Why movement is so important for back pain

More than 200 studies have looked into the effects of various types of exercise in people who have back pain. This makes exercise therapy by far the best-studied treatment approach.

Most of the studies involved people who had back pain for a long time – typically for at least 3 months. Almost 25,000 people took part in total.

At the beginning of the studies, most of them had moderate pain: On average, they rated the severity of their pain as 50 on a scale of 0 to 100, with 100 being the maximum pain. In the weeks and months following the exercise programs, the pain improved by an average of 15 points. In people who didn't do exercise therapy, the pain hardly improved. The studies also showed that the pain-relieving effects of exercise programs last over some time.

There is less research on the effectiveness of exercise in people who have had back pain for less than six weeks. Here, studies tend to suggest that the symptoms don't improve any faster with targeted exercises than without. But even then, it's a good idea to go about your normal everyday life as much as possible – and not to think about the pain all the time.

Once the acute pain has got better, it's a good time to start doing targeted exercises. Research on back pain prevention has shown that doing regular exercise can reduce the phases of pain by almost half. So it's worth becoming active and staying active, especially for people who have back pain that keeps returning.

Some people with back pain worry that exercise and sports could make their symptoms worse. Or they might be worried that the pain is a sign of a back injury. But that isn't the case when it comes to non-specific back pain, which is usually caused by a combination of different factors. These include weak or tense core muscles, inappropriate physical strain, a problem with the way pain is processed in the brain, as well as stress and other types of emotional strain. Exercise counteracts this in many ways: It strengthens the muscles, improves mobility and causes the body to release pain-relieving hormones such as endorphins. People who get more movement also seem to be less sensitive to pain.

Like other treatments, though, exercise therapy can also have side effects. It may lead to things like sore muscles or a temporary increase in back pain. For example, research on the effects of yoga found that the pain got worse for some time in 3 out of 100 people.

The types of exercise that have proven helpful include:

• Strengthening and stabilizing exercises for the muscles in the abdomen (belly), back, hips and pelvis.
• Pilates: A total body workout with a focus on strengthening the deep core muscles.
• Tai chi: Originally an Asian martial art, tai chi is now practiced with slow, flowing movements. It can improve your balance and coordination skills, strengthen your muscles, and is said to help you relax your body and mind.
• Yoga: A practice from India that aims to improve your body awareness and health. Yoga typically involves getting into various positions or carrying out certain sequences of movements that aim to promote strength and mobility, body awareness and a good posture.
• Going on walks: Research suggests that going on a walk or brisk walking (Nordic walking) can help relieve back pain when done regularly – for instance, every two days for 30 to 60 minutes.

A doctor or physical therapist can help you to find an appropriate type of exercise that suits you and that you enjoy.

You may need patience to start off with: It can take several weeks for the exercise to have an effect. Your body also needs to get used to the extra movement.

There are various options when it comes to doing targeted exercise therapy. Some are particularly suitable for people who would like to become more active on their own, while others are more suitable for those who wish to have personal support or would prefer to do the exercise in a group.

In Germany, public health insurers and pension funds often cover part of the costs. For example:

• Physical therapy: Doctors can issue up to three physical therapy prescriptions for back pain. One prescription covers six treatment sessions lasting around 20 minutes each.
• Prevention and exercise classes: These include pilates, yoga and back-strengthening classes. There are online classes too. You can find out what costs are covered by visiting your health insurer's website, for example.
• Medically prescribed apps (digital health applications, or DiGAs for short): A number of apps for the treatment and prevention of back pain are now paid for by public health insurers if the apps have been prescribed by a doctor. DiGA apps include exercise programs, information and support for managing back pain.
• Group rehabilitation exercise classes (Rehasport): These classes can be prescribed by a doctor – for example, once you have completed physical therapy.

In order for exercise to help over the long term too, you have to keep it up. This requires a lot of motivation, and many people find it tough after a while – particularly if they have a very busy job or home life. It is then important to find a way to fit the exercise into your daily routine.

Many people find it easier to exercise regularly if they sign up for classes on certain days, exercise together with friends, or use a fitness tracker to see their progress.

If you spend a lot of time sitting in an office, you can be kind to your back by taking regular breaks and moving your body – for instance, by getting up out of your chair, stretching, doing short exercises and going on a walk in your lunch break.

Other ways to get more exercise into your daily routine include the following:

• Not using escalators or elevators (lifts), and always taking the stairs instead.
• Regularly getting off one stop before your actual bus or tram stop, and walking the rest of the way.
• Trying to walk or cycle as much as possible.
• Getting up and walking around while you're talking on your phone.

Patient education classes for people with back pain (known as "Rückenschule" in Germany) provide you with facts and techniques to help prevent or relieve the pain. They usually have both a theoretical and practical part. The classes typically include modules on the anatomy of the spine and the back, advice on how to move in ways that don't put harmful strain on your back, and back-strengthening exercises. Like other exercise classes, these back-focused ones are offered by German public health insurers as prevention classes (Präventionskurs).

Research suggests that these patient education classes can help over the short term. But there has been much less research on them than on exercise therapy. Because of this, experts only recommend doing them in addition to exercise therapy.