PDX Monthly has named Dr David Westerdahl one of Portland’s Top Sports Medicine Doctors for 2024. He is the only Doctor in that group recognized by his peers who is not part of a large medical group.

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Exercise for Low Back Pain

low back pain

At my sports medicine practice in Portland, Oregon, I routinely see teenagers and adults with low back pain. While these injuries can result from sports activity, many other etiologies for back pain can occur commonly. These include injuries at work, trauma from motor vehicle accidents, waking up with pain, and even pain from repetitive activities such as lifting. 

Back pain is very common and will affect up to 85% of people during their lifetimes. As part of my injury assessment and treatment, I like to find out more about individuals exercise activity when evaluating them for low back pain. Exercise is a common recommendation for patients with low back pain because studies have found that it helps to reduce pain, maintain, or improve flexibility, and strength.

Low back pain is commonly divided into acute back pain, which has been going on for less than four weeks, subacute back pain occurring for 4 to 12 weeks, or chronic back pain which is been going on for greater than 12 weeks. The role of exercise in management of low back pain varies, according to the duration of symptoms. I encourage all patients with subacute and chronic low back pain to exercise because in several large meta-analysis studies, exercise is shown to modestly improve pain and function in patients with subacute and chronic back pain. In addition, individuals with chronic low back pain who regularly participate in moderate leisure time activities have less pain and better function compared to those who are more sedentary. Exercise therapy improves pain and function with chronic low back pain through several likely mechanisms, including neurologic, musculoskeletal, and psychological pathways. 

Exercise positively affects pain signaling.  Even exercise not involving the injured body part can also reduce pain in the affected low back area. Exercise has been shown to have positive effects on human muscles and vertebral discs by helping to improve absorption of fluid by the disc through motion and impact activity. Exercise also provides psychological benefits through reducing stress, anxiety, and even depression.

I’ve found that my patients with low back pain like to have clear advice from their physician regarding treatment options, including home exercises and prognosis on their recovery.

We also spend time educating patients about their back pain to address fear and uncertainty about their recovery.

I frequently tell individuals that when you have low back pain as you start getting more active and exercising, you may experience a temporary exacerbation of symptoms. This is usually not serious, and an increase in pain is common after starting exercise. I like to tell individuals that, as you start exercising, it may temporarily hurt, but you’re not causing additional injury. 

The good news about exercise is that everyone with low back pain will likely derive benefit from physical activity even though each individual has different exercise capability and tolerance. At Sports Health Northwest, we try to explore some of the exercise options that fit our patients’ preferences, circumstances, and level of fitness.

As with any movement activity, there can be some risk of injury or other adverse events, especially among older or more frail patients, this is where supervision by a physical therapist can be very important to help reduce the injury risk.

The good news about exercise is that no single exercise technique is superior to others for individuals with subacute or chronic low back pain.

Walking is one of the easiest and most available forms of exercise for treating back pain; recent meta-analysis studies have shown the benefit of walking for low back pain as well as other orthopedic conditions. Another excellent form of exercise is aerobic exercise. This can include bicycling, elliptical, trainers, and even swimming. Aerobic exercise has been shown to decrease pain and improve physical function in people with low back pain. Another great form of exercise that’s very popular for low back pain is stretching. And individuals who participated in a variety of different stretching programs were found to have less back pain when incorporating common leg and trunk stretches. In my sports injury clinic, we are commonly asked about other exercises, such as pilates, yoga, and tai chi. Each of these forms of exercise techniques have been shown to have benefit especially when performed multiple times per week. While these exercises are not superior to other forms of exercise, the general benefit of exercises like yoga, pilates, and other core exercises for spine stabilization, can all be beneficial when performed consistently and matched with exercise activity that the injured individual enjoys doing.

Exercising regularly can help prevent back pain. In a couple of large meta-analysis studies over the past five years, they found that involvement in sports or other leisure physical activity, reduce the risk of frequent or chronic low back pain compared to active individuals. Another study found a 33% reduction in risk of developing low back pain in an exercise group compared to a sedentary group.

When it comes to acute low back pain that has been going on for less than four weeks exercise is shown to not be harmful, but it has not clearly been shown to have additional benefit when compared to those who have had back pain for longer duration. People who have acute low back pain should try to stay active as they can tolerate and avoid prolonged sitting or bed rest. 

If you have low back pain that is adversely, affecting your ability to be active and enjoy life, please contact us at Sports Health Northwest. We are happy to discuss the causes of your low back pain and help provide you with solutions through exercise and other treatments to help you recover, have improved pain, and get back to enjoying activities.


Dr Westerdahl David Westerdahl MD FAAFP RMSK Sports Medicine Physician and owner Sports Health Northwest, Inc.

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