Dorsalgia: More Than Just a Pain in the Back

Have you ever had a back pain? Have you ever had a back injury? Well, if you have then you are certainly not alone. At least 10 percent of adults in the United States have back pain — or dorsalgia — at any given time.1

It ranks as the second most common reason people visit a medical clinic. About 5 million people in the United States are disabled by back pain and some 2.5 million are permanently disabled by back disorders. What is worse, is that at least half of those who have back pain/injury will experience another back injury.

 Viewing the Back from Different Perspectives

Various types of health care practitioners seem to have different views on the origin of back problems and how to treat them.2 In general, orthopedists believe it is the disc that causes problems due to its position relative to the spinal cord and vertebrae. The majority of treatments performed by physicians involve the discs. Chiropractors focus on the joints of the spinal column. They primarily treat the alignment of the vertebrae and the relationship of the shoulder and pelvic girdles to the spinal column, as a whole. Finally, physical therapists tend to treat the muscles and tendons surrounding the spinal column. Physical therapists often apply electostimulation, or heat to the erector spinae or upper hip muscles or try to stretch or strengthen the muscles to gain proper alignment or alleviate pain.

Are We Meant to Walk Upright?

The field of ergonomics has been looking at the back and its functions in the work place for quite some time. Many changes have been made to help protect the back including those “back belts” loosely worn by cashiers. All the modifications of exercises and avoidance of back movement is actually doing more harm than good. The back is no different than any other part of our body: You use, or you lose it.

As you may know, we have four divisions in our spinal column based on the curves and anatomical differences. The neck region, known as cervical vertebrae, is not injured much, but due to poorly positioned computers and time on the phone, (repetitive motion) injuries to this area are on the rise. The middle back or thoracic region also gets few injuries. The lumber or lower back region receives the greatest amount of injuries by far. This is because of the amount of force it must sustain, and the twisting and bending of our pelvis relative to the spine. Sitting is actually harder on this region than standing. All the exercises and stretches mentioned are focused on the lumbar region.

Exercises for Strengthening and Stretching the Back

There are probably as many ways to train the back as there are to strain the back, but for the purposes of this article, we will mention several that are relatively easy to do. The back is part of a linked system which provides movement of the body. The hamstrings, gluteal, hip stabilizers, flexors, and abdominals are all part of this system. Tight hamstrings and weak abdominals are often the main culprits in back injuries. To stretch the hamstrings or any muscle make sure you: 1) go slowly, 2) isolate the tendons and muscles you are trying to stretch, 3) hold the stretch at least 15 seconds (preferably 30 seconds) and out yourself into a “slight discomfort zone” not a pain zone or a bouncing pain zone.

First of all, perform a brief amount of light general activity if possible before stretching. Put a foot on some flat object at least 15 inches high (chair height). Try to lock the raised knee and keep the back real straight or even arched back a little. Move the torso or chest down slowly without curling the back over. Unless you are trying out for Cirque du Soleil, you probably are not keeping the back straight if you can move more than a couple of inches.

For the lower back, we will stretch it both sideways or in a rotary fashion and straight back and forward. While you are sitting on the floor or even a chair if you are inflexible, bend your trunk forward and grab your ankles with your elbows outside of your knees. Pull yourself forward until you feel some pain and gently take a long breath out. You should not try to keep your back straight on this one. While you are seated you can reach over with one arm to the opposite knee (outer edge) and twist around. Try to grab the back of the chair with the other arm and breath out. If you are standing then step forward with one foot and reach forward and grab the outer edge something stationary with the opposite arm. A door jam or vertical pole works best. Breath out and try to look behind yourself. You will often crack your back on this one. Don’t worry about it. It is simply the release of hydrostatic pressure and will probably feel great.

The gluteus muscles are a bit more difficult to stretch. Try crossing your legs with the ankle of one leg on the knee of the other. Grab your foot and the knee of the raised leg and pull it toward your torso. Try not to lean into it too much and hold the stretch for at least 15 seconds. Repeat with the other leg. This one may be a pain in the butt.

Strengthening the back should be done just as you would strengthen any other part of your body. Gradually, and progressively with the appropriate rest in-between workouts. My favorite involves the slanted hyperextension apparatus in most gyms. You should position yourself with your Achilles’ tendon against the lowest pad and your hips should be supported by the upper pads. Start with your hands dangling below you and work up to having them behind your head. To target the lower back you should perform a reverse crunch. Try to go back by bending only your upper torso or the shoulder blades. Try to hold the lower back in place. When you get tired go ahead and bend from the hips. The other one is performed by lying on your stomach on some pad. Simply lift your head and chest off the pad while feeling pressure on your toes. Eventually try to raise the heels while raising the upper back and go slowly.

Strong abdominals and obliques are also very important. Fortunately, the abdominals are included in most back strengthening programs. In fact, they are now being over emphasized and many of the exercises are not getting the hip flexors which are very important for back stability. Some variation of leg raises or hip shoot-ups are very good at strengthening the upper hip and lower abdominal region. Doing a side sit-up or situp with your knees aimed sideways are also great for trunk strengthening. Most people do not correctly perform the twisting motion or go to fast when doing sit ups. Try doing an exercise called the windmill. Bend from the waist 90 degrees with the feet shoulder-width and reach to each side with a full twist of the torso. This is also a great exercise to both stretch and strengthen the torso. The old Jack LaLanne opposite toe touch with the feet spread wide are still great. It may not get rid of the love handles but it will keep you in action to handle love.

Here are some other strategies for back relief:

  • Wear comfortable, low-heeled shoes.
  • When standing for long periods, try to rest a foot on some low stool or raised surface. Also try bending backwards with your hands on your hips every so often.
  • When driving long distances place a pad or pillow behind the small of your back and try to use the cruise control not have a wallet in your pocket. Try to take breaks often and walk and do that standing lower back and hamstring stretch.
  • When sleeping, try to do it on your back with a pillow underneath your knees. It is recommended to sleep on your side and in the fetal position.
  • When sitting at the computer try to have a chair that supports your lower back and your feet on the floor.
  • If you have a bad back, a slow or downhill run or hard stair climb are not recommended nor should you ski (water or snow) or do hard off-road cycling. Swimming, walking, road cycling or Spinning, the Eliptical Trainer, or moderate rowing are all recommended.


1.  U.S. Department of Health and Human Services. Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2002. Vital and Health Statistics Series 10, No. 222 [DHHS Publication No. (PHS) 2004-1550]. Hyattsville, MD, 2004.

2. Nachemson A. Epidemiology and the economics of low back pain. In: Herkowitz HN, et al, eds. The Lumbar Spine, 3rd ed. Philadelphia: Lippincott, Williams & Wilkins, 2004:3–10.


These resources are for the purpose of personal trainer growth and development through Continuing Education which advances the knowledge of fitness professionals. This article is written for NFPT Certified Personal Trainers to receive Continuing Education Credit (CEC). Please contact NFPT at 800.729.6378 or [email protected] with questions or for more information.
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