2 Abdominal Exercises Physical Therapists Actually Prescribe for Back Pain
Most people think core training means crunches. And most people with back pain have been doing crunches for years — yet their back still hurts.
That's not a coincidence. It's a clinical pattern we see constantly at Optimize Physical Therapy and Performance: patients who've been handed the same generic exercise sheet, told to "strengthen their core," and sent home — without anyone explaining which muscles to target, why those muscles matter, or how to execute the movement so it actually loads the right tissue.
Before we get to the exercises, it helps to understand exactly what your "core" is — because it's a lot more than the muscle you can see in the mirror.
Your Abdominal Muscles: What You're Actually Training
The abdominal wall is made up of four distinct muscle layers, each with a different mechanical role in how your spine behaves under load:
Rectus Abdominis
The "six-pack" muscle. Runs vertically from the ribcage to the pelvis. Controls spinal flexion — but is often overemphasized at the expense of the deeper stabilizers.
Transversus Abdominis
The deepest layer. Acts like a natural back brace, increasing intra-abdominal pressure to protect the spine during movement. This is the one that matters most for back pain.
Internal Oblique
Beneath the external oblique. Assists in trunk rotation and lateral flexion, and provides significant contribution to spinal compression and stability.
External Oblique
The outermost layer, running diagonally. Works with the internal oblique to control rotation and resist unwanted movement through the lumbar spine.
When all four layers work together, your spine is stable, protected, and capable of transferring force without breaking down. When they don't — typically because the deeper stabilizers are underactivated — your back picks up the slack. And that's when pain starts.
"The goal isn't a stronger six-pack. It's a spine that knows how to protect itself before the load arrives."
The 2 Exercises We Use in Physical Therapy
These aren't exotic movements. They're foundational — and their value comes entirely from executing them correctly. Done right, they teach your core to fire in the right sequence. Done wrong, they just load your hip flexors and call it a day.
Abdominal Crunch
The crunch gets dismissed a lot in performance circles — but when performed with proper mechanics, it's one of the most effective ways to train the rectus abdominis and anterior core without loading the lumbar spine. The key is eliminating the compensations that make it ineffective (and often painful).
How to perform it correctly
Lie on your back with knees bent at a comfortable angle. Feet flat on the floor.
Place your fingers lightly behind your head or cross your arms over your chest — whichever keeps you from pulling on your neck.
Take a breath in. On the exhale, contract your abdominals and curl your head, shoulders, and upper back off the floor. Think about bringing your ribcage toward your pelvis — not your head toward your knees.
Your lower back should stay in contact with the floor throughout. You should rise only a few inches.
Hold the top position for 2–3 seconds. Breathe out at the top.
Lower back down with control. Repeat for 10 repetitions.
IMPORTANT
If you feel pain in your lower back during this movement — not just muscle fatigue, but pain — stop immediately. A crunch performed with poor mechanics can aggravate rather than rehabilitate. A physical therapist can assess whether this exercise is appropriate for your specific presentation and modify it accordingly.
Low Abdominal Leg Raise
This movement targets the lower abdominals and hip flexors under an eccentric load — making it more demanding than a crunch and significantly more effective at training the anterior core's ability to resist lumbar extension. The arc-path is critical. It's what keeps the load on your abs and off your spine.
How to perform it correctly
Lie on your back. Before you move anything, take a breath in and gently brace your abdominals — pressing your lower back lightly into the floor.
Bend your knees to a comfortable angle. The straighter your legs are, the longer the lever arm — which means more demand on your core. Start bent and progress from there.
Keeping your lower back pressed into the floor, contract your abs and lift both feet off the ground in a slow arc. Aim for about 8–10 inches off the floor.
Pause briefly at the top.
Slowly lower your feet back to the floor along the same arc. Control the descent — this is where most of the work happens.
Reset your brace before the next rep. Repeat 10 times.
IMPORTANT
The moment your lower back arches away from the floor, the load has shifted from your abs to your lumbar spine. If you can't maintain contact throughout the full range, reduce your lever arm by bending your knees more — or stop and consult your PT about what's limiting you.
Why These Two Exercises — and Not Something Else
These are starting points, not endpoints. At Optimize, we don't hand patients a list of exercises and wish them luck. We use movements like these to re-establish a baseline — to get the right muscles online before we start layering on load, complexity, or sport-specific demand.
The reason so many people are stuck in back pain despite doing "core work" is that they're training the wrong muscles, in the wrong order, at the wrong intensity for where they are right now. A crunch and a leg raise done correctly by someone who's never truly engaged their deep stabilizers is genuinely therapeutic. That same movement done with compensation patterns locked in place just reinforces the problem.
This is why we always conduct a full assessment before prescribing anything. Not because we want to be overly cautious — but because the right exercise for you depends on what's actually driving your pain, how your muscles are firing, and what stage of recovery you're in. We don't guess at that. We find it.
Not Sure Where to Start with Your Back Pain?
We'll assess what's actually going on — not just hand you a sheet of exercises and send you home. Book a 20-minute call with our team to find out if we're the right fit.
