Progression of Exercises to Treat Low Back Pain and Sciatica

Start Treating Your Sciatica and Back Pain

Photo of the sanding back bend.
When back pain strikes, learn what to do and when to do it.. QxQ Images-Datacraft/Getty Images

If you have low back pain or sciatica, a common question you may have is, "What should I avoid, what should I do, and when should I do it?"  It seems there are hundreds of treatments for low back pain, and many different exercises that can be done to help treat your condition.  Some exercises are to help strengthen your spine, while others are to improve flexibility of your back.

If you are referred to a physical therapist for your back pain, he or she will likely teach you how to attain and maintain proper posture.  The slouch overcorrect procedure is a simple way to teach yourself the posture that is required to maintain appropriate spinal alignment

Your physical therapist may also use therapeutic modalities to help decrease your pain.  While these may feel good, caution should be used; many of these treatments have not been proven to effectively decrease pain-and keep it away.

Physical therapists trained in the McKenzie Method are specialists when it comes to treating people with low back and neck pain. If you can find a therapist certified in the McKenzie Method, he or she will likely perform a thorough assessment of your problem and teach you self care exercises that can quickly abolish your pain and help you return to your previous level of function.

This is an exercise program commonly used to treat low back pain and leg pain that is coming from your back. They are listed as a progression. Start with exercise number one, and progress as needed through the exercises. You may not need to perform all of the exercises, but if the first one fails to provide you with adequate relief from your pain, try the second one, and so on.

How Do I Know If the Exercise is the Correct One for Me?

If you are experiencing pain on one side of your back or leg, then try the first exercise and monitor symptoms as you exercise. Watch for centralization, which is a decrease in leg or thigh pain and an increase in low back pain.  Centralization that occurs while you are performing an exercise is a good sign and indicates that the particular exercise is the correct one for you to be doing.

If your symptoms worsen, fail to centralize, or only centralize partially, move on to the next exercise in the list. Attempt the exercise, and monitor any changes in your symptoms.  Remember pain that moves closer to your spine is a good sign.

Before starting any exercise for your back, it is a good idea to check in with your doctor to be sure that exercise is safe for you to do. Your local physical therapist can help you decide on the best exercises for your specific condition.

Prone Lying, Prone Props, and Press Ups

Photo of a woman performing the upward dog yoga position.
The prone press up is an exercise that may help your low back pain or sciatica.. David Lees/ Getty Images

In the case of sudden onset of acute low back pain, you should try the emergency back pain exercises first.  Lie on your stomach for a few minutes, then prop onto your elbows for a minute or two.  Monitor your symptoms for centralization.

After a few minutes in the propped up position, try a few press ups.  Try to keep your hips and back relaxed as you use your arms to press your upper body up.  Try to press up as far as possible to restore the normal forward curve in your low back.  Perform 10 repetitions and monitor your symptoms.

If your pain does not fully centralize with the press up exercise, you may need to move on to the next exercise: the press ups with your hips off center.

Press Up with Hips Off Center

The prone press up with hips off center.
The press up with hips off center is used to treat back pain that is off to one side or the other.. Brett Sears, PT 2013

The press ups with hips of center is simply a press up with your hips moved to one side or the other.  To do this, prop onto your elbows and shift your hips to one side.  Most often, people benefit from moving their hips away from the painful side.

Once your hips are off to one side, perform a press up.  You may notice that you are not able to press up as far as you did with the regular press up.  Perform 10 repetitions of the press up with your hips off center, and monitor your pain for centralization. If your symptoms persist, you may need to take the next step in the progression: lumbar side glide in standing.

Lumbar Side Glide in Standing

The side glide is used mainly in the treatment of one sided low back or leg pain.
Stand against the wall and use your hand to press your pelvis under your ribs.. Brett Sears, PT, 2013

If the press up with hips off center failed to offer significant relief or centralize your symptoms, you should then try the lumbar side glide exercise.

This exercise is done standing about a foot from a wall with your painful side away from the wall.  Lean your shoulder against the wall with your elbow tucked into your ribs, and slowly push your pelvis underneath your ribcage.

Perform 10 repetitions of the side glide, and watch for changes in your pain.  If your pain continues or fails to centralize, try the next exercise: the lumbar flexion rotation stretch.

Lumbar Flexion Rotation Stretch

Photo of the lumbar flexion rotation stretch.
The flexion rotation stretch can help relieve back pain and sciatica.. Brett Sears, PT, 2012

The flexion rotation stretch is started by lying on one side.  Usually, your painful side is down on the table.  Straighten your bottom leg, and tuck your top leg behind your bottom knee.

Reach your top hand to your top shoulder blade, and rotate your spine so your top shoulder moves backwards toward the floor.  Hold this position for a second or two, and then return to the starting position.  Repeat 10 repetitions, and note any changes in your symptoms.

Still dealing with symptoms? You may need to try a lumbar flexion progression. Check out the final step in this program to learn how.

Lumbar Flexion

Photo of woman stretching her back on the couch.
Your PT can help you set up a home exercise program for lumbar spinal stenosis.. PhotoAlto/Milena Boniek/Getty Images

The lumbar flexion stretch is done by simply lying on your back with both knees bent.  Slowly bring both knees up toward your chest, and grasp underneath your knees with both hands.

Give a gentle pull to your knees to stretch your back, and hold this position for a second or two.  Then, slowly release the stretch.  Perform the knees to chest stretch for 10 repetitions and closely monitor any changes in your symptoms.

Remember, checking in with your doctor whenever low back pain strikes is always a good idea. Working with your physical therapist to learn which exercise progression is best for your condition can help you quickly abolish your pain and return to your normal activity.

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