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Exercise After a Back Injury

By Kathy Shillue, physical therapist at Beth Israel Deaconess Medical Center

Even though you may feel like you have too much pain to move around--and all you want to do is get into bed and stay there - it's important to stay as active as possible.  Exercise after a back injury helps the healing process and can prevent recurrent back pain.

Cardiovascular Exercise

When you hurt your back, walking is one of the best exercises you can initially do because it allows you to keep the spine straight, which is generally a more comfortable position.Cardiovascular exercise or conditioning exercises should be the main component of your exercise program. When you hurt your back,  walking is one of the best exercises you can initially do because it allows you to keep the spine straight, which is generally a more comfortable position. Walking can be done with little or no equipment and you can reduce your speed and distance initially when you have more pain, and increase as you feel better. If walking for 20-30 minutes feels like too much, walk for 5-10 minutes at a time, five to six times during the day. Work your way up to 30 minutes at one time. 

If you already exercise regularly, you may need to make some adjustments initially in order to stay active and prevent any loss of conditioning as you recover. It is OK to take a day or two off from exercise after an acute injury and then return at a slightly lower intensity. For example, if normally you would run, you can walk instead. Or, if you would usually bike, you might find the sitting position uncomfortable but may be able to tolerate a recumbent bike. The important thing is to find something you can do without worsening your symptoms

Stretching

Stretching or flexibility exercises are important, especially in the hips and legs. Keeping the hips and legs flexible means you don't have to use as much movement of the spine to get your daily activities done, and that usually means less back pain.

Some of the main muscles that are often tight are: hamstrings (on the back of the thigh), the psoas muscle (on the front of the hip) and the gluteals (buttocks muscles).

  • Hamstrings are the muscles on the back of the thighs.  To stretch them, put one leg up on a small step.  Lean your trunk forward but try to keep the spine straight.  Stop when you feel a mild pulling on the back of your thigh.
  • The psoas or hip flexor muscle is on the front of your hip and can get tight if you sit a lot. To stretch, put the opposite foot up on a step or chair.  Lean your hips forward until you feel a mild stretch on the front of the standing leg. 
  • The gluteals are the muscles of the buttocks.  Lie on your back and cross one leg over the other.  Pull both legs towards your chest.  You can also use a towel or belt to help lift the lefts.   You will feel this pull on the buttock of the leg that is crossed. 

Stretching hamstrings (left), psoas or hip flexors (middle) and gluteals (right)

Stretches should be done slowly and gently and should never be painful. You may feel a pulling or stretch along the muscle you are stretching, and as you hold the stretch for 20-30 seconds that stretching sensation should get less intense. If you feel more discomfort the longer you hold the stretch, you are probably pulling too hard. Do each two to three times.

Strengthening

Adominal exerciseYou need strong muscles to support your spine and this means strengthening your "core" muscles. These are the muscles of your abdomen and back. In order to make sure you use the proper form, you should concentrate on tightening your lower abdomen. Think about pulling your belly button in towards your spine, or pretend your pants are too tight and you have to pull your abdomen in to get the zipper up. Hold that muscle contraction but make sure you don't also hold your breath.

You can begin to strengthen these muscles by holding this muscle contraction as you do daily activities. Try holding these muscles tight while you are sitting or standing, and practice doing this without holding your breath. If you can do that, try keeping the muscles tight as you take a few steps, or reach for something. See how long you can hold them tight before you get tired. 

The more you do these, the stronger your muscles will get and the longer you will be able to hold before getting tired. As you practice, you are training your core muscles to provide support for your spine throughout the day. 

Note: Beginning any exercise program may cause some muscle soreness, but exercises should never cause an increase in leg pain. If you feel any worsening of these symptoms, you may need to talk to your doctor or physical therapist about a more individualized exercise program. 

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted March 2011

Contact Information

Spine Center
Beth Israel Deaconess Medical Center
Shapiro Clinical Center, Second Floor
330 Brookline Avenue
Boston, MA 02215
617-754-9000
spinecenter@bidmc.harvard.edu

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