Cardio Conditioning for Back Pain

Prop­er exer­cise is crit­i­cal to alle­vi­at­ing low back pain and keep­ing it from com­ing back.

Exer­cis­es for core sup­port and spine lim­ber­ing are well-estab­lished modal­i­ties in the war on back pain.  But what about the spe­cif­ic effects of car­dio­vas­cu­lar con­di­tion­ing on the low back?

Can low back pain suf­fer­ers help them­selves by hit­ting the tread­mill or ellip­ti­cal machine, or by sim­ply going out for a walk?

What does the research say?

The research on this issue isn’t total­ly clear.

One rea­son is that many research stud­ies have test­ed the effects of exer­cise in gen­er­al for low back pain, with­out teas­ing apart the var­i­ous effects of aer­o­bic con­di­tion­ing, strength­en­ing, lim­ber­ing, bal­ance and pro­pri­o­cep­tive train­ing, etc.

For instance, two researchers in Cana­da stud­ied the effect of an exer­cise pro­gram on low back pain.  The exer­cise pro­gram includ­ed aer­o­bic con­di­tion­ing, but it also includ­ed exer­cis­es that focused on oth­er fit­ness com­po­nents (flex­i­bil­i­ty, strength).  Peo­ple in the exer­cise group fared far bet­ter than those who didn’t exer­cise.  But the research can’t tell use which spe­cif­ic aspects of exer­cise were impor­tant.

Oth­er research projects have tried to zero in on the spe­cif­ic ben­e­fits of car­dio con­di­tion­ing — with mixed results.

For instance, two researchers in Thai­land found that low back patients on a car­dio exer­cise pro­gram improved more than those who didn’t exer­cise.

Mean­while,  oth­er researchers who stud­ied the same issue con­clud­ed that patients engaged in aer­o­bic exer­cise improved their mood but not their pain lev­els.  (Not that there’s any­thing wrong with that.)

Then there’s yet anoth­er opin­ion.   This arti­cle favors strength train­ing over aer­o­bics for back pain.

The Bottom Line?  Is Cardio Training Good for Helping with Lower Back Pain?

Why split hairs? You need to be more fit any­way.  Just do it. Don’t ignore the oth­er aspects of exer­cise, but include car­dio­vas­cu­lar fit­ness exer­cis­es as part of your week­ly rou­tine.

What About Running for Back Pain?

Does run­ning com­press the low back discs and make back pain worse?  Can you get low­er back pain from run­ning?

These are good ques­tions.  I’ll give you three answers, and you can pick the one that make sense to you.

  1. Yes – run­ning does com­press the low back discs.  Instead of run­ning, choose anoth­er aer­o­bic exer­cise, such as an ellip­ti­cal machine.  Even walk­ing can be good.  To make walk­ing more chal­leng­ing, try walk­ing uphill or climb­ing stairs.
  2. The effects of run­ning depend on the way you run.  Wear­ing decent run­ning shoes and run­ning on a com­pli­ant sur­face make a big dif­fer­ence to the amount of low back impact when you’re run­ning. Anoth­er fac­tor mak­ing a big dif­fer­ence is whether you land on your heel when you’re run­ning or whether you’re a fore-foot lan­der.  Stay tuned for an upcom­ing blog post that deals with this issue.
  3. Answer #3 is my per­son­al obser­va­tion which may not prove to be of any val­ue when sub­ject to more scruti­ny.  But it occurs to me that the discs of the low back only get nour­ish­ment and can only get rid of waste prod­ucts by pas­sive dif­fu­sion.  The discs need repet­i­tive cycles of load­ing and unload­ing to squeeze flu­ids in and out.  The flu­id turnover speeds disc metab­o­lism for heal­ing and regen­er­a­tion.  That’s a pos­i­tive boost you give your­self when you run.

SUMMARY:  If you enjoy run­ning, and you have back pain, try a brief run on a com­pli­ant sur­face and see how it feels for you, not only while you’re run­ning, but for a day or two after.  If it seems benign to you, grad­u­al­ly increase your dis­tance.  You can also retrain your­self to be a fore­foot planter.

On the oth­er hand, if run­ning doesn’t feel right for your low back, switch to walk­ing, an ellip­ti­cal machine, sta­tionery bike, or anoth­er path to improved fit­ness.

Of great­est impor­tance: don’t use back pain as an excuse to be a couch pota­to.  That’s a los­ing propo­si­tion.


About Ronald Lavine, D.C.

Dr. Lavine has more than thirty years' experience helping patients alleviate pain and restore health using diverse, scientifically-based manual therapy and therapeutic exercise and alignment methods.

His website,, provides more information about his approach.

Please contact him at or at 212-400-9663.

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