Exercise and Back Pain — Why Movement Matters

If you are dealing with back pain, one of the most useful things you can do is keep moving. That might sound counterintuitive — especially if bending down to put your shoes on feels like an ordeal — but the research on this is clear and consistent. Movement is one of the most effective things we have for managing back pain, and it is something you can start doing today.

I understand the instinct to rest. When your back is sore, your body is telling you something hurts, and the natural response is to stop and protect. But decades of research have shown us that prolonged rest tends to make things worse, not better. The old advice of bed rest for back pain has been thoroughly replaced by guidelines that encourage staying as active as you can.

What the evidence tells us

The research supporting exercise for back pain is strong. A major review by Gordon and Bloxham, published in Healthcare in 2016, found that exercise — across many different types — was consistently associated with reductions in pain and improvements in function for people with chronic low back pain. The authors noted that no single type of exercise stood out as clearly superior; what mattered most was that people moved regularly.

The 2018 Lancet Low Back Pain Series (Foster et al.) reinforced this message on a global scale. It found that the most effective approaches to back pain combined physical activity with education and, where appropriate, manual therapy. The series explicitly recommended against bed rest and prolonged inactivity, identifying them as unhelpful for recovery.

Current Australian and international clinical guidelines consistently place exercise as a first-line recommendation for both acute and chronic low back pain. It is one of the few interventions where the evidence is strong across multiple high-quality studies.

Types of movement that may help

One of the reassuring findings from the research is that you do not need to do anything complicated or strenuous. Many different forms of movement have been shown to be beneficial. What matters is finding something that works for you and doing it regularly.

Some forms of exercise that many people find helpful for back pain include:

• Walking — simple, free, and easy to adjust to your level. Even short walks can make a meaningful difference. The Huon Valley has some wonderful options for this — the Cygnet foreshore, the Esplanade walk in Franklin, or even a gentle loop around your neighbourhood.
• Swimming and water-based exercise — the buoyancy of water reduces load on your spine while allowing you to move freely. The pool at Franklin is a good local option.
• Gentle stretching — a simple daily stretching routine may help reduce stiffness and improve how your back feels through the day. Our morning mobility guide has some ideas to get started.
• Core stability exercises — strengthening the muscles that support your trunk may help with long-term management of back pain. This does not mean sit-ups — it means learning to engage the deeper stabilising muscles around your spine.
• Yoga and Pilates — both combine movement, stretching, and body awareness in ways that many people with back pain find helpful. Look for classes that offer modifications for people with pain or limited mobility.
• Gardening and everyday activity — this is worth mentioning because many people in the Huon Valley are already active in ways they do not think of as exercise. Tending a garden, walking to the shops, splitting firewood — it all counts as movement, and it all contributes.

The important thing is not which type of exercise you choose. It is that you find something sustainable and that you feel comfortable doing. A 15-minute walk you do every day is more valuable than an ambitious programme you abandon after a week.

The fear-avoidance cycle

One of the biggest barriers to staying active with back pain is fear. This is completely understandable. If movement has been painful, your brain learns to associate movement with danger, and it becomes harder to get going again. Researchers call this the fear-avoidance cycle, and it is one of the most well-documented factors in back pain becoming persistent.

The cycle works like this: you experience pain, so you avoid the movements that seem to trigger it. Over time, you move less and less. Your muscles become deconditioned, your joints get stiffer, and your nervous system becomes more sensitive to movement. Activities that would not normally be painful start to hurt, which reinforces the belief that movement is dangerous. The cycle continues.

Breaking out of this cycle does not mean pushing through severe pain. It means gradually and gently reintroducing movement, ideally with guidance from someone who understands what you are going through. The goal is to help your body and your nervous system learn that movement is safe — because in the vast majority of cases, it is.

This is something I spend a lot of time on in the clinic. Understanding the fear-avoidance cycle is often one of the most helpful things a person can learn about their back pain.

Getting started when you are in pain

Starting to exercise when your back already hurts can feel daunting. Here are some practical principles that may help:

• Start small. A five-minute walk is a perfectly good starting point. You can build from there.
• Expect some discomfort. There is a difference between discomfort during activity and pain that is sharp, worsening, or radiating. Some muscle soreness after getting moving again is normal and usually settles within a day or two.
• Be consistent rather than ambitious. A little bit of movement every day tends to be more helpful than a big effort once a week.
• Choose something you enjoy. You are far more likely to stick with movement that you find pleasant or meaningful.
• Do not compare yourself to how you used to move. Start where you are now, not where you think you should be.
• Get an individual assessment if you are unsure. If you do not know what is safe for your particular situation, it is worth getting professional guidance. A consultation can help clarify what types of movement are appropriate for you and give you confidence to get started.

Exercise and manual therapy — better together

In my practice, I see exercise and manual therapy as complementary. One does not replace the other. Hands-on treatment may help in the short term by reducing pain and improving how your joints and muscles are moving. Exercise helps you maintain those improvements, build resilience, and reduce the likelihood of your pain returning.

The research supports this combined approach. The studies I mentioned earlier — both Gordon and Bloxham (2016) and Foster et al. (2018) — found that outcomes tend to be better when manual therapy is paired with active movement and self-management, rather than when either is used alone.

What this looks like in practice varies from person to person. For some people, a few sessions of hands-on treatment may be enough to get them moving comfortably again. For others, ongoing management that combines periodic manual therapy with a consistent movement routine works best. There is no single formula — it depends on your situation, your goals, and what you respond to.

Movement is not a prescription — it is a principle

I want to be clear about something: this article is general guidance, not a specific exercise programme. What is appropriate for you depends on your individual circumstances — your pain, your history, your fitness level, and what you enjoy. The purpose here is to share the principle that movement matters, not to tell you exactly what to do.

If you would like specific guidance tailored to your situation, that is something we can work through together. An individual assessment allows me to understand what is going on with your back and help you find a movement approach that makes sense for you.