Wednesday, February 6, 2013

The Direct Approach: Treating Lower Back Pain with Strength

Yesterday, I had a conversation with a member at the gym where I instruct. The woman--let's call her Melissa--was looking for a way to do aerobics since she has lower back (a.k.a. lumbar spine) pain that flares up while using ellipticals, treadmills, and even with long walks. My mind, as usual, was more concerned with the underlying issue more than working around the symptoms of the issue.

During our conversation, Melissa said she went to physical therapy (PT), which improved her back pain, but the pain has returned since PT ended. After I asked if she trains her lower back, she said her workouts include core exercises, but she later admitted that lower back strengthening was not a part of that.

I mentioned a few blogs ago that I used to have chronic lower back pain. In 2008, I took well-intentioned advice from a credible and experienced personal trainer on adjusting the seat setting for one of my usual exercises. I felt an odd sensation in my lower back during the exercise, and then had weeks of pain following the incident.

The pain subsided, returned months later, but disappeared again. Now, I participate in all sports and physical activities that I please without pain. Also, I regularly use the exercise where my pain first developed. What happened?

Lumbar Extension for Lower Back Pain

Since 2006, lumbar extension has been a part of my workout. The use of that exercise was inconsistent at times. However, when the injury first occurred, I resumed regular performance of lumbar extension, and the pain quickly went away. After a while of being pain-free, I stopped performing the exercise, and the pain came back within a few weeks. Now, I train my lower back once per week, and, as mentioned previously, my lower back feels great.

In the last seven years, I've used this exercise with dozens of clients who had lower back pain, and the majority of cases resembled mine: pain has mostly or completely subsided.

For those who are unfamiliar with lumbar extension, look at the picture above. The woman leaning forward is in flexion. An extension exercise takes her from leaning forward to the position where she is leaning all the way back (which is technically referred to as "hyperextension"). A lumbar extension exercise basically requires you to lean back against resistance.

Even though I have anecdotal evidence with client and personal experience, don't take my word when it comes to lumbar extension treating chronic lower back pain. Let's look at the research.

Over a nine year period, 197 minors in Montana averaged 2.9 back injuries per 200,000 hours worked [1]. In this study, those minors participated in a lumbar extension exercise program (using a machine based on the diagram below) for a minimum of 20 weeks. Considering that the starting dates were scattered, the entire study lasted a year. During that year, the back injury rate decreased to 0.5 injuries per 200,000 hours worked! Workers compensation decreased from $14,430 per month (over the previous 40 months) to only $380 per month during the study! Depending on the degree of flexion/extension, averaged lumbar strength increased from 54-104%.

The most notable detail from the miner study may be the exercise time requirement: two minutes per week! The minors performed only one set--to complete fatigue--per week. (If you own a business where a large percentage of employees struggle with lower back pain, how do you not drop what you are doing and buy one of these machines instantly?!).

Another study used a lumbar extension exercise with chronic lower back pain sufferers [2]. After 18 treatments in 10 weeks, lower back pain, leg pain, and ability to perform regular daily activities all improved. A six-month study with men and women between 60-82 years old also determined that one weekly set of lumbar extension exercise--performed to complete fatigue--improved strength and lumbar bone density [3].

As you see, two of the studies focused on a frequency of once per week. Do the results improve with increased frequency? No. When looking at lumbar strength, performing extension one, two, or three times per week over 12 weeks provided no differences in strength gained between the groups [4].

Researchers who put together a review of related studies had this to say about the most important detail of lumbar strengthening exercises:

What lesson did 100 years of back strengthening provide? The need for overload is most dominant [5].

In other words, as your lower back becomes stronger, keep increasing the resistance to stimulate further improvement.

Performing Lumbar Extension

Most of the studies used a MedX lumbar extension machine, which is pictured below. The advantage of this machine is the stabilization of the pelvis, which allows the lower back muscles to perform the movement instead of the hip muscles. Nautilus also makes a similar version.

While I'm a strong proponent of this machine, chances are your workout location does not have a lumbar extension machine. As a substitute, I have found the following exercises to work effectively for minimizing or eliminating lower back pain.

When using the two exercises above with clients, I recommend extending as far back as possible (assuming no pain is felt) and moving with a perpetual slow speed. If you choose to perform one of the exercises yourself, I recommend asking one of the trainers at your local gym.

While Melissa seemed lukewarm on the idea of lumbar extension, it has worked incredibly for many with chronic lower back pain--including yours truly--and it requires a minimal time commitment.


mrfreddy said...

Timely advice!

Anyway, I've been wondering what I could do for my back when I don't have access to that Medx contraption. I may buy one for myself some day haha...

Backstory: Had extreme lower back pain about seven years ago, Fred Hahn's Medx lumbar machine fixed me almost instantly. Seven years later, had another bout (had stopped going to Slow Burn, you see..)... I went back to Fred and co., and while it wasn't instantaneous like last time, I think it did help. After about six weeks I feel as good as new.

Steve Parker, M.D. said...

Great post, Sean.
I wonder one could get one of those lumbar extension devices pictured at the very top of the article. Pre-owned would be fine.
I think I'll work out something with my Swiss ball, as in the bottom photo.

Unknown said...

There can be any reason for low back pain and it is essential to diagnose properly so as to confirm the cause of low back pain. The methods used for the diagnosis are X-ray imaging, Discography, Magnetic resonance imaging (MRI) and many more. You can also consult a physiotherapist for the treatment and he can suggest you exercise according to the type of the injury or pain.
physiotherapy Dublin

Dr. Sean Preuss said...


Good to hear from you. Are you currently seeing Fred? If you aren't, most gyms have the 45 degree lower back extension. While it's not as great as the MedX machine, I have found it to be an effective replacement.


Pre-owned, the MedX low back extension is often around $3,000, give or take $500. If you're serious, look at As I mentioned to Fritz, the 45 degree lower back (or Swiss ball) exercise works well, too.


mrfreddy said...

Yeah I just started back with Fred, mainly to fix my back. My wifey bought a 25 pack, god bless her! But it's nice to know there are other ways to work my back so thanks for these posts. For one thing,I don't want to always be dependent on Fred's studio to avoid back pain. I may look into buying a swiss ball - that other 45 degree thing is too big for our place, and I dont think the gyms I have access to have one.