Which exercises help lower back pain, and which make it worse?

Does exercise really help back pain?

A Cochrane review of 249 trials found moderate-certainty evidence that exercise is probably effective for reducing pain in chronic low back pain compared with no treatment, usual care or placebo, although the effect on function was small 1. Exercise is recommended by UK and US guidance as a core treatment 23.

Exercise works through several routes: strengthening muscles, improving flexibility and fitness, reducing sensitivity of the nervous system to pain, improving mood and sleep and building confidence to move normally.

Which types of exercise are recommended?

UK guidance recommends considering a group exercise programme that may include biomechanical exercise such as strengthening and stretching, aerobic exercise, mind-body exercise such as yoga or Pilates, or a combination, taking people's preferences into account 2. US guidance lists exercise, motor control exercise, tai chi, yoga and other approaches for chronic low back pain 3.

Because different types work similarly well on average, the programme that works for an individual is usually one they enjoy, can fit into daily life and will continue.

What are good exercises to start with?

Walking is simple and effective for many people; start with a comfortable distance and increase gradually. Gentle movements such as pelvic tilts, knee rolls lying on the back, bridging and cat-camel stretches on hands and knees can reduce stiffness. Strengthening the trunk, hips and legs with exercises like sit-to-stand, step-ups and bird-dog builds support.

A physiotherapist can tailor exercises to your symptoms, fitness and goals and check technique. Programmes are usually progressed every week or two.

Is it normal for exercise to hurt?

Some discomfort during or after exercise is normal and does not mean damage. A useful guide is that pain should settle to its usual level within a day. If pain increases sharply, lasts longer, or leg pain spreads further down the leg, reduce the intensity or change the exercise.

Fear of pain often leads people to avoid movement, which increases stiffness and weakness. Gradually exposing the back to movements that feel worrying, with support, helps rebuild confidence.

What tends to make back pain worse?

Prolonged bed rest, avoiding all activity and relying only on passive treatments tend to slow recovery. UK guidance advises against belts or corsets, foot orthotics, traction, ultrasound and TENS for low back pain 2.

Exercises that sharply increase leg symptoms, sudden large increases in activity after a period of rest and heavy lifting without building up gradually can provoke flare-ups. Sitting for long periods without breaks can also increase stiffness.

Should exercise be different for acute and chronic back pain?

In acute back pain lasting less than a few weeks, staying active and continuing normal activities as much as possible is the priority, with gentle movement and short walks. Formal exercise programmes are more strongly supported for chronic pain.

In chronic back pain, a structured, progressive programme combined with advice about pain and activity, and sometimes psychological approaches when pain has not responded to simpler measures, is what guidance recommends.

When should back pain be checked by a doctor?

Seek urgent care for back pain with bladder or bowel problems, numbness around the genitals or buttocks, severe or worsening weakness in the legs, fever, unexplained weight loss, a history of cancer or significant trauma.

Also see a doctor if pain is severe and not improving after a few weeks, disturbs sleep every night or comes with other worrying symptoms.

Frequently asked questions