Chapter 19 · Back & Spine
Low Back Pain protocol
Indexed — full page in progressSource: Rehab Science · Ch 19 · PDF pp. 575–627📖 Rehab ScienceBuild my programme →
AMBER — get assessed before starting rehab
Screen for red flags before starting any protocol (safety check). Progress by symptoms and function, not by the calendar: > 3/10 pain → start phase 1; < 3/10 → phase 2 (PDF p. 205).Follow this programme to treat
- Non-specific low back pain (acute and chronic)
- Sharp, achy pain in the low back
- Lumbar flexion and hyperextension sensitivity
- Pain on one side of the back
- Muscle strain
- Facet joint sprain
- Spondylolysis and spondylolisthesis
- Sacroiliac (SI) joint pain
Conditions in this protocol
- Non-specific low back pain (acute and chronic) PDF p. 575
- Low back muscle strain PDF p. 579
- Facet joint sprain PDF p. 583
- Spondylolysis and spondylolisthesis PDF p. 585
- Sacroiliac (SI) joint pain PDF p. 587
Questions the book answers
Good for
- Alleviating low back pain
- Relieving muscle tension
- Warm-up for phase 2 and 3 exercises
Guidelines
- Perform every day
- Tools: foam roller, peanut tool, massage ball, stretch strap, balance pad
- Skip any exercises that cause more than mild pain (3/10) and add them to phase 2
- Add phase 2 when you have no pain at rest and no more than mild pain with the exercises
Soft Tissue Mobilizations
▶ Spend 1–2 minutes on each area · Perform in any order on both sides · Stop on tender points for 10–20 seconds
Stretching Exercises
▶ Do 3 reps with 30- to 60-second holds · Perform on both sides · Don’t stretch into pain
diagram pending
Knee to opposite shoulder
PDF p. 594 · instructions pending
diagram pending
Hamstring stretch with strap
PDF p. 595 · instructions pending
diagram pending
Hip flexor stretch
PDF p. 596 · instructions pending
diagram pending
Quadruped lumbar flexion and extension mobility
PDF p. 596 · instructions pending
Good for
- Alleviating low back pain
- Improving hip and back mobility
- Early glute and core strengthening
- Warm-up for phase 3 exercises
Guidelines
- Perform every day
- When there are multiple exercise options, start with the easiest (first) option and replace with the more advanced variations as your pain decreases
- Tools: bench, resistance loop, sports ball, resistance tube band
- Skip any exercises that create more than mild pain (3/10) and add them to phase 3
- Add phase 3 when you can do the exercises with no more than mild pain
Mobility Exercises
▶ Do 3 sets of 10–15 reps · Active range of motion (AROM)—move as far as you can without pain · Pause at end range for 2–3 seconds · Skip exercises that flare up pain symptoms
Lumbar flexion (choose one)
choose one▶ Do 3 sets of 10–15 reps · Active range of motion (AROM)—move as far as you can without pain · Pause at end range for 2–3 seconds · Skip exercises that flare up pain symptoms
Stretching Exercises
▶ Do 3 reps with 30- to 60-second holds · Perform in any order on both sides · Don’t stretch into pain
Glute/hip rotator stretch (choose one)
choose one▶ Do 3 reps with 30- to 60-second holds · Perform in any order on both sides · Don’t stretch into pain
Resistance Exercises
▶ Do 3 sets of 10–15 reps · Push sets to fatigue · Add load or reps to make the exercises more challenging
Bridge (choose one)
choose one▶ Do 3 sets of 10–15 reps · Push sets to fatigue · Add load or reps to make the exercises more challenging
Good for
- Strengthening the core (back and abdominal muscles) and lower body
- Preventing low back pain and injury
Guidelines
- Perform 3 or 4 days a week
- Do 3 sets of 10–15 reps unless otherwise noted
- Push sets to fatigue
- When there are multiple exercise options, choose a variation based on experience, fitness level, equipment availability, and personal preference
- Tools: resistance loop, bench, physio (exercise) ball, dumbbells
Exercises
Fire hydrant (choose one)
choose oneSingle-leg hip extension (choose one)
choose oneLumbar flexion (choose one)
choose oneLateral flexion (choose one)
choose oneLumbar extension (choose one)
choose onediagram pending
Bird dog (lumbar extension)
PDF p. 619 · instructions pending
diagram pending
Skydiver (lumbar extension)
PDF p. 620 · instructions pending
diagram pending
Superman (lumbar extension)
PDF p. 620 · instructions pending
diagram pending
Spinal extensor curl (lumbar extension)
PDF p. 621 · instructions pending
Deadlift/rdl (choose one)
choose onediagram pending
Dumbbell deadlift (deadlift/rdl)
PDF p. 624 · instructions pending
diagram pending
Bodyweight (dowel) deadlift (deadlift/rdl)
PDF p. 625 · instructions pending
diagram pending
Barbell deadlift (deadlift/rdl)
PDF p. 626 · instructions pending
diagram pending
Single-leg deadlift (deadlift/rdl)
PDF p. 626 · instructions pending
Source: Rehab Science · Ch 19 · PDF pp. 575–586· 9 original research citationsshow sources ▾
Also cited by the book on these pages:
- [Ch 19·1] Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344(5):363-370. find original ↗
- [Ch 19·2] Gianola S, Bargeri S, Del Castillo G, et al. Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis. Br J Sports Med. 2022;56(1):41-50. find original ↗
- [Ch 19·4] Saragiotto BT, Maher CG, Yamato TP, et al. Motor control exercise for nonspecific low back pain: a Cochrane review. Spine (Phila Pa 1976). 2016;41(16):1284-1295. find original ↗
- [Ch 19·3] Almeida M, Saragiotto B, Richards B, Maher CG. Primary care management of non-specific low back pain: key messages from recent clinical guidelines. Med J Aust. 2018;208(6):272-275. find original ↗
- [Ch 19·5] Quentin C, Bagheri R, Ugbolue UC, et al. Effect of home exercise training in patients with nonspecific low-back pain: a systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18(16):8430. find original ↗
- [Ch 19·6] Seyedhoseinpoor T, Taghipour M, Dadgoo M, et al. Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis. Spine J. 2022;22(4):660-676. find original ↗
- [Ch 19·7] Goubert D, Oosterwijck JV, Meeus M, Danneels L. Structural changes of lumbar muscles in non-specific low back pain: a systematic review. Pain Physician. 2016;19(7):E985-E1000. find original ↗
- [Ch 19·8] O’Sullivan K, O’Keeffe M, Forster BB, Qamar SR, van der Westhuizen A, O’Sullivan PB. Managing low back pain in active adolescents. Best Pract Res Clin Rheumatol. 2019;33(1):102-121. find original ↗
- [Ch 19·11] Donaldson LD. Spondylolysis in elite junior-level ice hockey players. Sports Health. 2014;6(4):356-359. find original ↗
Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.