Exercise is very important for good spine health. Exercise helps spinal health in a number of ways. Exercise to achieve and maintain a healthy weight is important because excess weight places additional unhealthy stresses on the spine. Cardiovascular exercise in general is helpful because good overall health and proper blood flow throughout the body and to the spine aid in achieving spinal health. Weight-bearing exercise is important to help with maintaining good bone density. The most important exercises for spinal health are exercises that target the muscles that directly relieve the pressure from the spine. This chapter focuses on these exercises, but it is important to emphasize to patients that these exercises belong as part of an overall healthy lifestyle and as part of that a broader exercise program.

The specific exercise program designed for a patient’s lower back pain will depend on the nature of that patient’s lower back pain. When a patient’s pain is flexion based (e.g., sitting increases the pain) and believed to be discogenic in origin, then the prescribed exercises will have an extension bias. Reciprocally, when a patient’s pain is extension based (e.g., standing increases the pain) then the prescribed exercises have a flexion bias. When pain is neither flexion nor extension based or when both types of positions produce back pain, then the prescribed exercises occur in a neutral spine position.

Every patient needs to be individually evaluated for muscle weaknesses and imbalances. Of course, there are some general principles. The hallmark of many lower back exercise programs includes lumbar stabilization exercises and hip flexor stretching. Two common lumbar stabilization exercises include posterior pelvic tilts and planks.