Back Pain Exercises: A Physiotherapist’s Guide
Back pain is very common and can affect your movement, sleep, work and everyday activities. For many people, staying active and gradually returning to normal activities are important parts of recovery.
As physiotherapists, we often recommend exercise as part of an individualised approach to managing back pain.
NICE guidance recommends considering an exercise programme for people with low back pain, with or without sciatica, while the Chartered Society of Physiotherapy (CSP) encourages people to remain active and progressively build their activity.
The important point is that there is no single exercise that is right for everyone with back pain.
The most appropriate exercises depend on your symptoms, movement, strength, goals and overall health.
An individual assessment can help determine which exercises are suitable for you.
Managing your back pain | The Chartered Society of Physiotherapy
Should You Exercise With Back Pain?
For most uncomplicated back pain, completely resting in bed is generally not recommended. Staying as active as your symptoms allow can help you maintain movement and function. CSP advises people with back pain to remain active and limit bed rest
Causes of back pain | The Chartered Society of Physiotherapy
You may need to temporarily modify activities that significantly aggravate your symptoms. This does not necessarily mean avoiding movement altogether.Try to:Continue normal daily activities as much as you comfortably can.Change positions regularly rather than staying in one position for long periods.Gradually increase activity as your symptoms allow.Choose exercises and activities that you enjoy and can maintain consistently.Avoid forcing painful movements or suddenly increasing your activity level.There is no single "best" exercise for everyone with back pain.
NICE recommends tailoring exercise to the individual.
Gentle exercises for back pain
The following exercises are examples of movements used in CSP resources. They should be adapted to the individual and should not be considered a substitute for an assessment by a physiotherapist or other healthcare professional
1. Pelvic tilts
Lie on your back with your knees bent and your feet supported on the floor.Gently activate your abdominal muscles and tilt your pelvis so that your lower back moves towards the floor. Then gently move in the opposite direction, allowing your lower back to arch slightly.Move slowly and comfortably rather than forcing the movement.Aim: To gently move the lower back and improve awareness and control of pelvic movement.
2. Knee-to-chest movement
Lie on your back with your knees bent.Bring one knee towards your chest, using your hands underneath the thigh if needed. Slowly return the leg to its starting position and repeat on the other side.Keep the movement comfortable and avoid forcing the knee towards your chest.Aim: To introduce gentle movement through the lower back and hip.
3. Core activation with heel slides
Lie on your back with your knees bent.Gently activate your abdominal muscles while continuing to breathe normally. Slowly slide one heel away from you until the leg is more extended, then return to the starting position. Repeat with the other leg.Try to keep your pelvis and lower back controlled throughout the movement.
Aim:
To develop trunk control while moving the legs. CSP includes this type of exercise in its back-pain exercise resources
Video exercises for back pain | The Chartered Society of Physiotherapy
4. Walking
Walking is a simple way of maintaining general activity while recovering from back pain.Start with a distance or duration that feels manageable. If this is comfortable, gradually increase the amount of walking over time.You do not need to wait until your back is completely pain-free before becoming more active.Aim: To maintain general fitness, confidence and normal activity.
5. Gradual strengthening
As symptoms improve, strengthening exercises can be introduced or progressed.Examples may include:Sit-to-stand exercisesSquatsBridgesStep-upsHip strengtheningGeneral resistance exercisesThe appropriate exercise and level of resistance will depend on the person's strength, symptoms, function and goals.
CSP guidance supports starting slowly, monitoring progress and gradually increasing the amount of exercise performed
What is strengthening and is it safe for me? | The Chartered Society of Physiotherapy
How often should you exercise?
There is no single exercise prescription that is appropriate for everyone with back pain. NICE specifically recommends taking the individual's needs, preferences and capabilities into account when choosing an exercise programme.
A useful approach is to begin with a manageable amount of activity and gradually increase the duration, repetitions, resistance or difficulty as your confidence and ability improve.For example, you might begin with short periods of walking and a small number of gentle exercises, then gradually increase the amount over several days or weeks.The goal is progressive return to normal activity, rather than remaining on a fixed programme forever.
Should exercise hurt?
Some people experience a temporary increase in discomfort when they start moving again. This does not automatically mean that they are damaging their back.
However, exercise should be appropriate to the individual's symptoms. If an exercise causes a significant or persistent worsening of symptoms, stop and seek advice from a physiotherapist or other healthcare professional.
CSP recommends seeking professional advice before starting a new exercise programme, particularly if you are unsure whether an exercise is appropriate for you
Video exercises for back pain | The Chartered Society of Physiotherapy
Is there a "best" exercise for back pain?
No.Different people respond differently to different types of exercise.
NICE therefore recommends considering different forms of exercise and taking individual preferences and capabilities into account.
For one person, walking may be the most useful starting point. Another person may prefer strengthening exercises, yoga, swimming, Pilates or a structured physiotherapy programme.
The most effective programme is often one that is safe, appropriate, enjoyable and sustainable.
NG59 Low back pain and sciatica in over 16s: Full guideline
Exercise and persistent back pain
Back pain can sometimes persist for longer than expected. In these situations, simply resting the back is unlikely to be the best long-term strategy.For persistent low back pain or sciatica, NICE recommends considering a combined physical and psychological programme when there are significant psychosocial obstacles to recovery or when previous treatments have not been effective.
This reflects the fact that back pain can be influenced by many factors, including physical activity, sleep, stress, mood, beliefs about pain and fear of movement. CSP similarly recognises that physical, psychological, lifestyle and social factors can influence someone's experience of back pain.
Causes of back pain | The Chartered Society of Physiotherapy
When should you seek medical advice?
Most back pain is not serious, but some symptoms require medical assessment.
Seek urgent medical attention if back pain is associated with symptoms such as:
New difficulty passing urine
Loss of bladder or bowel control
Numbness or altered sensation around the genitals or buttocks
Significant or new loss of strength in the legs
Severe or progressive neurological symptoms
Feeling significantly unwell with back pain, particularly with symptoms such as fever
These symptoms are uncommon but can indicate a more serious condition and should not be ignored.
You should also seek professional advice if your symptoms are progressively worsening, are not improving as expected, or are preventing you from carrying out normal activities.
The key message
Exercise is an important part of modern back-pain management.
NICE recommends appropriately selected exercise programmes, while CSP encourages people to remain active and progressively return to normal activities.
Rather than looking for one special exercise that will "fix" your back, focus on regular movement, gradual strengthening, maintaining normal activities and choosing exercise that you can realistically continue.
If you are unsure which exercises are appropriate, a physiotherapist can assess your symptoms and help develop an individualised exercise programme.
Disclaimer:
The exercises and information in this article are provided for general educational purposes and are not a substitute for an individual physiotherapy assessment.
Back pain can have many different causes, and not every exercise is appropriate for every person. If you are experiencing severe, worsening or unusual symptoms, or are unsure whether an exercise is suitable for you, seek advice from an appropriately qualified healthcare professional.