If you have yet to experience back pain, the odds are sadly stacked against you. According to World Health Organization data, most people will experience low back pain at some point in their lives. Fortunately, when it comes to mitigating back pain (or avoiding it altogether), fitness is your friend. With a little expert guidance, a simple workout regimen can help you shore up any weaknesses that might be causing back pain, and bolster your back’s natural support system to help prevent future injuries. We spoke to experts about how it originates, and the best workouts for back pain. Why do so many people have back pain? One of the reasons why back pain is so common is that it can stem from pretty much anywhere. “Back pain is so multi-factorial,” says Nicholas Hershfield, PT, DPT, OCS, physical therapist at Hospital for Special Surgery in New York City. “Anything from diet to stress levels to activity or inactivity can really affect low back pain.” Oftentimes, however, back pain is simply the result of us neglecting to maintain these muscles—and ignoring the fact that something as seemingly unrelated as ankle mobility can burden your back with more than its fair share of strain. ”The reason why most back pain or injuries tend to happen is not because certain positions are necessarily wrong or dangerous, but because you don't have the tissue capacity to go about your day-to-day life,” says Alex Corbett, PT, DPT, physical therapist at BreakThrough Physical Therapy in Cary, North Carolina. “If you never load a tissue in a certain direction, then you're more likely to have that happen. But if you're exposing that back to load and volume, your tissue capacity and tolerance is going to be much higher. So you can handle day-to-day stuff much better than somebody else.” How to reduce back pain at the gym A lot of guys, when faced with back pain, will try to take matters into their own hands by stacking their workouts with back exercises like rows, lat pulldowns, and reverse flyes. There’s nothing inherently wrong with these exercises, but you’re basically throwing spaghetti at the wall in the hope that something will stick. The key to improving back pain through exercises—and not accidentally injuring yourself further—begins with a fundamental understanding of how the spine works, and then selecting the specific exercises that will provide holistic coverage of all the relevant muscles involved. “The spine moves in four different planes,” says Dr. Corbett. “It's going to flex, which would be any kind of crunch movement or bending forward. It's going to extend backwards, so any type of deadlift movement would train that. It's also going to rotate, and it's going to side bend. So if somebody wants a truly comprehensive back and core program, they'd have to touch on all four of those.” The best exercises for back pain Here, Dr. Hershfield and Dr. Corbett share their top exercises to help reduce back pain—and prevent it from showing up in the first place. Reps: 15 each side Frequency: daily The first plane of spinal movement to focus on is flexion, and that means your abs. However, rather than focusing on your mirror muscles, you’re going to want to take aim at the transverse abdominus, a deeper layer of core musculature that provides support. “It's like a corset muscle,” Dr. Hershfield says. “It's not your six-pack muscles. Everybody likes to work their glamour muscles, but this sits deep and should be firing in the background all day, every day. Sometimes, in people with low back pain, it's just not as active, or it kind of shuts down a little bit. So working on activation of that muscle and neuromuscular re-education is super important.” To hit these muscles most effectively, Dr. Hershfield recommends the bird dog—a body-weight exercise that you can do anytime, anywhere. “I usually tell patients to do it every day,” he says. How to do it: Get on all fours with your hands directly below your shoulders and knees under your hips. Maintaining a neutral spine, draw your abs in. This is your starting position. Slowly reach one arm out in front of you while extending the opposite leg behind you. Imagine you’re creating a straight line from your hand to your foot. Slowly reverse the movement to return to the starting position. That’s one rep. Kettlebell Deadlift Frequency: Once or twice a week Spinal extension mostly falls under the jurisdiction of the erector spinae and multifidi muscles. While the erector spinae, which run vertically along the spine, are large muscles that you can see with the naked eye, the multifidi are much deeper, connecting the vertebrae to one another. “The multifidi is more of a stabilization muscle group,” Dr. Corbett says. “They're tiny muscles that are connected to the actual spine, whereas erectors are the big, muscular ones that you'll see on your back and in the mirror.” To target these muscles, Dr. Corbett and Dr. Hershfield both recommend some form of deadlift. Dr. Hershfield strongly prefers the kettlebell version. “I really don't like straight-bar deadlifts, because it's just a tough movement to teach, and a lot of people move through their low back more than anything else, which is really not the purpose of the lift,” he says. “I tend to like a neutral spine deadlift better, whether that be a kettlebell deadlift or a trap bar deadlift.” How to do it: Set a single kettlebell on the ground, and stand over it with your feet about hip-width apart. Bending from the hips, knees, and ankles, reach down and grab the handle of the kettlebell with both hands, palms facing you. Maintaining a neutral spine, extend first at the knees, followed by the hips, to stand up tall, squeezing your glutes at the top of the rep. Reverse the movement with control to return to the starting position, setting the weight back down on the floor. That’s one rep. Pallof Press Sets: 2 each side Frequency: daily Preparing your back for rotational movements is critical, especially if you play sports. “Whether you're playing baseball, pickleball, or golf, all of that requires some sort of spinal rotation stabilization,” Dr. Hershfield says. That means you need to start showing some love to your oblique muscles, which you’ll find on either side of your torso, just below your ribcage. “You have a little bit of the rectus spinae that does rotation, but it's mostly the obliques,” says Dr. Corbett. To get these muscle groups firing, both doctors recommend the Pallof press, a simple core stabilization exercise that you can do at your local gym’s cable station or even at home using a resistance band. “It's coaching spinal stabilization in the rotational plane, which a lot of people don't work on in their day-to-day,” Dr. Hershfield says. How to do it: Stand next to a pulley station, with the handle attachment set to just below shoulder height. Grab the handle with both hands and take about two steps away from the pulley’s base. Stand with your body perpendicular to the pulley station, and get into an athletic stance with knees slightly bent. Start by holding the handle close to your chest, and then slowly press it out in front of you until your arms are completely straight. Pause for a count at the top of the rep, and then slowly return to the starting position. That’s one rep. Single-Arm Farmer’s Carry Reps: 1 each side Frequency: 3–4 times a week Back pain often stems from the most mundane activities—situations so ordinary that you’d never think to prepare for them. Like carrying groceries home from the store, or hoisting a suitcase onto the scale at baggage check. But even though these moments aren’t contenders for your personal highlight reel, that doesn’t make them any less capable of sidelining you from the gym and doing the activities you love. As the fourth plane of spinal motion, side bending is an important base to cover—specifically, the quadratus lumborum, another oft-overlooked back muscle. “This one is connected to your lower spine and to your hip,” Dr. Corbett says. “You can't really see it. It's a deep muscle, so it's not going to pop in the gym or anything like that.” To zero in on this deeply embedded musculature, while simultaneously recruiting your obliques, which are as integral to side bending as they are to rotation, Dr. Corbett favors the single-arm farmer’s carry. How to do it: Grasp a heavy kettlebell in one hand and stand tall. Walk slowly in a straight line for about 30 feet, then turn around and return to the starting point. Keep your hips and shoulders level throughout. Set the kettlebell down. That’s one rep. Switch hands and repeat. Ankle Dorsiflexion Mobilization Sets: 5 (spread out over the course of a day) Reps: 30 each side Frequency: Daily Your ankles might seem like they are quite literally the furthest thing from your back, but poor ankle mobility is actually the cause of many people’s back pain, Dr. Hershfield says. “They might have an ankle movement impairment, and that's the reason that they can't bend well, and they use their back to bend instead of using their hips, knees, and ankles.” To relieve back pain stemming from tight ankles, Dr. Hershfield recommends an exercise you’re more likely to see in a physical therapist’s office than a weight room. “Ankle dorsiflexion, which is your ankle bending forward, is a movement that's necessary for anything like a squat, deadlift, or lunge,” he says. “It helps to take pressure off the back in the sense that you're not overly moving from your back to substitute for the lack of mobility at the ankles.” Dr. Hershfield recommends doing this one five times a day, which might sound like a lot, but the truth is it’s an equipment-free exercise that takes less than five minutes, and you probably won’t even have to break a sweat. “Anytime you want to make a substantial difference in your day-to-day life, you have to be working on it every day,” says Dr. Hershfield. “With something like ankle dorsiflexion, it has to be more frequent if you really want to make a difference.” How to do it: Facing a wall, set up in a lunge position with the toes of your front foot about three or four inches from the wall. Keeping your heel on the floor, try to touch your knee to the wall. Move your front foot forwards or backwards so that your knee is just able to make contact with the wall. Measure and make a note of the distance from your big toe to the wall. (This is so you can track your progress over time.) Now, move your foot backwards about an inch. This is your starting position. Once again, try to touch your knee to the wall, stopping just before you feel like your heel is about to come off the ground. Hold this position for about five seconds, and then relax. That’s one rep. Complete all reps one one side and then switch legs. Every week or so, repeat steps one and two to see how you’re progressing.