Does your back hurt and have you started avoiding movements for fear of making it worse? Have you stopped training, lifting weights, or doing certain activities because you're not sure if they're good for you?
Many people come to the clinic after having gone through something similar: they receive treatment, improve for a while, and weeks or months later, the pain returns.
When lower back pain occurs, our first priority is to feel better. And that makes sense. If bending over, sitting, working, or simply moving normally hurts, reducing those symptoms is important.
At that point, various physiotherapy tools can help reduce pain and make some movements more comfortable again. But the problem arises when recovery stops right there.
Because feeling better today doesn't always mean you've recovered everything you need to go back to doing what you used to do normally.
If every time the pain appears you need to stop, receive treatment and wait to feel better to return to the exact same point, we are probably missing an important part of the process.
The goal shouldn't just be to reduce the pain today. We also want your back to be ready for what you need to do tomorrow.
And that's where exercise has a lot to offer.
Is manual therapy effective for lower back pain?
Yes. And it can be especially useful at certain times.
If a person arrives in a lot of pain, very limited, or quite irritable, it may make sense at first to use manual therapy and other strategies to try to reduce symptoms and facilitate movement.[1]
From there, the goal is to progress with exercise.
Why? Because exercise allows us to regain strength, load tolerance, and functional capacity, which is what we need for a person to return to their normal life.
Therefore, manual therapy and exercise are not competing treatments. They can coexist within the same process and complement each other.[1,2]
If we can get the patient to experience less pain and move better, we can take advantage of that moment to start regaining movement, introducing load and progressing little by little.
As symptoms decrease and tolerance increases, exercise usually becomes more important.
In our general physiotherapy service We use different tools depending on the moment and the needs of each person.
Manual therapy can help improve how you feel today. Exercise helps prepare you for what you need to do tomorrow.
If my lower back pain is improving, why continue training?
Because having less pain and having recovered your full capacity are not always exactly the same thing.
Imagine you've been avoiding bending over for several weeks because it bothers you. You've stopped exercising, you pick up objects trying to keep your back completely rigid, or you've reduced certain activities because you're afraid the pain will return.
A few weeks go by and you start to feel much better.
That's a good sign. But perhaps you haven't yet recovered everything you haven't done in a while.
Here, exercise allows us to gradually expose ourselves to those situations again and regain strength, endurance, mobility, and tolerance for exertion. It also helps us recover something that is often just as important: the confidence to use our back normally again.
Furthermore, we know that episodes of lower back pain can recur. Exercise does not guarantee that you will never experience pain again. However, current evidence suggests that exercise and staying physically active can provide benefits in preventing new recurrences.[3]
An interesting example is the WalkBack studio, published in The Lancet In 2024, people who had recently recovered from an episode of lower back pain completed a progressive and individualized walking program accompanied by education. The median time to a new recurrence was 208 days, compared to 112 days in people who did not undergo that intervention.[4]
This does not mean that walking is "the exercise for the back" or that everyone has to follow that program.
What's interesting is the idea behind it: Continue to regain activity and ability even though the pain has already improved.
How does exercise help with lower back pain?
Exercise is not only for "strengthening the back".
Its usefulness goes far beyond that.
When someone has had lower back pain for a long time, they often start moving less, avoid certain positions, or lose their ability to tolerate exertion they previously did with ease. Exercise allows us to address precisely these issues.
We can use it to improve strength, endurance, movement control, and load tolerance, but also to to gradually recover movements and activities that had become uncomfortable or generated insecurity.
The evidence supports this approach. Cochrane review The study, which included 249 trials, found that exercise can improve pain in people with chronic low back pain compared to no treatment, usual care, or placebo.[5]
Among these possibilities, strength training is a particularly interesting tool. A recent meta-analysis found improvements in pain and disability with strength training programs in people with nonspecific chronic low back pain.[6]
But this does not mean that everyone has to do the same exercises.
The key is to choose exercises that make sense for the person and progress them according to what they need to recover.
We don't train the back simply to make it "stronger." We train it so that it can better respond to the demands of daily life, work, or sports.
That's why the program can be very different for someone who wants to pick up their child from the floor again, someone who works long hours on their feet, a bricklayer, or someone who wants to get back to weight training.
What is the best exercise for lower back pain?
There is no single exercise that is best for everyone with lower back pain.
Current recommendations include different options: strength and endurance exercise, aerobic work, movement control, general exercise, aquatic exercise, or programs that combine several modalities.[7]
That's why we try to be careful with overly restrictive recommendations like "you have to do Pilates", "go swimming", "strengthen your core" or "never do deadlifts again".
All of those options might make sense for some people at some point. The problem is turning them into a one-size-fits-all solution.
Before asking ourselves what exercise your back needs, perhaps we should ask ourselves something much more useful:
What do you need to do again?
To expand on this topic, this video demonstrates different ways to incorporate exercise and movement into your lower back pain routine. The exercises are examples and not a set routine that will necessarily work for everyone.
Lower back pain: how do we choose which exercise to do?
Not everyone with lower back pain needs the same starting point or has the same goal.
For someone who has been inactive for a while, starting with walking and gradually increasing their activity can be a very good option. As we have seen previously, even relatively simple walking programs combined with education can have interesting results.[4]
But if your goal is to get back to lifting weights, running, working for hours in certain positions, or playing a sport, we probably need to progress towards something more specific.
To decide, we take into account, among other things, What activities are limited, what movements modify your symptoms, how much exercise do you currently do, and what do you need to get back to doing?.
From there we can use strength, mobility, movement control or resistance exercises and modify variables such as load, number of repetitions, range of motion or frequency.
Therefore, rather than looking for a list of "exercises for lower back pain", we are interested in finding a starting point that you can tolerate and progress from there.
The exercise should increasingly resemble the demands you want to make again.
Lower back pain and core: should it always be strengthened?
Trunk work can be helpful and will often be part of the treatment.
But having lower back pain doesn't necessarily mean you have a "weak core," nor does all rehabilitation have to be reduced to doing planks, bird-dog exercises, or stabilization exercises.
For some patients, these exercises can be a good starting point. They allow us to begin with a simple load, easily modify the difficulty, and gradually restore certain movements.
But if your goal is to run again, lift a box, play padel, work bent over, or train in the gym, we will have to gradually approach those demands.
The exercise we start with doesn't have to be the exercise we finish with.
Lower back pain and weightlifting: can I do squats or deadlifts?
In many cases, yes.
Having lower back pain does not automatically make squatting, deadlifting, or lifting something from the floor dangerous movements.
What we need to value is what amount of load can you tolerate at that time.
It might not be a good idea to use the same weight you were lifting before the symptoms appeared. But we can reduce the load, use a shorter range of motion, lift from a higher position, decrease the repetitions, or temporarily try another variation.
We'll make progress later.
This changes the question quite a bit.
Instead of thinking:
“"Is deadlifting bad for my back?"”
We are more interested in asking ourselves:
“"How much of this exercise can I tolerate now, and how can we progress it?"”
This concept of load progression is much more useful to us than constantly classifying movements as good or bad.
That is precisely one of the objectives of our work. rehabilitation and therapeutic exercise: recover first what the person can tolerate and then progress towards the demands they really need.
Can I train if I experience some lower back pain?
Not all pain during exercise necessarily means that we are hurting ourselves.
But that doesn't mean we should ignore it either.
We are interested in knowing how bothersome it is, when it appears, if it increases while you are exercising, how long it takes to return to normal, and how you feel during the following hours or the next day.
A review published in 2025 in people with chronic musculoskeletal pain It compared programs that allowed some pain during exercise with others that aimed to train without pain. It found no clear differences in pain or disability between the two strategies, and the certainty of the evidence was low or very low.[8]
Therefore, allowing some discomfort may be acceptable in some patients and situations. Not because you have to train through pain, but because a little discomfort doesn't automatically mean that the exercise is causing harm.
For example, we will not interpret an exercise that causes mild discomfort that disappears shortly after finishing in the same way as one that progressively increases symptoms and leaves you clearly worse for many hours or the next day.
In the second case, we will probably have to adjust some variables: weight, volume, range, frequency, or even temporarily change the exercise.
We're not looking to train by enduring. We're looking to find a dose you can tolerate and from which we can make progress.
How do I know if my lower back pain is getting better?
Pain matters, but it shouldn't be our only way of measuring progress.
We also want to know what you can do now that you couldn't do a few weeks ago.
Perhaps you can walk for longer periods. Or bend down without being overly cautious. Maybe you've gone back to the gym, can pick things up from the floor normally, or are much more tolerant of your workday.
It is even possible that some discomfort may still appear, but that it no longer significantly affects your decisions.
That's also an improvement.
Sometimes recovery doesn't begin when the pain completely disappears. It begins when You gradually get your life back, and your back stops taking up so much space in your decisions..
What is the goal of lower back pain treatment?
First we need to understand what's happening and, above all, what things are limited in your case.
At certain times, we can use different tools to reduce symptoms and facilitate movement. But then we want to take advantage of that improvement to gradually regain what you need to do.
For one person, it will mean being able to walk again without worrying about their back. For another, it will mean regaining strength. Another will need to be able to run again, and someone else will have to be prepared to lift heavy loads for long hours at work.
We don't want you to ignore the pain or train at any cost.
But we also don't want you to have an ever-growing list of moves you can no longer perform after each episode.
We're not trying to make your back do more and more things. We're trying to make it able to do more and more things.
Feeling better is important. But ultimately, the real goal is to get you back to living your life normally.
Do you need help with your lower back pain in Alcalá de Henares?
If you have been suffering from lower back pain for a long time, have had several episodes, or don't know what exercises you can do, the first step is to understand your situation well.
In Evolution Physiotherapy, At our clinic in Alcalá de Henares, we combine on-table treatment with a personalized exercise program designed not only to relieve your pain but also to strengthen your back. Have you been suffering from lower back pain for a while?
The goal is not to give you a permanent exercise routine, but to help you regain ability and independence so you can go back to living your life normally.
Can Schedule your appointment with us and we will assess the condition of your lower back.
References
- Narenthiran P, Smith IG, Williams FM. Does the addition of manual therapy to exercise therapy improve pain and disability outcomes in chronic low back pain: a systematic review. J Bodyw Mov Ther. 2025;42:146-152. doi:10.1016/j.jbmt.2024.12.004.
- González-Gómez L, Moral-Munoz JA, Rosales-Tristancho A, Cuevas-Moreno A, Cardellat-González M, Rodríguez-Domínguez ÁJ. Exercise therapy versus manual therapy for the management of pain intensity, disability, and physical function in people with chronic low back pain: a systematic review with meta-analysis and meta-regression. Eur J Pain. 2025;29(8):e70090. doi:10.1002/ejp.70090.
- Comachio J, Beckenkamp PR, Ho EKY, Abdel Shaheed C, Stamatakis E, Ferreira ML, et al. Benefits and harms of exercise therapy and physical activity for low back pain: an umbrella review. J Sport Health Sci. 2025;14:101038. doi:10.1016/j.jshs.2025.101038.
- Pocovi NC, Lin CWC, French SD, Graham PL, van Dongen JM, Latimer J, et al. Effectiveness and cost-effectiveness of an individualised, progressive walking and educational intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomized controlled trial. Lancet. 2024;404(10448):134-144. doi:10.1016/S0140-6736(24)00755-4.
- Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790. doi:10.1002/14651858.CD009790.pub2.
- Rodríguez-Domínguez ÁJ, Moral-Munoz JA, Guzmán-Gómez JD, Valero-Ortiz J, González-Gómez L, Cardellat-González M. Does resistance training improve pain intensity, quality of life, and disability in people with chronic nonspecific low back pain? A systematic review and meta-analysis. Disabil Rehabil. 2026;48(6):1532-1545. doi:10.1080/09638288.2025.2566275.
- George SZ, Fritz JM, Silfies SP, Schneider MJ, Beneciuk JM, Lentz TA, et al. Interventions for the management of acute and chronic low back pain: revision 2021. J Orthop Sports Phys Ther. 2021;51(11):CPG1-CPG60. doi:10.2519/jospt.2021.0304.
- Tran I, Gibbs MT, Yu N, Powell JK, Smith BE, Jones MD. Effectiveness of painful versus nonpainful exercise on pain intensity, disability, and other patient-reported outcomes in adults with chronic musculoskeletal pain: an updated systematic review with meta-analysis. J Orthop Sports Phys Ther. 2025;55(8):1-11. doi:10.2519/jospt.2025.13253.
