5 Evidence-Based Exercises for Lower Back Pain Relief
- Hardev Goraya
- Dec 29, 2025
- 13 min read
Updated: Dec 30, 2025
Lower back pain affects approximately 80% of Canadians at some point in their lives, making it one of the most common reasons people seek physiotherapy in Brampton, Mississauga, and Vaughan. While rest might seem like the logical solution when your back hurts, research consistently shows that appropriate exercise is actually one of the most effective treatments for both acute and chronic lower back pain.
As a registered physiotherapist with eight years of experience treating musculoskeletal conditions, I've seen these five exercises help hundreds of patients reduce pain, restore function, and prevent future episodes. These aren't random stretches—they're evidence-based movements supported by research and clinical practice guidelines.
Why Exercise Works for Lower Back Pain
Before diving into the exercises, it's important to understand why movement helps when you're in pain:
Pain science principles:
Movement reduces pain sensitivity by releasing natural pain-relieving chemicals (endorphins)
Exercise decreases inflammation in affected tissues
Activity prevents the nervous system from becoming overly sensitized to pain
Movement improves blood flow, promoting healing
Mechanical benefits:
Strengthens muscles that support your spine
Improves flexibility and reduces stiffness
Restores normal movement patterns
Reduces stress on injured structures
Prevents muscle atrophy from disuse
Psychological benefits:
Reduces fear of movement (kinesiophobia)
Increases confidence in your body's abilities
Provides sense of control over your condition
Breaks the pain-inactivity-more pain cycle
Important note: While these exercises are safe for most people with lower back pain, if you have severe pain, numbness/tingling down your legs, loss of bladder/bowel control, or recent trauma, see a healthcare provider before starting any exercise program.
Understanding Your Lower Back Pain
Lower back pain isn't a single condition—it has many causes:
Common types:
Mechanical/non-specific back pain: Most common (85% of cases), pain from muscles, ligaments, joints without specific structural damage
Disc-related pain: Bulging or herniated discs irritating nerves
Facet joint pain: Arthritis or inflammation in spinal joints
Sacroiliac joint dysfunction: Pain from the SI joint where spine meets pelvis
Muscle strain: Overuse or acute injury to back muscles
The good news: Exercise helps all of these conditions, though specific exercise selection may vary. The exercises below target the most common causes of lower back pain and are generally safe for most people.
The 5 Evidence-Based Exercises
Exercise 1: Cat-Cow Stretch (Spinal Mobilization)
Why it works:
Gently mobilizes all segments of your spine
Reduces stiffness in spinal joints
Promotes fluid movement in intervertebral discs
Relieves muscle tension through gentle stretching
Improves awareness of spinal positioning
Research support: Spinal mobilization exercises reduce pain and improve function in people with chronic low back pain (Cochrane Review, 2021).
How to perform:
Starting position:
Hands and knees on floor (quadruped position)
Hands directly under shoulders, knees under hips
Neutral spine (natural curves maintained)
Look at floor, neck aligned with spine
The movement:
Cat position (spinal flexion):
Exhale slowly
Round your spine toward ceiling
Tuck tailbone under
Draw belly button toward spine
Let head drop gently (look toward knees)
Hold for 2-3 seconds
Cow position (spinal extension):
Inhale slowly
Arch spine, letting belly drop toward floor
Lift tailbone toward ceiling
Lift chest and gaze forward (not up—avoid straining neck)
Hold for 2-3 seconds
Dosage:
10-15 repetitions
Move slowly and smoothly (not quickly)
2-3 times daily, especially in morning
Common mistakes to avoid:
Moving too quickly (should be slow and controlled)
Forcing range of motion (stay within comfortable limits)
Hyperextending neck (keep neck neutral in cow position)
Holding breath (breathe rhythmically throughout)
Progression: Once comfortable, you can add a "thread the needle" component by reaching one arm under your body during the cat position, increasing thoracic spine rotation.
Who benefits most: People with morning stiffness, general back pain, or those who sit for long periods.
Exercise 2: Bird Dog (Core Stabilization)
Why it works:
Strengthens deep core muscles (transverse abdominis, multifidus)
Improves spinal stability without excessive loading
Enhances coordination and balance
Strengthens gluteal muscles that support the lower back
Teaches neutral spine maintenance during movement
Research support: Core stabilization exercises significantly reduce chronic low back pain and improve function (multiple systematic reviews show moderate to large effect sizes).
How to perform:
Starting position:
Hands and knees (same as cat-cow starting position)
Hands under shoulders, knees under hips
Engage core by gently drawing belly button in (not sucking in)
Maintain neutral spine (don't let back sag or arch excessively)
The movement:
Basic version:
Slowly extend right arm forward to shoulder height
Keep hips level (don't rotate pelvis)
Maintain neutral spine (don't arch back)
Hold for 5-10 seconds
Return to starting position
Repeat with left arm
Then repeat with each leg separately
Advanced version:
Simultaneously extend right arm forward and left leg back
Arm and leg should form straight line with torso
Keep hips level (this is challenging!)
Hold for 5-10 seconds
Return to starting position
Repeat opposite side (left arm, right leg)
Dosage:
8-10 repetitions per side
2-3 sets
Daily, or at least 5 days per week
Common mistakes to avoid:
Arching lower back (most common error—engage core to prevent)
Rotating hips or shoulders (keep them level)
Lifting limbs too high (shoulder and hip height is sufficient)
Holding breath (breathe normally throughout)
Rushing through the movement (slow and controlled)
Modifications:
Easier: Start with just arm raises or just leg raises until you build strength
Harder:
Increase hold time to 20-30 seconds
Add small circles with extended limbs
Place unstable surface under hands (foam pad)
Who benefits most: Anyone with lower back pain, especially those whose pain increases with prolonged standing or walking (suggests need for better core stability).
Exercise 3: Pelvic Tilts (Lumbar Mobility & Motor Control)
Why it works:
Teaches conscious control of pelvic and lumbar spine positioning
Gently mobilizes lower back joints
Activates deep abdominal muscles
Reduces lower back stiffness
Provides foundation for more advanced exercises
Research support: Pelvic stabilization exercises reduce disability and improve pain in chronic low back pain patients (Clinical Rehabilitation, 2020).
How to perform:
Starting position:
Lie on your back (supine)
Knees bent, feet flat on floor (hip-width apart)
Arms relaxed at sides
Neutral spine (small natural arch under lower back)
The movement:
Posterior pelvic tilt:
Gently flatten lower back against floor
Do this by tilting pelvis backward (pubic bone moves toward ribs)
Feel abdominal muscles engage
Hold for 5 seconds
Lower back should press firmly into floor
Anterior pelvic tilt:
Increase the arch in your lower back
Tilt pelvis forward (tailbone moves toward floor)
Feel slight stretch in abdominals
Hold for 5 seconds
Gap under lower back increases
Return to neutral:
Release to natural resting position
Small arch under lower back
Pelvis level
Dosage:
10-15 repetitions (full cycle: neutral → posterior → neutral → anterior → neutral)
2-3 times daily
Can be done in bed upon waking and before sleep
Common mistakes to avoid:
Using legs or buttocks to create movement (should come from pelvis/core)
Pushing too hard into extreme ranges
Holding breath (breathe naturally)
Moving too quickly (slow, controlled movements)
Progression: Once you master this lying down, practice pelvic tilts:
Sitting in a chair
Standing against a wall
Standing without support
During daily activities
Who benefits most: People with stiffness, those learning to control spinal positioning, anyone with pain related to posture (improves postural awareness).
Exercise 4: Modified Bridge (Glute Strengthening & Hip Extension)
Why it works:
Strengthens gluteal muscles (glutes are often weak in people with back pain)
Reduces excessive load on lower back muscles
Improves hip extension (often limited in back pain sufferers)
Strengthens hamstrings and core
Teaches proper hip hinge pattern
Research support: Hip and gluteal strengthening reduces lower back pain and improves function, particularly in people with weakness-related pain (Journal of Orthopaedic & Sports Physical Therapy, 2019).
How to perform:
Starting position:
Lie on back, knees bent, feet flat on floor
Feet hip-width apart, heels about 12 inches from buttocks
Arms at sides, palms down
Neutral spine
The movement:
Basic bridge:
Engage core (gentle abdominal contraction)
Squeeze gluteal muscles
Lift hips toward ceiling
Create straight line from shoulders to knees
Keep knees aligned (don't let them fall inward or outward)
Hold for 5-10 seconds
Slowly lower with control
Dosage:
10-15 repetitions
2-3 sets
Daily or 5-6 days per week
Common mistakes to avoid:
Arching back excessively (should be straight line, not hyperextended)
Lifting too high (shoulder-to-knee line is sufficient)
Pushing through back instead of glutes (focus on squeezing buttocks)
Feet too close or too far from buttocks
Knees collapsing inward (keep them aligned over ankles)
Modifications:
Easier:
Perform smaller range of motion
Don't hold at top (continuous movement)
Place feet on slightly elevated surface
Harder:
Single-leg bridge (extend one leg while lifting)
Hold at top for 20-30 seconds
Pulse at the top (small up-down movements)
Place feet on unstable surface (foam pad or pillow)
Add resistance band around thighs
Progression sequence:
Basic bridge with holds
Bridge with marching (alternate lifting feet while hips stay elevated)
Single-leg bridge
Single-leg bridge with extended hold
Who benefits most: People with weak gluteal muscles, those whose pain increases with prolonged sitting (glute weakness is common in sedentary individuals), anyone with poor hip extension.
Exercise 5: Knee-to-Chest Stretch (Lumbar Flexion Mobility)
Why it works:
Gently stretches lower back muscles and fascia
Mobilizes lumbar spine into flexion
Reduces muscle tension and spasm
Provides pain relief through gentle traction
Stretches hip flexors and piriformis (muscles often tight with back pain)
Research support: Stretching exercises improve flexibility and reduce pain intensity in chronic low back pain (multiple studies support flexibility training as part of comprehensive treatment).
How to perform:
Starting position:
Lie on back
Legs extended or knees bent (whichever is more comfortable)
Arms at sides
Relaxed position
The movement:
Single knee-to-chest:
Bend right knee toward chest
Clasp hands behind thigh or over shin (not on knee itself)
Gently pull knee toward chest
Keep opposite leg extended on floor (or bent if that's more comfortable)
Keep lower back pressed gently into floor
Relax into the stretch
Hold 20-30 seconds
Release and repeat opposite side
Double knee-to-chest:
Bring both knees toward chest
Clasp hands behind thighs or over shins
Gently pull both knees toward chest
Keep lower back and buttocks on floor
Relax shoulders and neck
Hold 20-30 seconds
Dosage:
2-3 repetitions per side (single knee)
2-3 repetitions (double knee)
2-3 times daily, especially after prolonged sitting or upon waking
Common mistakes to avoid:
Pulling too aggressively (stretch should be gentle, not forceful)
Lifting head/shoulders off floor (keep upper body relaxed)
Holding breath (breathe deeply and rhythmically)
Tensing muscles (relax into the stretch)
Bouncing or pulsing (hold steady stretch)
Modifications:
Easier:
Use a towel or belt looped around thigh to assist the pull
Start with very small range and gradually increase over days/weeks
Keep opposite leg bent instead of extended
Harder:
After pulling both knees to chest, gently rock side to side (massages lower back)
Combine with trunk rotation (knees to chest, then slowly lower both knees to one side)
Progression:
Single knee-to-chest
Double knee-to-chest
Double knee with gentle rocking
Double knee with rotation (advanced stretch)
Who benefits most: People with acute back pain, muscle spasms, stiffness in the morning, or those whose pain is relieved by flexion (bending forward).
Caution: If you have a disc herniation that increases pain with flexion (bending forward), this exercise may not be appropriate. Consult a physiotherapist for assessment.
Creating Your Exercise Program
How to use these five exercises:
For Acute Lower Back Pain (Pain for less than 6 weeks)
Week 1-2:
Focus on gentle mobility: Cat-Cow and Pelvic Tilts
Perform 2-3 times daily
Add Knee-to-Chest stretch if it provides relief
Listen to your body—mild discomfort is okay, sharp pain is not
Week 3-4:
Add Bird Dog (basic version)
Continue mobility exercises
Start Modified Bridge (lower repetitions)
Increase frequency if tolerated
Week 5-6:
Progress all exercises in intensity
Increase repetitions and sets
Add progressions (single-leg bridge, advanced bird dog)
Continue exercises even after pain resolves to prevent recurrence
For Chronic Lower Back Pain (Pain for more than 3 months)
Daily routine:
Morning: Cat-Cow (10 reps) + Pelvic Tilts (10 reps) + Knee-to-Chest (2 reps each side)
Midday: Bird Dog (2 sets of 10 reps per side)
Evening: Modified Bridge (2 sets of 15 reps) + Knee-to-Chest (2 reps)
Weekly progression:
Increase difficulty of one exercise per week
Add holds, increase repetitions, or try harder variations
Track progress in a journal (pain levels, function improvements)
For Prevention (No current pain)
Maintenance program:
Perform all five exercises 3-4 times per week
Use moderate to advanced variations
Focus on quality over quantity
Combine with regular physical activity (walking, swimming, cycling)
Exercise Guidelines and Safety Tips
General principles:
Start slowly: Begin with basic versions and fewer repetitions. It's better to do 5 perfect repetitions than 20 poor ones.
Listen to pain signals:
Acceptable: Mild discomfort, muscle fatigue, slight stiffness
Not acceptable: Sharp pain, shooting pain down leg, numbness, increased pain that lasts hours after exercise
Breathe properly: Never hold your breath during exercises. Exhale during exertion, inhale during relaxation.
Maintain proper form: Quality matters more than quantity. One well-executed repetition beats ten sloppy ones.
Progress gradually: Increase difficulty by 10-20% per week. Jumping too quickly to advanced exercises causes setbacks.
Be consistent: Daily exercise is more effective than occasional intensive sessions. Even 10 minutes daily makes a difference.
Warm up first: Do these exercises after light activity (walking, gentle stretching) or a warm shower, not first thing when cold and stiff.
Track your progress: Note pain levels (0-10 scale), functional improvements (can tie shoes without pain, can sit longer), and exercise tolerance (can do more reps, harder variations).
When to Stop and Seek Help
Stop exercising and consult a physiotherapist or doctor if:
Pain significantly increases during or after exercises
Numbness or tingling develops in legs or feet
Weakness in legs (difficulty standing on toes, lifting foot)
Loss of bladder or bowel control (emergency—go to ER)
Pain radiates down both legs simultaneously
Exercises that previously helped now make pain worse
No improvement after 4-6 weeks of consistent exercise
Pain is accompanied by fever, unexplained weight loss, or night sweats
Beyond These Five Exercises
These exercises are a foundation, but comprehensive back care includes:
Cardiovascular exercise:
Walking (30 minutes, 5 days/week)
Swimming or aqua fitness
Cycling (stationary or outdoor)
Low-impact cardio reduces pain and improves overall health
Lifestyle modifications:
Ergonomic workstation setup
Proper lifting technique
Regular breaks from prolonged sitting
Stress management (stress increases muscle tension)
Adequate sleep (7-9 hours)
Maintain healthy body weight
Additional strength training:
Gradually add exercises targeting legs, hips, and upper body
Total body strength supports spinal health
Prevents overreliance on back muscles for daily activities
Flexibility work:
Hamstring stretches (tight hamstrings increase back strain)
Hip flexor stretches (tight hip flexors alter pelvic position)
Thoracic spine mobility (reduces compensatory lower back movement)
Real Patient Success Stories
Case 1: Office worker with chronic lower back pain
Sarah, 34, desk job, 2 years of intermittent back pain
Initial presentation: Pain 6/10, worse end of day, difficulty sitting more than 30 minutes
Exercise program: Started with Cat-Cow, Pelvic Tilts, and Knee-to-Chest twice daily. Added Bird Dog week 2, Modified Bridge week 3.
Results: After 6 weeks, pain reduced to 2/10, sitting tolerance improved to 2+ hours, returned to recreational volleyball.
Key factor: Consistency—Sarah did exercises every morning before work and during lunch break.
Case 2: Construction worker with acute back strain
David, 45, physically demanding job, acute injury from lifting
Initial presentation: Pain 8/10, muscle spasm, limited mobility
Exercise program: Started very gently with Pelvic Tilts and Knee-to-Chest only (pain was too acute for others). Gradually added Cat-Cow after 1 week, then Bird Dog and Bridge after 3 weeks.
Results: Pain resolved to 1/10 after 5 weeks, returned to full duties with modified lifting technique at 6 weeks.
Key factor: Patience—David didn't rush progression despite wanting to return to work quickly. Gradual progression prevented re-injury.
Case 3: Retiree with chronic degenerative changes
Margaret, 68, arthritis in spine, chronic pain 15 years
Initial presentation: Pain 5/10 constant, stiffness especially mornings, reduced activity due to fear of pain
Exercise program: Very gradual approach—started with Cat-Cow only for 2 weeks, added one exercise every 2 weeks. Modified exercises to accommodate arthritis and reduced mobility.
Results: After 12 weeks, pain reduced to 3/10, morning stiffness improved significantly, resumed gardening and walks with grandchildren.
Key factor: Modified expectations—goal wasn't pain-free, but improved function and quality of life. Margaret continues exercises as permanent routine.
The Science Behind Exercise for Back Pain
Key research findings:
Systematic reviews show:
Exercise is as effective as manual therapy for chronic low back pain
Exercise reduces pain intensity by 10-15 points on 100-point scale
Exercise improves function and reduces disability
Benefits persist long-term with continued exercise
Exercise prevents recurrence of back pain episodes
Specific evidence for these exercises:
Core stabilization (Bird Dog, Pelvic Tilts, Bridge): Multiple high-quality studies show core exercises reduce pain and improve function in both acute and chronic back pain.
Spinal mobilization (Cat-Cow): Gentle movement exercises reduce stiffness and improve pain in people with mechanical back pain.
Stretching (Knee-to-Chest): Flexibility exercises combined with strengthening provide better outcomes than either alone.
Clinical practice guidelines:
American College of Physicians recommends exercise as first-line treatment
Canadian Chiropractic Guideline Initiative endorses exercise therapy
European Guidelines recommend exercise for acute, subacute, and chronic pain
My Professional Approach
At my clinics in Mississauga and Vaughan, I use a comprehensive approach to lower back pain:
Assessment includes:
Detailed history of your pain pattern
Physical examination of movement, strength, flexibility
Identification of contributing factors (posture, work demands, lifestyle)
Clear explanation of your diagnosis
Personalized treatment plan
Treatment combines:
Manual therapy to reduce acute pain and restore mobility
Evidence-based exercise prescription (like these five exercises)
Education about pain science and self-management
Ergonomic and lifestyle advice
Progression plan toward independence
My philosophy: These five exercises are powerful tools, but they work best when:
Prescribed at the right time in your recovery
Progressed appropriately based on your response
Combined with manual therapy during acute phases
Part of comprehensive approach addressing all contributing factors
You understand why you're doing them (knowledge is empowering)
Getting Started Today
Your action plan:
Step 1: Assess your pain
Rate pain 0-10
Note what makes it better/worse
Identify functional limitations
Step 2: Start with two exercises
Choose Cat-Cow and Pelvic Tilts
Perform twice daily for one week
Note response to exercise
Step 3: Gradually add exercises
Week 2: Add Knee-to-Chest if helpful
Week 2-3: Add Bird Dog (basic version)
Week 3-4: Add Modified Bridge
Step 4: Progress as tolerated
Increase repetitions before increasing difficulty
Add advanced variations when current level feels easy
Continue exercises even after pain improves
Step 5: Track progress
Keep exercise log
Note pain levels and function
Celebrate improvements
When Professional Help Is Needed
Consider physiotherapy if:
You need guidance on proper exercise form
Pain isn't improving with home exercises after 4-6 weeks
You're unsure which exercises are appropriate for your specific condition
You need manual therapy to complement exercise
Your pain is severe or limiting daily activities
You want to prevent recurrence after previous episodes
You have complex medical history requiring individualized program
At PinPoint Health in Mississauga and Rehab Science Health Centre in Vaughan, I provide:
Comprehensive assessment to identify exact cause of your pain
Hands-on manual therapy for immediate relief
Personalized exercise prescription
Education and self-management strategies
Direct billing to most insurance providers
Your Recovery Journey
Lower back pain can be frustrating, but remember:
✓ Exercise works—research consistently proves it
✓ You have control—these tools empower your recovery
✓ Consistency matters—daily practice beats occasional exercise
✓ Progress takes time—improvement happens gradually over weeks
✓ Prevention is possible—continued exercise reduces recurrence
These five evidence-based exercises have helped thousands of my patients find relief, restore function, and return to the activities they love. Start today with just two exercises, be patient with yourself, and trust the process.
Ready for personalized guidance? Book an appointment at PinPoint Health in Mississauga or Rehab Science Health Centre in Vaughan. I'll assess your specific condition and create a customized exercise program to get you moving pain-free.
Experiencing lower back pain? Don't let it limit your life. Contact me today for a comprehensive assessment and evidence-based treatment plan that combines hands-on care with empowering exercise strategies.
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