No crunches, no sit-ups, and no generic “core workout” advice. Instead, you’ll find physical therapist-recommended exercises to help relieve back pain, backed by official clinical practice guidelines and decades of spine research.
80%
of people will experience low back pain at some point in their life
30+
years of spine research behind the most-cited exercise protocol in this guide
5 – 6
days per week is the typical recommended frequency for core stability work
6 Wks
RCT timeframe showing meaningful pain and function improvement
There’s no one exercise program that helps all backs. That being said some movements have been tested over years and are used in clinics. They help the spine do its job. To keep steady not just to bend. The exercises here are the ones I use most and are also in the guidelines, for my profession.
What Clinical Guidelines Actually Recommend Exercises to Help Relieve Back Pain
Before we start talking about exercises it is worth knowing where this advice actually comes from. The Academy of Orthopaedic Physical Therapy which is part of the American Physical Therapy Association publishes clinical practice guidelines for low back pain. These guidelines are like a book of recommendations that physical therapists use to learn and to help their patients. The Academy of Orthopaedic Physical Therapy says that physical therapists should use intense exercise training to help patients with back pain.
This includes things like making the muscles, in the trunk stronger helping the trunk last longer and teaching patients how to move properly. The Academy of Orthopaedic Physical Therapy says physical therapists should do this for patients who have back pain that just started and for patients who have had low back pain for a long time.
This matters because it helps separate proven advice from the countless “do this one stretch” tips online. The exercises physical therapists recommend in this guide are based on clinical research and the same evidence they use to treat patients.
Your core’s main function isn’t to move. It’s to resist movement and protect the spine — which is exactly why traditional crunches often make things worse, not better.
The McGill Big 3
When it comes to exercises that physical therapists recommend there are a few that really stand out. The McGill Big 3 is one of them. Professor Stuart McGill developed these exercises. He is a researcher who has spent over 30 years studying back pain. He has written hundreds of papers on the subject.
The McGill Big 3 includes three exercises: the modified curl-up, the side plank and the bird dog. These exercises help your core do its job. This job is to stop your spine from moving in ways it should not. It does not try to make your spine move more.
Some researchers did a study on people with term back pain. They wanted to see if the McGill Big 3 exercises would help. The study lasted for six weeks. The people who did the McGill Big 3 exercises felt pain and could do more things. They got results that were as good, as people who went to therapy. This is a deal because it shows that the exercises really work. The results are not just based on what people think. They are based on tests.
Modified Curl-Up
The modified curl-up is different from a crunch. It helps keep the curve of your spine. It does not bend your spine over and over like regular crunches do. This is why the modified curl-up is safer for people with pain than sit-ups are. The modified curl-up is a choice, for people who have back pain because it does this.
How To Do It
- Hold for 8–10 seconds, breathing normally, then lower slowly.
- Lie on your back with one leg straight and the other knee bent, foot flat on the floor.
- Place your hands under the natural arch of your lower back to help preserve that curve.
- Gently brace your abdominals — enough to stabilize your trunk, not so much that your low back flattens into the floor.
- Lift your head, shoulders, and upper back slightly off the floor as one unit, keeping your neck and low back still.
Reps: 5–10 per side Hold: 8–10 seconds Targets: Abdominals, minimal spinal stress
Side Plank (Side Bridge)
The side plank is great for the muscles on the sides of your body, which are often not exercised much as the front and back. These muscles are very important because they help prevent injuries to your spine. They do this by resisting forces that can bend your spine to the side. The side plank is good, for these muscles because it trains the side muscles of your trunk.
How To Do It
- Lie on your side, resting on your forearm, with your knees bent at roughly 90 degrees (modified version).
- Brace your core and lift your hips up, keeping your knees, hips, and shoulders in one straight line.
- Hold the lifted position for 8–10 seconds, breathing steadily — avoid holding your breath.
- Lower slowly and repeat on the same side before switching.
- To progress, extend your legs fully so only your feet (stacked one in front of the other) and forearm are in contact with the floor.
Reps: 5–6 per side Hold: 8–10 seconds Targets: Obliques, lateral trunk stability
Bird Dog
The bird dog exercise helps your back and hips work in a steady way when you move your arms and legs around. This is much like what your spine needs to do when you are doing everyday things like walking or reaching for something or lifting things up. The bird dog exercise for back pain is good, because it makes your spine stay stable.
How To Do It
- Start on all fours (quadruped), hands under shoulders, knees under hips, spine in a neutral position.
- Engage your core gently, keeping your neck in line by looking at the floor between your hands.
- Simultaneously extend one arm straight forward and the opposite leg straight backward, keeping both parallel to the floor.
- Keep your hips level — do not let your pelvis rotate or your low back sag or arch.
- Hold for 8–10 seconds, then return with control and repeat on the opposite side.
Reps: 5–10 per side Hold: 8–10 seconds Targets: Erector spinae, glutes, posterior chain
A useful warm-up first:Â Many doctors suggest doing some cat-camel stretches. You do this on your hands and knees. Slowly arch your back then round it all while keeping it pain-free. This helps loosen you up and makes your spine more flexible before you start working on your core muscles.
Why These Beat Traditional Abs Exercises
Traditional core exercises, like sit-ups and Russian twists. Turn your spine a lot. Which can actually make a sore back feel worse. The McGill approach does things differently: it focuses on keeping your spine steady and still while your arms and legs move. This trains your core to do its main job. Stopping your body from moving in ways it shouldn’t. Than making it move.
Why consistency matters more than intensity here:Â A doctor usually suggests doing all these exercises two times a day when you still have symptoms. Once the pain goes away you can do them three to six times a week. This is to help prevent injuries from happening not just to fix the current problem. The whole exercise routine only takes a minutes to do.
When to modify or stop:Â Stop any exercise that causes pain. Sharp pain, pain that spreads numbness or tingling are not signs to keep going. If the side plank hurts your shoulder or wrist try a side-lying leg lift instead. It is safe. If these movements make your pain worse not tired muscles see a physical therapist. Book an assessment than keep going on your own.
How to Progress Safely
These exercises are not meant to stay the same. As core stability exercises for lower back become easier, physical therapists usually introduce more challenging movements in a gradual, structured progression. First they have patients hold the position for a time. Then they add movements like when you do the bird dog exercise and you move your arms and legs slowly.
Finally they add a weight or something to make the exercise a bit harder. The important thing to remember is that how you do the exercise how times you do it and when you make it harder are more important, than the exercise itself. If you try to do the versions too soon you might get hurt and have to start over.
Research Citations
· George SZ, et al. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. Clinical Practice Guidelines, Academy of Orthopaedic Physical Therapy, APTA. Journal of Orthopaedic & Sports Physical Therapy, 51(11):CPG1–CPG60. DOI: 10.2519/jospt.2021.0304
· Childs JD, et al. Low Back Pain: Clinical Practice Guidelines Linked to the ICF. Orthopaedic Section, APTA. Journal of Orthopaedic & Sports Physical Therapy, 42(4).
· McGill S. Back Mechanic and Low Back Disorders. Spine biomechanics research, University of Waterloo — cited via Squat University and PT Progress clinical summaries.
· BodySpec. McGill Big 3: 10-Min Core Routine and 4-Week Plan. Citing 6-week RCT, Journal of Physical Therapy Science: bodyspec.com ↗
· Petersen Physical Therapy. Stuart McGill Big 3: Chronic Back Pain Relief. Clinical instruction reference: petersenpt.com
· BackFitPro / Brian Carroll. Mastering the McGill Big Three: Progressions, Variations, and Common Pitfalls. Aug 2025: backfitpro.com ↗
· PT Progress. McGill’s “Big 3” Exercises for Back Pain. Physical therapist clinical summary: ptprogress.com ↗
Medical disclaimer:Â This article is for educational and informational purposes only and does not constitute medical advice. It is not intended to diagnose, treat, cure, or prevent any condition. Please consult a qualified healthcare provider or licensed physical therapist before beginning any new exercise program, especially if you have an existing back condition, recent injury, or persistent pain.
