Provider Practice Essentials registered nurse continuing education

Chronic Low Back Pain Solution: Physical Activity

Patients often ask, “what exercise or stretch can I do to help my low back?” Most of the time
they are looking for a one exercise, one stretch chronic low back pain solution and it isn’t that simple. The reality is there is no one exercise or stretch that is going to fix and prevent chronic low back pain. The answer is a combination of physical activity components (and even this isn’t a cookie cutter solution.)

A common belief is if one has a strong core, they won’t have low back pain. While having a strong core is definitely an important key factor in preventing low back pain, it goes much deeper than that.

Possible Solutions for Chronic Low Back Pain

In a systematic review of literature, Gordon and Bloxham (2016) discuss a general exercise
program combining muscular strengthening, flexibility and aerobic fitness as being highly
beneficial for the rehabilitation and prevention of non-specific chronic low back pain.
Let’s take a further dive into the three physical activity components for non-specific chronic low back pain:

  1. Aerobic Exercise
  2. Flexibility
  3. Muscle strengthening and stabilization

Aerobic Exercise

We know that the term aerobic means “with oxygen” so with aerobic exercise, the body will be getting an increase in oxygen through the vascular system. This in turn is going to feed oxygen and nutrients to the soft tissue, promoting healing and repair of tissue.

Aerobic exercise also increases our bodies production of endorphins. The magical power of endorphins is that they bind to our bodies’ opiate receptors in the brain and spinal cord, decreasing the perception of pain.

Research also shows that aerobic exercise improves body movement and decreases the fear of movement (Gordon & Bloxham, 2016). Wouldn’t that be an awful feeling to be afraid of simple movements like bending down to tie your shoe?


Many different moving parts of the body affect the low back directly. There’s the buttocks, hips, legs and abdominal muscles just to name a few. If any of these areas have decreased flexibility it can and likely will cause low back issues.

As an example, anyone who sits the majority of their day and doesn’t stretch their legs, hips and low back is going to have tight muscles. By stretching the hip flexors, quadriceps, hamstrings, buttocks and low back, the mobility of the spine will increase and the pain will decrease.

Gordon and Bloxham (2016) state that by improving flexibility of the lumbar spine and hamstrings, chronic low back pain is reduced by 18.5%-58%.

Muscle Strengthening and Stabilization

The phrase “if you don’t use it, you’ll lose it” comes to mind when thinking of muscle strength and stabilization. If muscles are not worked, they will waste away over time. When deep stabilizing muscles are not used, superficial muscles take over and this is a common reason for acute low back injuries. Through strengthening and stabilization of the deep lumbar muscles along with the deep abdominal muscles, chronic low back pain is reduced, the risk of injury declines and functionality is increased.

Advance Practitioner Role in Treating Lower Back Pain

As physicians, physician assistants and nurse practitioners, we will be referring our patients out to physical therapy and physical rehabilitation for non-specific chronic low back pain. We likely won’t be the health care provider teaching our patients the physical activity program for chronic low back pain.

However, we are responsible for educating our patients on why they need to comply with exercise and stretching programs. I truly believe if a patient understands why we want them to do something and how it is going to benefit them, they are more likely to follow through with the treatment and have success.

More Low Back Pain Solution Articles


Gordon, R., & Bloxham, S. (2016). A systematic review of the effects of exercise and physical
activity on non-specific chronic low back pain. Healthcare, 4(2), 1-19.

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