The Basics of Lower Back Pain (Part 3): How to Progress Management – Ask a Physiotherapist!

The following is a general four week sample plan which focuses on general strengthening, posture, products and life style changes to help alleviate low back pain. If any of the exercises increase your pain, do not continue. For a more specific plan for your injury, make an appointment with a doctor or physiotherapist.
Week 1:

  • Stop all lifting
  • Check the ergonomics if you work a desk job
    • Make sure your computer is at eye level and your chair has adequate lumbar support. Try the MuscleCare Infinity Chair from Clinic Supplies Canada.
    • A standing desk would be ideal
  • wear a back brace during the day
    • try the Access Aerated Lumbar Support Belt from Clinic Supplies Canada
  • Sleep on your side with a pillow between your legs
  • Gentle stretching and IT band foam rolling
    • You can purchase a EVA foam pro roller from Clinic Supplies Canada

IT Band foam rolling for 30 seconds at least 3 times/day

Lumbar flexion:
Hold each stretch for 30 seconds and do at least 3 times/day

Lumbar extension:
Hold for 15 seconds and do at least 3 times/day


  • Check your daily routine:
    • If you are sitting for most of the day:
      • Feet flat on the floor
      • Computer is at eye level
      • Stand up every hour
      • Lumbar support
    • If you have to lift or stand all day
      • Lift with your legs
      • Avoid heavy loads
      • Do not hinge from the hips
      • Wear supportive footwear
    • If you are driving a lot
      • Be sure your seat is positioned in a way which encourages correct posture and has good lumbar support. You can place a pillow or rolled up towel in the small of your back to increase the support in that area. Try to get out of the car every hour to stretch.
    • Use a heating pad on your back for 20 minutes a day (or more!)

Week 2:

  • Continue with lifestyle modifications outlined during week 1
  • begin core strengthening

Lie on your back with knees bent and hands under the small of your back. Tighten your pelvic floor muscles and gently pull your lower stomach in.
Lift your head and shoulders off the floor towards the ceiling.  Hold for 10 seconds and repeat 10 times.
Crawling position. Pull your stomach in. Hold for 15 seconds and repeat 3 times.
Lying face down. Support your body weight on your forearms and knees.
Tighten your stomach muscles and keep your neck and back straight. Hold for 30 seconds.

Week 3:

  • continue stretching and rolling out your IT band (week 1)
  • stop wearing the brace
  • Begin postural exercises
  • Progress core exercises

Lie face down. Support your body weight on your forearms and toes.
Tighten your stomach muscles and keep your neck and back straight.
Crawling position.
Lift opposite arm and leg to horizontal position. Hold 5 – 10 secs. Try to keep your body still.

Squeeze shoulder blades down and back.  Hold x 5 sec repeat 10 times.

Stand in a walking position. Bend your elbow and support the forearm against a door frame or corner.
Gently rotate your upper trunk away from the arm until the stretching can be felt in the chest muscles. Stretch approx. 30 secs.

Week 4

  • continue week 3 exercises
  • begin to resume activities of daily living
    • when lifting be sure to bend at the knees and use the legs to lift. Do not lift heavy loads
    • you should always try to stand hourly when sitting for prolonged periods of time
    • be aware of your posture, regardless of what you are doing. Shoulder blades should be pulled back, chest up, your ears should be in line with your shoulder.
    • If you are pain free, you can begin introducing other activities slowly into your routine. If they cause increased pain, stop the activity, and continue the core exercises for a week before trying the activity again.

If after 4 weeks, your pain has not subsided substantially, it would be wise to go book an appointment with a specialist. Physiotherapists are trained in treating and preventing low back pain, and may be a good professional to meet with to address your lower back pain. A physiotherapist will assess your alignment, muscle strength, joint movement and muscle patterning to diagnose and ultimately treat your lower back pain more specifically. After the assessment, the physiotherapist can put together a specific treatment plan for you that will likely include hands on work done by the physiotherapist, as well as a home exercises program and further life style changes to incorporate into your daily routine.
In Ontario, physiotherapy is not covered by OHIP unless you are over 65. If you qualify for OHIP physiotherapy, there are only certain clinics, which can offer the service, and they can only treat you a handful of times before the coverage is maxed out. Most extended health care plans do cover private physiotherapy, but you would have to inquire with your specific plan carrier to see the extent to which they cover. Some cover 100% and others cover a percentage of the cost.
No one should live with persistent lower back pain, so make some changes today to get closer to living a back pain free life!
Written by:
Charlotte Anderson, MSc. PT, PhD
Registered Physiotherapist
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