Home Exercise Program for Low Back and Thoracic Back Pain

What you are treating

This is the program for the back pain most people have at some point: an ache across the low back after a day of sitting or lifting, stiffness and burning between the shoulder blades from hours at a screen, or both together. There is no pinched nerve and no single injury. The spine is simply being held in one position too long and asked to do work that the hips and the upper back should share.

The thoracic spine, the part between the neck and the low back where the ribs attach, is the key that is usually missed. When it is stiff and rounded, the neck pokes forward and the low back has to arch harder to keep the head up, and both ends hurt. Restoring motion in the middle takes the load off both.

If your back pain has a clear direction, worse with bending or worse with arching, use the flexion-based or extension-based program instead. If you have pain down a leg, start with the home program for sciatica.

Part 1: move the upper back (daily)

• Foam roller extension. Lie on your back with a foam roller across the upper back, knees bent, hands behind the head. Let the upper back extend over the roller, then move the roller a couple of inches and repeat, from the bottom of the shoulder blades to the top. 2 minutes.
• Open book. Lie on your side with knees bent and arms stacked in front. Lift the top arm and rotate it over to the other side, following it with your eyes, while the knees stay together. 10 slow repetitions each side.
• Thread the needle. On hands and knees, slide one arm under the body and reach through, letting the upper back rotate, then reach that arm up to the ceiling. 10 each side.
• Cat-camel. On hands and knees, round the back up, then let it sag, slowly, 10 times. Keep the motion comfortable at both ends.
• Wall extension. Face a wall with the forearms on it, step back and let the chest drop toward the wall while the hips stay back. Hold 20 seconds, 3 rounds.
• Doorway chest stretch, 20 seconds, 3 rounds each side.

Part 2: posture breaks (every 30 to 45 minutes of sitting)

A break is one minute, and it is the most effective thing on this page.

• Stand up. Reach both arms overhead and lean back gently, 5 times.
• Squeeze the shoulder blades down and together, hold 5 seconds, 5 times.
• Chin tuck, hold 5 seconds, 5 times.
• Walk for a minute, or at least to the end of the hall and back.

Set the screen at eye level, keep the keyboard close so the elbows stay under the shoulders, and use a chair with low back support. A standing desk is helpful only if you move; standing still is as bad as sitting still.

Part 3: strengthen what holds you up (four days a week)

• Rows with a band, elbows close, shoulder blades down. 3 sets of 15.
• Prone Y, T, and W, no weight, then 1 to 2 pounds. 10 each.
• Wall angels, 2 sets of 10.
• Dead bug, 10 each side.
• Bird-dog, hold 5 seconds, 10 each side.
• Side plank from the knees, then the feet, 20 to 30 seconds, 3 rounds each side.
• Bridge, then single-leg bridge, 2 sets of 10.
• Front plank on the forearms, 20 to 45 seconds, 3 rounds.
• Hip hinge with a dowel along the spine, 10 repetitions, then with a light weight. The hips should do the bending, not the back.
• Squat to a chair, 2 sets of 10.
• Clamshells and side-lying leg raises, 2 sets of 15 each side.

Part 4: stretch what pulls you forward (daily)

• Hip flexor stretch, half-kneeling, 20 seconds, 3 rounds each side.
• Hamstring stretch with a strap, 20 seconds, 3 rounds each side.
• Piriformis stretch: on your back, cross one ankle over the opposite knee and pull that knee toward the chest. 20 seconds, 3 rounds each side.
• Child's pose, 30 seconds, 3 rounds.
• Knee-to-chest, 20 seconds, 3 rounds each side.
• Upper trapezius and levator stretches, 20 seconds, 2 rounds each side.

Why the hamstrings matter

Of everything that pulls you forward, the hamstrings deserve a paragraph of their own. The hamstrings run from the sitting bones at the back of the pelvis to just below the knee. When they are tight, they pull the back of the pelvis down and tuck it under (a posterior pelvic tilt), which flattens the natural inward curve of the low back (the lumbar lordosis). A flat low back then has to round forward every time you bend, sit, or reach, because the hips cannot. Freer hamstrings reverse that chain: the pelvis can tilt forward again, the low back keeps its curve, bending comes from the hips (the hip hinge) instead of the spine, and the pressure inside the discs and the strain on the structures behind them fall. Stretch each hamstring for 20 to 30 seconds, 3 to 5 times, once or twice a day, with the low back kept flat, and roll the back of the thigh on a foam roller first if that helps. The gain comes from the nervous system allowing more length, so it stays only with regular stretching. The full explanation is in my core program for low back pain.

Part 5: build endurance

• Walk 30 minutes most days. It is the best medicine for ordinary back pain.
• Swimming, cycling with an upright position, and rowing with good form all help.
• Once the program is comfortable, add resistance training two or three times a week with a neutral spine: goblet squats, deadlifts with a light load, and rows. A strong back does not hurt.

Notes for the physical therapist

• Non-specific mechanical low back and thoracic pain without directional preference or radicular signs.
• Thoracic mobility (extension and rotation), scapular stabilizer and posterior chain strengthening, trunk endurance (McGill big three progressions), hip flexor and hamstring length, and hip hinge training.
• Thoracic manipulation or mobilization as indicated; graded activity rather than passive modalities as the main treatment.
• Ergonomic review for sitting and screen work; movement breaks as part of the plan.
• Refer back to me if pain is not improving at 6 to 8 weeks, if there is thoracic pain with night pain, weight loss, or a history of cancer, if there is new leg or arm pain, or if there is pain after a fall in an older patient (compression fracture).

Call 911 or go to an emergency room if you have

• New trouble controlling your bladder or bowels.
• Numbness in the groin, buttocks, or inner thighs.
• Weakness in both legs, or weakness that is getting worse quickly.
• Severe back pain with chest pain, shortness of breath, or a fever.

Learn more

OrthoInfo, Low Back Pain: orthoinfo.aaos.org (opens in a new tab)

My guides to the core program for low back pain, the posture program for kyphosis, and degenerative disc disease.

This program is a starting place and a set of suggestions for your physical therapist, not a prescription. Your therapist will adjust it to your exam. Stop and call us if an exercise sends pain down a leg or an arm, or if you notice the warning signs at the end.