The Best Core Exercises for Low-Back Pain

Eighty percent of Americans are estimated to experience at least one episode of back pain in their lives. And according to the American Chiropractic Association, the total cost of back pain treatment in the United States surpasses $100 billion annually.

My question: How can this be when most forms of low-back pain are typically treatable with conservative management and specific exercise? As a practicing physical therapist, I would say most, if not all, of my clients respond extremely well to exercise in order to reduce symptoms. Once they commit to exercise and understand the cause of the pain and how to manage their symptoms, it’s much easier to prevent recurrence.

While it’s fun to show off your rectus abdominis muscles (aka six-pack) at the beach, they do very little for the stabilization of the lower back. I’m here to highlight the transversus abdominis (TA) muscle, a deep, strap-like muscle located in the core — one of the only muscles that attaches to the lumbar spine. Therefore, it’s one of the main spinal stabilizers necessary to keep back pain at bay.

The exercises below focus on the TA muscle and support the reduction of low-back pain.

Transversus Abdominis Activation Exercises

The TA muscle wraps around the abdomen between the lower ribs and the pelvis and functions like a corset. The function of this muscle is to stabilize before movement of the arms and legs and is important in preventing deterioration of the lumbar spine and pelvis. You cannot strengthen a muscle that your brain is not accustomed to using. Therefore, training always comes before strengthening.

• Imagine a line that connects the inside of your two pelvic bones (front of hips). Think about connecting, or drawing, the muscle along this line as if closing two book covers.
• No movement of your hips, pelvis or spine should occur as you contract this muscle.
• Feel just inside the left and right hipbones and cough gently to feel this deep contraction.
• You should feel a light tension under your fingertips, not a contraction that pushes your fingers out.
• Hold the contraction for three to five seconds and then release. Breathe throughout this exercise. Repeat the contraction and hold for three sets of 10 repetitions three to four times per day for four weeks.
• Avoid posterior tilting of the pelvis, bulging of the abdomen, depression of the rib cage, holding your breath, and pressing out your fingertips with a strong muscular contraction (internal oblique holding).
• Goal: Do 10 sets of 10 holds.

Once you feel comfortable with engaging this muscle in this position, you can begin to progress this exercise in the following ways — in this order of difficulty. Achieve each goal set before moving on to the next exercise.

TA Exercise With Arms

Lift your arms off the mat for a three-second count, up and down to 90 degrees, holding this contraction. Gently release after each rep. Goal: Do two sets of 10 reps.

TA Exercise With Marching

Alternate lifting your legs off the mat or marching while keeping your pelvis stable and holding this contraction. Goal: Do two sets of 10 reps.

TA Exercise With Arms and Legs

Lift opposite arms and legs for a three-second count up and down, maintaining a braced core without pushing your back down into the mat. Goal: Do three sets of 10 reps.

Tabletop

Begin by supporting yourself with your arms underneath your shoulders, stacked above your wrists and hips at a 90-degree angle, with your weight evenly distributed. Unweight both legs and hold for three sets of 60-90 seconds.

Tabletop With Taps

Keep both legs unweighted while you gently tap each foot, maintaining a braced core. Goal: Do two sets of 10 reps.

Dead Bug

Practice a cat-cow exercise to go between the end ranges of lumbar flexion and extension in order to find a neutral spine and activate your TA. Extend both arms and legs off the mat while you extend the arm and the leg of the same side. Take note if you are pressing your lower back into the mat and losing your core stabilization with this exercise. If you are, decrease your reps or scale down.

Begin with 10 reps total on each side and increase up to two sets of 10.

Bird Dog

Get on all fours and perform the cat-cow exercise to feel the end ranges of lumbar flexion and extension in order to find a neutral spine (flat back) and activate your TA.

Begin with 10 reps total on each leg and increase up to two sets of 10.

Isometric Squat

Use isometrics to bring your new core activation skills off the mat and into more functional movement. Because most of us don’t exercise laying down, this progression is meant to be just that: a progression. These exercises are meant to assist in TA activation as you incorporate them into your regular exercise routine.

Begin with two sets of 10, ensuring that you do not sacrifice form.