Why movement is so important for back pain

Photo of a yoga group
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One of the most important things that people with low back pain can do is to stay as physically active as possible in daily life and exercise regularly. Things that have been proven to help include exercises to strengthen the core muscles, as well as certain exercises used in pilates, tai chi and yoga.

Not moving enough can weaken your core muscles, make the pain worse over the long term, and also lead to other health problems. Because of this, people who have back pain are often advised to get "more exercise" and "stay active." There are good reasons for this advice: For a start, regular physical exercise has been shown to reduce pain. What's more, it's a good idea to go about your daily life as normally as possible, and not to let the pain limit your activities too much. Isolating yourself or no longer doing things you enjoy will make it even harder to cope with back pain.

More than 100 studies have looked into various types of exercise. So this is by far one of the best studied treatment approaches. Exercise and sports are also among the few treatments that have been proven to relieve back pain. This is the reason why most medical societies around the world recommend regular exercise for people with back pain.

Although exercise programs don't always make back pain go away completely, they often relieve the pain and improve your overall fitness and mobility. Research has also found that doing regular exercise can reduce the frequency of recurring back pain attacks by almost half.

No fear of movement

It is often hard to stay active if you are in pain. Some people are even scared of moving too much. 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 many different factors. These include weak or tense core muscles, inappropriate physical strain, a problem with the processing of pain in the brain, as well as stress and other types of emotional strain. It's important to remember that if the doctor has ruled out (rare) serious causes of the symptoms, there is no need to be afraid of movement.

Types of exercise that have proven effective include the following:

  • Special programs consisting of exercises to strengthen and stabilize the deep abdominal (tummy), back and pelvic muscles, as well as endurance training and exercises to stretch the muscles in the calves, hips and thighs.
  • Pilates: A total body workout in which strengthening the deep core muscles is key.
  • 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: An ancient Indian practice 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 flexibility, body awareness and a good posture.
  • Going on walks: Initial research suggests that going on a walk or brisk walking (Nordic walking) can help relieve back pain if done regularly – for instance, every two days for 30 to 60 minutes.

A doctor or can help you to find a suitable type of exercise that is tailored to your situation and that you enjoy. People who have medical problems often find it helpful to have a course instructor or trainer with the appropriate experience.

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. That can be tiring and lead to harmless muscle ache, and it sometimes makes the pain worse for a while.

What can help you stick to it?

In order for it to help in the long run too, you have to stick to your exercise program. 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 a class or exercise together with friends. Some make sure they pack their sports bag before going to work, or increase their motivation by rewarding themselves with a treat afterwards. It is also a good idea to have check-ups with a or doctor to adjust the exercise program if necessary.

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. Some people find it helpful to wear a fitness tracker watch, or to set reminders on their mobile phone or computer.

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 mobile or cordless phone.

Patient education classes

Patient education classes provide you with facts and techniques to help prevent or relieve back pain. There is usually both a theoretical and practical part. The classes typically include modules on the anatomy of the spine and the back, advice on postures and movements that don't put harmful strain on the back, and back-strengthening exercises. These courses are often offered at gyms and physiotherapy practices.

Patient education classes haven't yet been scientifically proven to help people with chronic low back pain. Some studies found that they helped a bit, while others did not. There are a lot of different patient education classes, sometimes differing greatly in terms of what they cover and the approaches they use. This might explain why the results of the studies varied so much.

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Medina-Mirapeix F, Escolar-Reina P, Gascon-Canovas JJ, Montilla-Herrador J, Collins SM. Personal characteristics influencing patients' adherence to home exercise during chronic pain: a qualitative study. J Rehabil Med 2009; 41(5): 347-352.

Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J 2018 [Epub ahead of print].

Saragiotto BT, Maher CG, Yamato TP, Costa LO, Menezes Costa LC, Ostelo RW et al. Motor control exercise for chronic non-specific low-back pain. Cochrane Database Syst Rev 2016; (1): CD012004.

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Steffens D, Maher CG, Pereira LS, Stevens ML, Oliveira VC, Chapple M et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med 2016; 176(2): 199-208.

Vanti C, Andreatta S, Borghi S, Guccione AA, Pillastrini P, Bertozzi L. The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials. Disabil Rehabil 2017 [Epub ahead of print].

Wieland LS, Skoetz N, Pilkington K, Vempati R, D'Adamo CR, Berman BM. Yoga treatment for chronic non-specific low back pain. Cochrane Database Syst Rev 2017; (1): CD010671.

Yamato TP, Maher CG, Saragiotto BT, Hancock MJ, Ostelo RW, Cabral CM et al. Pilates for low back pain. Cochrane Database Syst Rev 2015; (7): CD010265.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on February 14, 2019
Next planned update: 2022

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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