Exercises for back pain.
Movement is the best medicine.
Movement is the one approach every guideline agrees on, and it is free, always available and virtually without risk. What not to expect from it: a big drop in pain. Exercise is one of the treatments that does beat a placebo, but the difference is small (Cashin et al., 2025). Where movement really is strong: keeping the pain from coming back. Below you will find a progression from simple movements to an active walking programme.
Walking: the #1 recommendation
The WalkBack study (Lancet, 2024) followed 701 adults who had just recovered from an episode of back pain. In the group that followed a guided walking programme it took a median of 208 days before the next activity-limiting episode, against 112 days in the control group: not fewer painful days, but a much longer stretch before the pain came back.
Walking is accessible, free, and safe for almost everyone. Start with short walks (10-15 minutes) and gradually build up to 30 minutes per day, 5 days per week.
Build-up schedule
Six gentle exercises
Calm movements to get started with. The figures show the core movement of each exercise.
1. Knees to chest
Safely stretches the lower back and glutes.
- 1Lie on your back with your knees bent.
- 2Gently pull one knee toward your chest.
- 3Hold, then switch sides.
2. Pelvic tilts
Activates the deep core muscles and mobilises the lower back.
- 1Lie on your back, knees bent.
- 2Press your lower back flat against the floor.
- 3Hold briefly, then relax.
3. Cat-cow stretch
Improves mobility of the entire spine.
- 1Come onto hands and knees.
- 2Let your back sag gently (cow).
- 3Then round your back upward (cat).
4. Supine rotation
Gives a gentle rotation through the lower and mid back.
- 1Lie on your back with knees bent.
- 2Let both knees drop to one side.
- 3Keep your shoulders down and switch sides.
5. Bridges
Strengthens the glutes and core.
- 1Lie on your back, feet flat on the floor.
- 2Push your hips up into a straight line.
- 3Hold, then lower slowly.
6. McKenzie extension (press-up)
May reduce pain radiating into the leg (centralisation).
- 1Lie on your stomach, hands under your shoulders.
- 2Push your upper body up; hips stay on the floor.
- 3Lower slowly and repeat.
Mainly useful when radiating leg pain moves toward your back ('centralises') as you do it. An MDT/McKenzie therapist can help you decide whether this exercise suits you.
When to stop?
Progression
Week 1-2: Gentle
Focus on the gentle movements above. Do them 2x per day. Short walks of 10-15 minutes. The goal is movement, not training.
Week 3-4: Building up
Extend walks to 20 minutes. Do more repetitions of the exercises above, with extra attention to bridges. Start with light daily activities you were avoiding.
Week 5-6: Normalizing
Walk 25-30 minutes. Pick up more activities. Start with light strength training or swimming if appropriate.
Week 7+: Maintenance
Build toward 150 minutes of moderate exercise per week, the amount the WHO recommends for adults. Choose activities you enjoy, and keep it up rather than going hard.
One thing to be open about: this build-up and the numbers with the exercises are practical guidance, put together from what the guidelines advise. They do not come from a trial that compared exactly this schedule against another one. Use them as a starting point and adjust to what your back allows.
Three principles
- Start slowly: Always start below your pain threshold and build up gradually. Overdoing it in the beginning can cause a setback.
- Keeping it up beats going hard: A short daily moment is easier to keep going than one long session a week, and what you keep doing is what counts. That is not a research finding, it is what makes it stick.
- Pain doesn't always mean damage: Some pain during exercises is normal and does not mean you are causing damage. Learn to distinguish between the "good pain" of movement and a sharp, sudden pain that is a stop signal.
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