How to Exercise With a Bad Back: What Actually Helps

By Paul Butler · Online Coach & Personal Trainer

Nobody ever hurt their back doing something impressive. It is always a sock, a sneeze, or the boot of the car.

And then somebody tells you to rest it. So here is how to exercise with a bad back, which is a question I get asked more than almost any other, and the short answer is that you probably should be exercising rather than resting. Not the thing that hurt you, and not yet at the weight you were using. But moving, and soon. Resting a back for three weeks is how a two week problem becomes a two year one.

Can you exercise with a bad back?

For ordinary back pain, yes, and you are usually better off doing it. The NHS is direct about this: stay active, keep your normal activities going, and do not spend long periods in bed. What changes is the choice of exercise and the weight on it, not whether you train at all.

Why "rest it for a couple of weeks" keeps letting people down

This is the bit that frustrates me, and it is worth being precise about why. It is not that rest is evil. It is that rest on its own does not change anything, so when the episode settles, you are handed back exactly the same back that gave up in the first place.

The NHS puts it about as plainly as a health service ever puts anything.

"Stay active and try to continue with your daily activities... do not stay in bed for long periods of time."

So if you were told to do nothing for three weeks, that advice is out of step with what the NHS itself publishes. That is worth knowing, because it means going back and asking about a referral is a reasonable thing to do rather than being difficult.

And here is the number that explains the whole pattern. In a review of the research on preventing back pain, roughly half of people who recover from an episode have another one within a year. Rest gets you through the episode. It does nothing about the year.

What the evidence actually says about backs and exercise

There is a large review in JAMA Internal Medicine that pooled twenty one trials and just over thirty thousand people, and looked at what actually stops back pain happening. It is one of the tidiest answers in this whole field.

Read the bottom three rows again, because they are the things people actually buy. The belt does nothing. The insoles do nothing. The thing that works is the thing nobody sells you in a shop.

Then the authors add the line that I would put on a wall.

"...for exercise to remain protective against future LBP, it is likely that ongoing exercise is required."

The protection faded once people stopped. Which is the same thing I say about everything else: it is not a course you complete. It is a thing you keep doing, and that is the entire argument for training your back rather than resting it.

What I actually do with somebody who has a dodgy back

Nothing clever, and nothing that looks like treatment.

First we find what does not hurt. There is almost always a hinge, a push, a pull and a carry that feel fine, and that is a full session right there. We load those properly, because a weight you could do twenty of is not training, it is waving.

Then we go back towards the thing that hurt, slowly, from a shorter range and a lighter weight. The aim is not to avoid bending forever. A back that never gets asked to do anything stays a back that cannot do anything.

Hips and midsection do a lot of the work people think their lower back is doing, so those get trained on purpose rather than by accident. And we keep going once it feels better, which is the step almost everybody skips.

Here is my own opinion, and I will label it as opinion rather than dress it up as a finding: I think a lot of lower back pain in ordinary, desk-bound people is a back that has simply never been asked to be strong. The trials above show exercise prevents episodes; they do not single out lower back work specifically. But after a lot of hours on a gym floor, the pattern I see is people whose backs are not weak from injury, they are weak from twenty years of nothing. It is the same story as what actually changes about training after forty: the problem is rarely the years, it is what got skipped during them.

Where I stop and a physio starts

I am a personal trainer with a nutrition and coaching background. I am not a physiotherapist and I do not diagnose anything. That is not modesty, it is the actual line.

If pain is getting worse rather than settling, if it travels down a leg, if it wakes you at night, or if it has been hanging around for weeks without budging, that is a physio or a GP, and it is worth pushing for a referral rather than accepting another fortnight of waiting. A good trainer works alongside that person rather than instead of them. Some of the best sessions I have run have been the ones where a physio told me exactly what to avoid.

It is also the first thing I ask about in a first session, which is why the boring questions at the start matter so much. Every old injury you forget to mention is a session I write wrong.

This article is general information and not medical advice. If in doubt, get it looked at.

Frequently asked questions

Should I stop training completely when my back flares up?

Usually not. Most people can keep training something, even if that is upper body and walking for a week. Complete rest tends to make the return harder, and the NHS advice is to keep moving. Drop the load and the range before you drop the session, and if all you can face is ten minutes, do the smallest possible version of it.

Is deadlifting bad for your back?

No more than picking up a toddler, which nobody warns you about. The hinge is a movement your back does every day whether you train it or not. Done at a sensible weight with a coach watching early on, it is one of the better things you can do for it.

Do back belts help?

For preventing back pain, the research above found no effect at all. Experienced lifters use them for very heavy work, which is a different thing entirely. If you are wearing one to get through ordinary days, that is worth a conversation with a physio rather than a bigger belt.

How long before my back feels normal again?

Most ordinary episodes settle over days to a few weeks. The honest thing nobody tells you is that settling is not the finish. About half of people have another episode within a year, and staying trained is the part that changes those odds.

This article is general information, not medical advice. Ongoing or worsening back pain needs a GP or a physiotherapist, not a blog. The red flags near the top of this article mean urgent care.

More honest guides on fat loss, nutrition and training

The stay-active advice and the red flag list are quoted from the NHS back pain page, linked in the text. The prevention figures are Steffens et al. 2016, JAMA Internal Medicine 176(2):199-208, a systematic review and meta-analysis of 21 randomised trials and 30,850 participants, also linked. The recurrence figure and the line about ongoing exercise come from the same paper. Images from Pexels (free to use): Kindel Media, Ketut Subiyanto, Julia Larson.