands on either side of your knees. Using your hands, push your knees together, and resist this motion with the muscles in your hips so no actual movement occurs. Push as hard as you can without triggering pain. You may also place a towel, or belt around your knees and push against this instead of using your hands. Hold this contraction for the recommended amount of time or the amount of time you have determined to be optimal.
Exercise Description: To perform the "Isometric Hip Adduction" exercise sit in a chair with your feet flat on the floor and place a ball or rolled-up towel between your knees. Squeeze the object between your knees as hard as you can without triggering pain. Hold this contraction or the recommended amount of time, or the amount of time you have determined to be optimal.
Exercise Description: To perform the "Counter Rotation" exercise, begin by lying face up on a comfortable but firm surface like a yoga mat or carpeted floor. Bring One leg up towards you until your hip is bent to 90 degrees. Place both your hands on the raised leg and push the leg downward. Resist this and push your hip muscles so that no actual movement occurs. At the same time push your outstretched leg down into the surface you are laying on as hard as you can without triggering pain. Hold these contractions for the recommended amount of time or for the amount of time you have determined to be optimal. Switch the position of your legs and repeat this sequence.
Section 4: Pain Management
In general, activities that challenge the stability at the SIJ are the most likely to be aggravating. So, things like jumping, standing on one leg, or sitting for long periods of time should be avoided. These are just a few examples of things that may trigger your pain, it is not a complete list and anything that triggers your back pain should be avoided.
With this said, use your judgment to modify your daily routine to remain as active as possible while avoiding triggers. Continuing with your daily routine the best you can will help your back recover faster than complete rest.
As you progress and the exercises become easier, you should reintroduce the activities and positions that previously bothered you. But, do so gradually. This way you increase your back’s ability to handle these positions without overwhelming it.
When sitting, you should choose a seat that is firm but still has some cushion. Something like a high-quality office chair would fit this criteria. Regardless of the chair you use, switch positions frequently. It may even be helpful to interrupt long periods of sitting with 30 seconds or so of standing. Avoid sitting with your legs fully extended such as you might when putting your feet up on a coffee table. This position increases tension on nerves and puts additional pressure on your back.
Standing and walking may at times be difficult and you may need to rest more often than you normally would. This does not mean you should avoid walking and standing entirely, the more you are able to do pain-free the better. When walking, try taking shorter steps to decrease the amount of stress the SI joint experiences. When standing, engage your core and glutes (squeeze your butt gently and tilt your pelvis upward). This will help reduce stress at the SIJ as well.
The best sleeping position for you would be on your painful side. You may find the non-painful side more comfortable in which case go with this position. Either way, you should try placing a pillow between your legs and under your ribs, just above your hip, to help support your spine.
You may also prefer to sleep on your back with pillows under your knees to keep your back in a neutral position and remove tension on the nerves. Sleeping on your stomach may not make your symptoms worse but it should be avoided if possible.
You may also want to try some of your exercises right before bed to help you sleep pain-free.
In the early stages of recovery, avoid lifting heavy objects. But, if you must, follow these steps:
1. Stand close to the object, position your feet shoulder-width apart.
2. Squat down and keep your back straight and your chest up.
3. Tighten your core muscles, and use your legs to lift the object, keeping it close to your body.
Don't twist your back as you lift. Instead, pivot your feet and turn your entire body. If possible avoid lifting overhead until your back pain has subsided as reaching overhead brings your back into extension.
If bending forward is painful, it should be avoided. You may want to use an assistive reacher until your pain subsides. For something like tying your shoes, bring your foot onto an elevated surface so you do not have to reach as far down. Using a shoe horn may also be helpful.
Some of the exercises we provided may have an immediate pain-relieving effect. These exercises can be done multiple times a day as a way to control pain when you need it. Motion can have a therapeutic effect through many avenues including increasing blood flow, releasing endorphins, and promoting relaxation. To avoid "overdoing it" listen to your body, if something feels good do more of it, if it hurts do less.
Ice and heat can also help control pain. Both can be useful, but if you're unsure, try using heat for stiff muscles and ice for sharp, acute pain. You can use both in combination, starting with ice and finishing with heat. Use each for 15-20 minutes at a time, and monitor your skin temperature to avoid burns or frostbite. Typically, you should place ice or heat directly over a sore area with a layer of cloth separating your skin from the ice or heat pack. You may also find benefit from icing and heating the surrounding areas.
There are many different types of medications used in the treatment of back pain. Some of these can be obtained over-the-counter and others will require a prescription. If this is something that interests you, a conversation with your doctor or pharmacist is a good way to determine the pharmaceutical treatment options for you. Keep in mind that medication is not necessary and is rarely enough on its own to stop back pain. Instead, when appropriate, it should be used in addition to a more comprehensive program such as this one.
Finding things that provide you with temporary relief is a very normal way to get through the day. Some ways to find temporary relief include TENS (Transcutaneous Electrical Nerve Stimulation) machines and self-massage.
TENS machines use electric current to provide temporary relief by "overriding" the pain signals sent to your back. The pads and intensity should be adjusted to the instructions of your individual machine.
Massage can help loosen your back and relieve stiffness. There are many at-home massage solutions, including electric massagers and foam rollers. Electric massagers are highly adjustable to fit your needs, however, they can be expensive. Foam rollers are a cheaper option but maybe a little more intense. A massage should feel strong but comfortable, you do not get more benefit from pushing as hard as you can.
Please also keep in mind that fancy gadgets are not necessary in the treatment of back pain and you can get better without them. But if you have the means to access them, they can be a helpful adjunct to a more comprehensive program.
Despite your best efforts, some days might just be worse than others, this is all part of the process. In such moments, adjust your routine accordingly and have confidence that you’ll have more good days soon.
Section 5: Back Pain and your Brain
With practice, a body scan can help you release muscle tension, promote relaxation, and reduce back pain by fostering a sense of self-care and deepening your mind-body connection. The point of a body scan is not necessarily to change how you feel immediately, but rather to help you understand your body's needs.
To perform a body scan:
You should find that after a body scan, you feel more control over your emotions and you should feel a restored sense of control over your body.
Breathing is a unique aspect of our physiology as it bridges the gap between our conscious and subconscious minds. With ease, you can switch between breathing automatically and actively controlling your breath. We can take advantage of this connection and use our breath to consciously have an effect on our autonomic nervous system. Our autonomic nervous system plays a big part in regulating anxiety, muscular tension, and pain perception. Below you will find two breathing techniques you can use to have a positive effect on your autonomic nervous system:
Technique #1: The Physiological Sigh
You should feel a sense of immediate calm and relaxation after performing this breathing technique.
Technique #2: Box Breathing
Repeat this cycle as needed until you feel begin to feel a sense of calm and relaxation.
Back pain has likely decreased your ability to participate in activities that you find enjoyable. Before you are able to do these things again without any pain, it is important to find modified ways you can participate in things you enjoy without triggering pain. When you participate in activities that bring you joy, your body releases endorphins, which act as natural pain relievers. Additionally, doing things you love helps distract your mind from the pain, reducing its intensity and allowing you to remain more active.
Understandably, it can be difficult to prioritize activities we enjoy and we might be discouraged if we cannot do them to the full extent we want. But playing with your kids, going on walks, riding a bike, or doing whatever else it might be that brings you joy in whatever capacity you can manage will promote relaxation, improve your mood, and over time will help you experience an increase in function.
One Last thing…
If you ever have any questions about your program or anything else related to our website, please don’t hesitate to reach out. Additionally, If you would like to share some feedback or your personal story we would also be happy to hear from you. You can reach us by clicking here.