Health and safety

What exercise is best for lower back pain?

By GyroscopeUpdated November 15, 20267 sources

The one you’ll keep doing. Walking, strength work, yoga and tai chi have all helped in trials, and UK guidance says to pick the kind that suits you. For new back pain, keep moving gently instead of resting in bed. For pain that has lasted more than 12 weeks, regular exercise eased it in a review of 249 trials. A few warning signs need a doctor first, and they’re listed below.

When your back hurts, every instinct says to lie down, stop lifting and stay still until it settles. Then the internet offers a hundred stretches, each sold as the one that fixes it. But bed rest isn’t recommended, most new back pain gets better within a few weeks, and the evidence points to moving more, in whatever way you’ll keep up.

A sore back is a bit like a stiff door hinge. Leaving it shut doesn’t loosen it, and gentle use every day does.

When to see a doctor first

Get medical help right away if back pain comes with any of these:

• Loss of control over your bladder or bowels.
• Weakness or numbness in your buttocks, thighs, legs or pelvis.
• A fever you can’t explain.

See a doctor soon if the pain came after a fall or an injury, if it’s severe and medicine doesn’t help, if you’re losing weight without trying, or if it hasn’t improved after a few weeks. These come from MedlinePlus and the US National Institute of Arthritis and Musculoskeletal and Skin Diseases. Pain that spreads down a leg with numbness or tingling is also one to have checked.

New back pain: keep moving

MedlinePlus says bed rest isn’t recommended. If there are no signs of a serious cause, stay as active as you can and cut back only for the first couple of days. Most people improve within 4 to 6 weeks, and many feel better within a week.

The American College of Physicians says the same thing in its 2017 guideline. Since most new back pain improves over time whatever you do, it puts heat, massage, acupuncture or spinal manipulation first, before pills. A gentle walk fits alongside any of those.

Long-lasting back pain: exercise is a first treatment

Back pain that lasts more than 12 weeks is called chronic. For chronic pain, the American College of Physicians puts exercise first, along with tai chi, yoga, motor control exercise (training the deep muscles that steady your spine), mindfulness and others, before medicine.

The biggest review is from Cochrane in 2021. Jill Hayden’s team pooled 249 trials of exercise for chronic low back pain, with people averaging 44 years old. Against no treatment, usual care or a placebo, exercise cut pain by about 15 points on a 100-point scale, a difference people notice. Its effect on how much people could do was smaller, about 7 points. Most of the side effects reported were minor, like sore muscles.

UK guidance from NICE suggests a group exercise program and says to choose the type by what the person needs, likes and can do. It also says not to offer back belts or corsets.

Which kind?

Any of these has trial evidence behind it:

For the strength moves, strength.guide’s lower back page shows each one and how to build it up. If you’re new to exercise, how to start has a first week that fits here too.

Keeping it from coming back

Back pain often returns, and walking helps keep it away. In the WalkBack trial in Australia, 701 adults who had just recovered from back pain were split into two groups. Half got a walking plan built up over 6 months, with six visits to a physical therapist, and half got nothing. The walkers went a median of 208 days before their next bout of pain that limited what they could do, against 112 days for the others.

A 2016 review of 21 prevention trials with 30,850 people found exercise with education cut the risk of a new bout by about 45%. Education alone, back belts and shoe insoles didn’t seem to help.