Conditioning: Phase 1

The following is the first of four phases that will guide you from lower back pain toward healthy running. Progress from each phase as instructed, applying rehabilitation modalities such as taping where needed.

Duration: 1 Week (or when symptoms decrease significantly)
Goal: Reduce pain
Frequency of Exercises: Daily, twice per day until symptoms subside

a. HIGH PAIN

START HERE if your pain has occurred for less than 3 days and/or if the pain is at a level >7/10 (e.g. sharper, uncomfortable to sleep and sit or stand for prolonged periods of time)

Pelvic Tilt: Every lower back has a certain tolerance to pain, with some being more sensitive than others. To progress, we need to find a position that decreases the pain in your low back. Start by lying on your back with your knees bent (hooklying position). Rotate your pelvis posteriorly or anteriorly (or within that range) to find a position that is most comfortable. Many people find comfort with a posterior tilt (i.e. when the low back is flat). You can place your hands under your lower back to determine when it is flat against the ground. It may be a little sore, but continue with the posterior tilts a few times to see if the pain subsides and the motion gets easier. If it is too painful or gets worse then being in the middle range may be ideal. Though rare, an anterior tilt can help some people (i.e. extend/arch the back). Before you begin your exercises, it is important that you get comfortable with this concept, as this will be used as you progress in your training.

Supine Push Down (With Ball): 30 x (5 seconds “On”, 5 seconds “Off”). Lie on your back with your knees bent. Find the position most comfortable for your back (see Posterior Tilt). Next, place a big exercise ball on your stomach (or a few harder pillows could work). While in a hooklying position with your low back in the most pain-free position, engage your abdominals and then push down with your hands on the ball toward your thighs. You can also lie on ice or heat to help reduce pain and inflammation. You should feel muscles working in your abdominals and arms. Purpose: Activate the abdominal muscles without increasing strain in the lower back. Doing this creates an unloading/traction force on the lower back that helps reduce inflammation.
Supine Arm/Legs Apart: 3 x 12 reps (5 seconds each rep). Lie on your back with your knees bent. Find the position most comfortable for your back (see Pelvic Tilt). Engage your abdominals to stabilize your spine and then, with a firm belt around your knees (or Strap) and holding a towel, pull your arms apart and push your legs apart as you engage your abdominals. It may help to lie on ice or heat to reduce the inflammation during the exercise. Purpose: Engage lats, strengthen back muscles, and activate glutes. It will also help reduce low back inflammation and pain.
Supine Legs (Side to Side): 2 minutes. Lie on your back with your knees bent. Find the position most comfortable for your back (see Pelvic Tilt). Engage your abdominals to stabilize your spine and then bring your knees to the side while keeping your low back on the ground. Come back up and repeat with the other side. It is okay to go into mild discomfort during this exercise. Purpose: Reduce inflammation in the lumbar spine through movement and activate lumbar spine rotator muscles.
Calf Stretch: 1 minute per side. Standing with one foot back, place your toes on a half roll or rolled-up towel to increase stretch. Lean forward while keeping your knee straight. Purpose: Decrease calf restrictions to decrease strain on the lower back.
Walking throughout the day, if it causes no pain, can also help heal your lower back.
Ice: 10 minutes

b. MODERATE PAIN

START HERE if your pain is at a level 4-6/10 (e.g. moderate lingering pain, some trouble sleeping and sitting or standing for prolonged periods of time)

Pelvic Tilt: Every lower back has a certain tolerance to pain, with some being more sensitive than others. To progress, we need to find a position that decreases the pain in your low back. Start by lying on your back with your knees bent (hooklying position). Rotate your pelvis posteriorly or anteriorly (or within that range) to find a position that is most comfortable. Many people find comfort with a posterior tilt (i.e. when the low back is flat). You can place your hands under your lower back to determine when it is flat against the ground. It may be a little sore, but continue with the posterior tilts a few times to see if the pain subsides and the motion gets easier. If it is too painful or gets worse then being in the middle range may be ideal. Though rare, an anterior tilt can help some people (i.e. extend/arch the back). Before you begin your exercises, it is important that you get comfortable with this concept, as this will be used as you progress in your training.

Supine Push Down (With Ball): 30 x (5 Seconds “On”, 5 Seconds “Off”). Lie on your back with your knees bent. Find the position most comfortable for your back (see Posterior Tilt). Next, place a big exercise ball on your stomach (or a few harder pillows could work). While in a hooklying position with your low back in the most pain-free position, engage your abdominals and then push down with your hands on the ball toward your thighs. You can also lie on ice or heat to help reduce pain and inflammation. You should feel muscles working in your abdominals and arms. Purpose: Activate the abdominal muscles without increasing strain in the lower back. Doing this ]creates an unloading/traction force on the lower back that helps reduce inflammation.
Supine Arm/Legs Apart: 3 x (12 x 5 Seconds). Lie on your back with your knees bent. Find the position most comfortable for your back (see Pelvic Tilt). Engage your abdominals to stabilize your spine and then, with a firm belt around your knees (or strong Band) and holding a towel, pull your arms apart and push your legs apart as you engage your abdominals. It may help to lie on ice or heat to reduce the inflammation during the exercise. Purpose: Engage lats, strengthen back muscles, and activate glutes. It will also help reduce low back inflammation and pain.
Supine Legs (Side to Side): 2 minutes. Lie on your back with your knees bent. Find the position most comfortable for your back (see Pelvic Tilt). Engage your abdominals to stabilize your spine and then bring your knees to the side while keeping your low back on the ground. Come back up and repeat with the other side. It is okay to go into mild discomfort during this exercise. Purpose: Reduce inflammation in the lumbar spine through movement and activate lumbar spine rotator muscles.

Supine “Dying Bug”: 10 x 10 seconds. Lie on your back with your knees bent. Find the position most comfortable for your back (see Pelvic Tilt). Engage your abdominals to stabilize your spine. It may be helpful to place your hands underneath your low back to feel the posterior tilt of the lumbar spine. Next, bring one leg up to the “90/90 Position” while maintaining the posterior tilt. It is important to stabilize your spine here. Next, if strong enough, bring the other leg up without arching your low back off of your hands, and then bring your leg up to meet the other in the “90/90 Position”. If this is too difficult or causes too much pain then work on bringing one leg up and then down, repeating with the other side while keeping your spine/ posterior tilt stable throughout the movement. Purpose: Activate abdominal muscles.
Front Planks (On Knees): 10 x 10 Seconds. On your elbows and knees, come up in a plank position. Do not arch your low back. If this is too painful then hold off until you can tolerate the position. If it is too easy, then you can do regular planks on your elbows and toes while keeping your back in a neutral position. Purpose: Strengthen abdominals and shoulder muscles.
Calf Stretch: 1 minute per side. Standing with one foot back, place your toes on a half roll or rolled-up towel to increase stretch. Lean forward while keeping your knee straight. Purpose: Decrease calf restrictions to decrease strain on the lower back.
Walking throughout the day, if it causes no pain, can also help heal your lower back.
Ice: 10 minutes

c. MILD PAIN

START HERE if your pain is at a level 2-3/10 (e.g. mostly sleeping well, minimal pain with prolonged sitting or standing; bending forward and backward may still be painful, but not significant)

Pelvic Tilt: Every lower back has a certain tolerance to pain, with some being more sensitive than others. To progress, we need to find a position that decreases the pain in your low back. Start by lying on your back with your knees bent (hooklying position). Rotate your pelvis posteriorly or anteriorly (or within that range) to find a position that is most comfortable. Many people find comfort with a posterior tilt (i.e. when the low back is flat). You can place your hands under your lower back to determine when it is flat against the ground. It may be a little sore, but continue with the posterior tilts a few times to see if the pain subsides and the motion gets easier. If it is too painful or gets worse then being in the middle range may be ideal. Though rare, an anterior tilt can help some people (i.e. extend/arch the back). Before you begin your exercises, it is important that you get comfortable with this concept, as this will be used as you progress in your training.

Supine “Dying Bug”: 10 x 10 seconds. Lie on your back with your knees bent. Find the position most comfortable for your back (see Pelvic Tilt). Engage your abdominals to stabilize your spine. It may be helpful to place your hands underneath your low back to feel the posterior tilt of the lumbar spine. Next, bring one leg up to the “90/90 Position” while maintaining the posterior tilt. It is important to stabilize your spine here. Next, if strong enough, bring the other leg up without arching your low back off of your hands, and then bring your leg up to meet the other in the “90/90 Position”. If this is too difficult or causes too much pain then work on bringing one leg up and then down, repeating with the other side while keeping your spine/ posterior tilt stable throughout the movement. Purpose: Activate abdominal muscles.
Side Planks (On Knees): 3 x 30 seconds or until fatigue (each leg). On your side with your elbow directly under your shoulder, come up on your elbow and knees. Maintain positions without rotating. Purpose: Activate muscles on the side of your core and hip.
Back Planks (On Ball): 3 x 45 seconds. With your feet against the wall and in a high kneeling position, come down on the ball (55 cm ball preferred), and then straighten your legs so that your knees are off the ground and your hands are supporting you. The ball should be positioned under your abdominals. Maintain a parallel position to the ground, bring one hand to your glutes, and then the other hand to the other glute while maintaining form. You should feel muscle activation in the glutes, hamstrings, and lower back. If too easy, bring your arms up near your head to increase lever arm and demand. (No Ball): 3 x 10 repetitions. On your hands and knees in a quadruped position, bring one leg back while maintaining a level and stable core. Hold your leg out for 3 seconds then come back and alternate with the other leg. If that is too easy, you can alternate the hand/leg sequence to increase demand on the core and back musculature. Purpose: Activate hamstring, glute and lower back musculature.

Kneeling Hip Flexor Stretch: 1 minute (each side). In a kneeling position with your hands on the wall for support, perform a posterior tilt by engaging your abdominals and glutes. Keeping your spine in a neutral position (do not extend your low back), lean forward until you feel a decent pull at the front of your hip. For a challenge, bring one arm up overhead and lean away. Purpose: Stretch the hip flexor muscles while also decreasing anterior tilt to reduce strain on the lower back.
Double Leg Glute Bridge (With Band): 3 x 12 repetitions (or until fatigue). On your back with knees bent in hooklying position, perform a posterior tilt and then engage you glutes by coming up in the air. If you have a Band or Belt, place it around your thighs and push out into it to increase recruitment of the glutes. Maintain the posterior tilt the entire time. If you feel some achiness in your back, do not go up as high, but assess if you are maintaining your posterior tilt. Purpose: Activate in glutes, hamstrings, quads, and low back.
Wall Squats (With Ball): 3 x 12-16 repetitions. (No Ball): 3 x 30 seconds. Place a ball behind you with your feet out nearly, shoulder-width apart, 2 feet from the wall. Keeping your back straight, bring yourself down in a squat, knees bent at about 90 degrees without the knee caving in, feeling the primary work in the quadriceps. Purpose: Strengthen quads to support lower back.
Calf Stretch: 1 minute per side. Standing with one foot back, place your toes on a half roll or rolled-up towel to increase stretch. Lean forward while keeping your knee straight. Purpose: Decrease calf restrictions to decrease strain on the lower back.

TO GRADUATE TO PHASE 2

Required: Able to bend forward and backward at a pain level <2/10
Required: Pain does not linger for more than 1 minute after being aggravated
Required: Able to perform a posterior tilt consistently when exercising.

Principles of Lower Back Pain: A Review

CAUSE – Tensile, compression or shear overload of the disc, joint, muscles, or surrounding lumbar ligaments.
NEED – Unload the lumbar spine to decrease symptoms with isometric contractions to restore muscle function and decrease inflammation.
PLAN – Once pain decreases, gradually increase load to improve tissue resiliance and structural integrity.

Still Need Help?

You are welcome to meet virtually with our PT for additional feedback and assessment. Otherwise, continue to the next step to learn how best to manage the pain from your injury.