Back pain is an epidemic: According to the American Association of Neurological Surgeons, as many as 80 percent of Americans will experience some form of low back pain in their lives, and, in a large survey, more than a quarter of adults reported having lower back pain in the past three months.

If you’ve suffered a back injury, you know it can be terrifying to resume any kind of exercise routine. “I think there’s a lot of hesitation because of the pain and worry of re-injuring the spine,” says Joseph Herrera, DO, system chair of rehabilitation medicine at the Mount Sinai Health System. “Once you have had an episode of back pain, you’re four times more likely to have a re-occurrence.”

Bed rest is the worst thing you can do for back pain. Resuming activity helps to release endorphins (feel-good hormones) that minimize pain, boost your mood and speed your recovery.

“When you have issues with your back, your body has two lines of defense.The first is muscle spasm, or pain to prevent further movement. The pain tells you to stop. The second is psychological, where you don’t want this to happen again so you move as little as possible,” says Jeff Halevy, a health and fitness expert from New York City who runs Halevy Life, an integrated health and wellness gym.

Yet, Herrera says the worst thing you can do is lie in bed until the pain completely subsides. “Bed rest is the worst thing you can do for back pain. Resuming activity helps to release endorphins (feel-good hormones) that minimize pain, boost your mood and speed your recovery,” he says.

While working through back pain recovery, many physical therapists will recommend working on your core, but Halevy says it’s how you work the core that’s just as important. “There are more core muscles than just your six pack,” he says. “The problem becomes if you work this area in isolation, there’s zero transfer to what you do when you really start to stand up and move.”

A Phased Approach

Halevy recommends those who are cleared to exercise but are nervous about it transition through “phases” of exercise positions that support the spine. Bo Babenko, DPT, a physical therapist at Halevy Life, explains:

Phase 1: Exercises that begin flat on your back or lying on your stomach. “If I’m going to exercise, this is the most supportive of the spine.”

Exercises that begin flat on your back or lying on your stomach. “If I’m going to exercise, this is the most supportive of the spine.” Phase 2: Exercises that begin quadruped, tabletop or on hands and knees. “The spine is still very supported here but the supporting structures are working much more to help support the back,” says Babenko.

Exercises that begin quadruped, tabletop or on hands and knees. “The spine is still very supported here but the supporting structures are working much more to help support the back,” says Babenko. Phase 3: Exercises that begin on your knees, or half-kneeling. “We begin to introduce gravity bearing down onto the spine,” Babenko explains.

Exercises that begin on your knees, or half-kneeling. “We begin to introduce gravity bearing down onto the spine,” Babenko explains. Phase 4: Exercises you can do standing up. “Standing will be the full return to normal daily activities as we get closer to discharging someone from a rehab program,” says Babenko.

Babenko also shared these four exercises, one for each stage.

Stage 1 exercise: Crocodile breathing Bo Babenko/Halevy Life

Stage 1: Crocodile breathing

Lie flat on your stomach and breathe deeply, filling your belly with air and releasing it (not breathing through your chest). This relaxes the spine and gives a 360-degree expansion of the ribs and belly.

Stage 2 exercise: Banded kickbacks Bo Babenko/Halevy Life

Stage 2: Banded kickbacks

Using a band, create a long loop, holding the ends in one hand. Once on all fours, insert one foot into the loop. Maintaining a table top posture, kick your leg straight back to the wall behind you five times, working your glute muscles. Switch legs for five more reps.

Stage 3 exercise: The Paloff Press Bo Babenko/Halevy Life

Stage 3: The Pallof Press

This exercise helps your spine with anti-rotation and teaches the muscles to stay stable and continue to build safety into movement patterns.

Secure an exercise band around a pole aligned in height with your midsection, creating a loop. Grab the loop and stand so the pole is behind you. Align your feet with your hips. Keeping your posture straight, slowly extend the band in front of you, pressing from your belly button straight out in front of you without letting the band change your direction. Bring your arms back and repeat 10 times.

Stage 4 exercise: The Kettlebell Bo Babenko/Halevy Life

Stage 4: The Kettlebell

Though the common fear around back injuries is that you shouldn’t lift any weights, we need to be prepared to hold weighty objects in life, whether it be from backpacks or groceries.

Beginning with a light weight, hold a kettlebell up against one shoulder and raise one leg up towards your hips for 30 seconds. Slowly lower that leg and raise the other.

Protect and Listen to Your Body

Bobenko recommends check with your doctor before beginning these exercises to be sure you’re ready. And, whatever you do, don’t exercise with a back brace. Though Herrera says using a brace (if you need to) at work can be good because they reminder to improve your posture and your lifting mechanics, prolonged use of a back brace can weaken the paraspinal muscles (muscles that support the spine).

This isn’t a no pain, no gain scenario. If you do have pain while exercising, that’s your body saying you’re not ready or the injury is still present.

Though trepidation about exercise is completely understandable for people with back problems, you can move — just carefully. Listen to your body. “This isn’t a no pain, no gain scenario,” Herrera says. “If you do have pain while exercising, that’s your body saying you’re not ready or the injury is still present.”

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