80% of people will suffer from low back pain at some time in their life. A proven treatment for low back pain is to do core exercises like sit-ups. But what do you do when the treatment, in this case, sit-ups, is causing low back pain?
People experiencing pain while doing sit-ups either had back pain they were trying to treat by doing core exercises OR are trying to prevent back pain by strengthening part of their core muscles by doing sit-ups.
The purpose of this post is to offer both populations of people alternate exercises to help strengthen core muscles if you currently have low back pain or not.
We first have to know back pain can come on without any event or trauma. It happens from progressive weakening in your core muscles commonly caused by sitting for long periods of time. This gradual weakening of the core muscles can lead to lower back pain from any movement or posture, even a sneeze. See this post answering the question “can a weak core cause back pain?”
Sitting is a form of bracing or casting. Have you ever noticed how skinny someone’s arm is when they first get out of a cast?
This is caused by the muscles getting weaker and smaller from not being used.
The body does this automatically as a way to save energy. These are muscles not being used so it begins to take them away.
Sitting is similar to casting for our core muscles, including, our glutes, hamstrings, hip flexors, and abdominal muscles. This core weakness from sitting for long periods of time can lead to low back pain, poor posture, and hip pain.
The medical community has proven time and time again the best treatment for low back pain is movement and exercise with some focus on the muscles that make up your core.
Why do your sit-ups cause lower back pain?
If you spend too much time sitting down, your body will adapt to this position as a way to stay efficient. However, this efficiency leads to core muscles becoming weak which serve as active spinal stabilizers. This is a combination of weak and tight hip flexors and weak glute muscles.
With weak active stabilizers, our body is forced to rely on passive spinal stabilizers such as joints, ligaments, and vertebral discs. The hip flexors anchor to the front of the lumbar spinal vertebrae causing more compression on the discs when they contract forcefully while doing a sit-up.
These structures will respond to this load by forming bone spurs around joints and overstretched ligaments.
Bone spurs lead to stenosis, a condition when the space around nerves narrows, creating an environment for the nerves to be injured more easily.
When ligaments become overstretched they weaken and can be torn. This is how vertebral discs herniate or bulge, which can cause pain but not always.
This is why sit-ups cause low back pain. People will do sit-ups to try to strengthen their core not knowing they need strong and healthy active stabilizers to take pressure off the back.
Sit-ups activate the hip flexors that pull from the front of the lumbar spine causing compression on tender vertebral discs and causing pain. This forward pull from the hip flexors is called anterior tilting of the pelvis.
To learn about common back pain conditions we treat click here.
How do I fix back pain with sit-ups?
To fix back pain with sit-ups you have to know if your core is strong enough. To perform this simple test start by laying on your back (see image below) and tilting your pelvis backward as if to flatten it against the bed or floor you are laying on as seen in the top image below.
As you hold your pelvis backward and your back flat on the floor, try to perform a sit-up.
If your back comes off the floor and arches first and you have pain in your back you need to work on core exercises to stabilize your lumbopelvic muscles. These are the muscle that connects your pelvis and low back. Think glutes, abdominals, hip flexors, groin muscles, and low back extensor muscles among others make up your lumbopelvic stabilizers.
If you are able to do a sit-up but it still hurts this means you have the strength but some of your discs are irritated you need to work on other core muscles to avoid irritating your back while still strengthening the core.
If you can do it without pain, you must remember to keep flattening your back by tilting your pelvis backward before you do each sit-up rep. This is really important. The moment you get too tired and your technique gets sloppy you put yourself at risk for injury or more pain.
What Core Exercise Can I do Instead if Sit-ups Hurt my Low Back?
While there are certainly lots of options here, I’m going to give you two of my favorites. The first one is called the McGill Curl Up:
Start as the top image shows, on your back with one knee bent up and your hands behind your back.
Curl up through your upper trunk and shoulders trying to squeeze your hands behind into the floor with your low back. Hold for 3 seconds 5-10 times.
Progress until you can hold for 10 seconds 10 times without pain in your low back.
The next exercise to help if you have back pain with sit-ups is called the bridge. In this video starting at the 1:11 mark on our youtube channel you can see how to do it correctly.
Start with laying on your back with both knees bent. Tilt your pelvis backward to flatten your back on the floor or bed just like the first exercise listed above.
Once your back is flat keep it flat as you push your feet into the floor and squeeze your glutes to lift off the floor or bed.
Only lift up as high as you can while keeping your pelvis tilted backward. This becomes more difficult to notice the higher up you go so you have to go slow and try to tilt backward as you lift. Perform this 30 times without pain and only go up as high as is not painful.
The reason you have pain with sit-ups is that you have passive core stabilizers like vertebral discs irritated from an already weak set of active spinal stabilizers.
This is usually caused by a weakening of the core muscles from long-term sitting, like at a desk job. We showed you a simple test to demonstrate the strength of your core. We also showed you my two favorite exercises to help low back pain while doing sit-ups.
Comment below if you have any questions.
Dr, Nick’s greatest passion is seeing his patients recover from injury and return to their activities that bring them joy.
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