Almost everyone experiences low back pain at some point in their life (Hoy, 2010). While common, it is something that you will want to address earlier rather than later. The low back is considered the part of the trunk surrounding the lumbar spine.
Lower back pain can be caused by issues with the lumbar vertebrae or the muscles of the back and the surrounding body parts. This is why exercises for low back pain may involve various body parts, such as the mid back, core, hips, and legs.
Lower back pain can occur in those with osteoporosis due to what is happening at the vertebrae level. When osteoporosis occurs in the lumbar spine and bone density is low, vertebrae can compress together, potentially leading to compression fractures. Because of this, pain and inflammation can occur in this area.
Low bone density in the spine can cause people with osteoporosis to assume a forward rounded spinal posture. This can lead to stiffness of the muscles around the spine, further contributing to low back pain.
Muscles That Cause Low Back Pain
The lower back muscles are not always the lone culprit for low back pain. Muscles that move the upper body, hips, and legs can also affect the back. When these muscles are tight, they can change your gait pattern and posture, putting a strain on the lumbar spine.
For example, muscles such as your glutes, piriformis, and hamstrings can cause back pain if they're too tight. Because of their close proximity to the low back, these muscles can pull on the pelvis and put pressure on the back in a way that can lead to pain.
Listed below are a handful of muscles located close to the lumbar spine. Stretching these muscles are typically part of a low back pain prehab or rehab program It is thought that if you can decrease the tension, or lengthen these muscles, there will be less stress on the low back and result in less pain (Radwan, 2015).
- Gluteus Maximus
- Piriformis Muscle
- Latissimus Dorsi
- Hamstrings
- Psoas
- Iliacus
- Rectus Femoris
Types of Stretching to Avoid with Osteoporosis
Stretching can be an essential part of an exercise program for those with osteoporosis. Stretching is considered a low-impact physical activity typically safe for most populations (Chilibeck, 2011). However, before starting a stretching program to help with your back pain, take caution. Stretching, especially at specific ranges and in certain directions, can cause stress on fragile bones. Those with progressed osteoporosis and low bone density should avoid certain exercises that cause extreme movements into:
- Flexion (bending over of the spine)
- Twisting (turning in a way that the hips are facing a different direction than the shoulders)
- Extension (bending backward and arching the spine).
If you are unsure which type of stretching program is the safest for you, talk to your healthcare provider to get their advice.
Best Lower Back Stretches
Below is a list of exercises that can ease low back pain. Ideally, tight muscles benefit from prolonged stretches (held for at least 60 seconds at a time) and from performing a stretching routine every day (Page, 2012). A regular stretching routine helps alleviate pain and can contribute to an overall state of wellness.
You will see that all of the stretches below have a suggested hold of 30-60 seconds. If you can hold for the full minute, please do so. When you first start a stretching program, these stretches may be uncomfortable. This is why there is a 30-second hold option. Hopefully, as you perform the stretches more frequently, you will work yourself up to holding for a full minute.
1. Cat-Cow
Cat-cow is a non-weight-bearing exercise that introduces gentle flexion and extension of the spine. It helps stretch the muscles involved in spinal flexion (bending forward) and spinal extension (bending backward). Because it is performed in a non-weight bearing position, it is typically safer than if replicated standing upright.
If you have osteoporosis, you should avoid flexion (or the "cat" portion of this exercise) and simply move between neutral spine and "cow" stretch.
How to:
- Start on a soft surface, such as a yoga mat, blanket, or bed.
- Position yourself on all fours, with your hands shoulder-width apart, just under your shoulders and your knees hip-width apart, just under your hips.
- Start by tucking your chin to your chest and rounding your spine up towards the ceiling, engaging your core muscles. Hold for 1-2 seconds.
- Then reverse this by looking up towards the ceiling, reaching your tailbone up towards the ceiling, and dropping your belly towards the floor.
- Perform 10 repetitions of this, then take a 30-second break.
- Perform another 1 or 2 sets.
Tips:
- Do not force this movement. Gently move through this. This exercise does involve flexion and extension of the spine. If you have low bone density, move through a small range. If you are unsure if this exercise is for you, please ask your healthcare provider before giving it a try.
- Place a pillow or extra towel under your knees if you have sensitive knees.
- Try linking your breath with the movement by inhaling while you drop your belly and look up and exhaling while you tuck your chin and you round your spine upward.
2. Knee-to-Chest
Although this may look like a hip and knee stretch, this exercise provides low back pain relief because it gently stretches out the back muscles and takes some pressure off of the lumbar vertebrae.
How to:
- Start by laying on your back on a comfortable surface such as a yoga mat, blanket, or bed.
- Bring both hands behind your left knee and gently pull it into your chest. Hold for 30-60 seconds.
- Your opposite leg can remain straight or with a bent knee.
- Next, relax and then bring your right leg up, grabbing behind the knee with both hands. Pull the right knee into your chest and hold for 30-60 seconds.
- Repeat one more time on both the left and right sides.
Tips:
- Try to keep your head and shoulders relaxed as you hold this stretch.
- If holding behind your knee is difficult, use a towel, belt, or strap behind the knee to assist with this exercise.
- Do not force this stretch, especially if you have hip or knee pain. Excessive force to these joints may exacerbate pain.
3. Child's Pose
This is a standard yoga pose that allows gentle stretching of the muscles around the lower back and upper back.
How to:
- Start on a soft surface, such as a yoga mat, blanket, or bed.
- Position yourself on all fours, just as you did with the cat-cow pose.
- Next, without moving your hands, rock your hips back until they sit on your heels.
- Hold for 30-60 seconds.
- Rest, but coming back up to all fours.
- Repeat for 1 or 2 more sets.
Tips:
- If this exercise hurts because your knees are sensitive to kneeling, place a towel or pillow under your knees.
- If the bending of your knees hurts, place a towel roll or pillow behind your knees (in the crease of your knees) to bolster the knee bend.
- Try to relax into this movement by taking nice slow breaths as you hold the stretch.
4. Posterior Pelvic Tilt
This exercise is often seen in a physical therapy setting. The pelvic tilt is a common core exercise that also provides a gentle stretch to the lumbar spine.
How to:
- Lay on your back on a firm but comfortable surface. A yoga mat or blanket on the floor works best here.
- For the starting position, bend your knees so that both feet are flat on the floor. Note the slight arch in your low back here.
- Tuck your pelvis so that the arch of your low back flattens into the floor and your belly button moves upward slightly towards your rib cage. Next, gently engage your abdominal muscles. Hold for 1-2 seconds.
- Relax to the starting position, and repeat this for 10-15 repetitions.
- Rest for 30-60 seconds before performing another 2 sets.
Tips:
- Do not force this exercise by clenching your abdominal muscles. Instead, this should be a very gentle abdominal engagement.
- Try to maintain a steady breathing pattern while performing this exercise. Try to avoid holding your breath.
5. Piriformis Stretch (also called Figure 4 Stretch)
As mentioned above, the piriformis muscle can be a pesky culprit of low back pain. This stretch is predominantly felt in the glutes but can help with back pain. It is often given to people who suffer from sciatica since the sciatic nerve is located very close to the piriformis muscle.
How to:
- Start by laying on your back on a comfortable surface. Bend both knees so that both feet are flat on the floor, mat, or bed.
- Lift your left leg, resting your left foot over your right thigh. Gently push your left knee away from your body. You may feel a stretch in your left glute.
- If you do not feel a stretch yet, reach your hands around your right leg and hug it to your chest. You should now feel a stretch in your left glute.
- Hold for 30-60 seconds.
- Repeat this on the other side by resting your right foot on your left thigh. Then, either use your hands to push on your right knee or hug your left leg to your chest.
- Repeat a total of 2-3 sets on each side.
Tips:
- Try to maintain a relaxed upper body and steady breath as you perform this stretch.
- If you have difficulty hugging your leg into your chest, use a towel, belt, or strap to assist.
6. Pigeon Pose
This is a common yoga pose for both the piriformis and hip flexors. It is another exercise given for sciatica.
How to:
- Start by laying on your stomach on a comfortable surface.
- Use your hands to press your chest and hips upward off of the floor.
- While you are here, bring your right knee up towards your chest and let it rest on the mat towards your right hand. Your foot should be positioned towards your left hand.
- Lean your chest forward until you feel a stretch in your right glute.
- Hold for 30-60 seconds.
- Repeat 2-3 sets total on each side.
Tips:
- Try to maintain a steady breath with this stretch.
- If you feel a strain on the knees while doing this exercise, flex your foot (toes upward towards the knee).
- This can be an uncomfortable stretch as it involves moving into significant ranges of hip and knee range of motion. If you are unsure if this exercise is for you, please seek medical advice.
- This exercise can also be performed by sitting in a chair, crossing one foot over the opposite knee, and your chest leaning forward over your legs. This is called a Seated Pigeon Pose.
7. Sphinx Stretch
This is a great exercise to move into gentle lumbar extension and relax the lower back muscles.
How to:
- Start by laying on your belly on a comfortable surface.
- Place your elbows directly under your shoulders with your forearms flat on the floor.
- Look straight ahead or slightly downward with a soft gaze.
- Hold this position and breathe for 30-60 seconds.
- Relax by lying flat on your stomach for 30 seconds.
- Repeat this for 2-3 sets total.
Tips:
- If this exercise strains your low back, walk your elbows in front of you, which will lead to a smaller bend in the back. You can also place a small pillow under your hips.
- If you have pain radiating down the legs with this exercise, please seek medical advice.
8. Modified Cow Face Pose
This stretch is a yoga pose that stretches both glutes simultaneously. As mentioned above, tight glute muscles can lead to lower back pain, so it is important to stretch them.
How to:
- Start by sitting on a large and comfortable surface. Avoid sitting on a chair for this one. Instead, try to use the floor or your bed.
- Cross your right leg in front of you so that your knee is centered to the middle of your body.
- Then cross your left leg, stacking your left knee over your right knee.
- You may feel a stretch in your glutes here.
- For a deeper stretch, gently lean your trunk forward.
- Hold for 30-60 seconds.
- Rest by relaxing out of this position.
- Repeat for a total of 2-3 sets.
Tips:
- If this stretch is too uncomfortable or causes pain in the knee, please refer to the seated pigeon pose mentioned above.
9. Prone Quadriceps Stretch
This stretch is performed lying on your stomach. It elongates the muscles at the front of the thigh and hip, which can help reduce pressure on the lower spine.
How to:
- Start by lying on your stomach. If this is uncomfortable, place a pillow under your stomach.
- Use your hand to help you bend one knee as far as you can behind you.
- Hold the static stretch for 30 seconds.
- Then lower your leg back down to the starting position.
Tips:
- Breathe while performing this stretch. As you breathe, you may find that you can sink deeper into the stretch.
- Make sure you do not arch your lower back as you bend your knee.
- You should not experience any pain with this exercise. If you do, back off on how much you are bending your knee to the point where you feel stretch but not pain.
- If you cannot reach your foot with your hand in this position, you can use a rolled up sheet, towel, or exercise strap wrapped around your foot to help you.
10. Seated Hamstring Stretch
As noted above, the hamstrings are a huge muscle group that attaches to the low back. Therefore, tight hamstrings play a significant role in low back pain. There are many different ways to stretch your hamstrings, including the one below.
How to:
- Start by sitting on the edge of a chair or bed with your feet flat on the floor.
- Straighten out your right leg so your heel is on the floor and your toes are pointing upward.
- Slowly lean your trunk forward, reaching your hands towards your right foot. You should feel a stretch in the back of your right thigh.
- Hold for 30-60 seconds.
- Repeat on the left side.
- Perform a total of 2-3 sets on each side.
Tips:
- Feel free to bend the outstretched leg slightly if this stretch is too uncomfortable.
- Do not force this stretch. Only lean forward until you feel a stretch—no need to force your trunk forward.
Additional Ways to Address Back Pain
Stretching to gain a range of motion and relieve pain takes time. However, even with a disciplined daily stretching routine, it may not address some really deep back pain since the source of the pain can be caused by various other ailments.
If stretching regularly has not relieved your low back pain, try some other options such as:
- Working with a physical therapist.
- Trying alternative therapies like acupuncture or chiropractic medicine.
- Back exercises and workouts to strengthen the muscles surrounding the low back.
- Improving your seating posture.
- Checking that your mattress and sleeping position is supporting a healthy spine.
