Why staying active matters in low back pain

When low back pain starts, most of us react the same way: we keep still and wait for it to pass. That is an understandable instinct. Pain is a warning signal and it is trying to protect us. Yet for most episodes of back pain, long periods of rest do not speed up recovery, and they can even slow it down.

In this article I want to explain why staying active matters, clear up some of the myths I hear most often, and set out the signs that mean you should see a doctor without delay.

Most back pain is not caused by serious disease

Low back pain is very common, and many people experience it at some point in their lives. Most of it is not linked to a serious condition. It often cannot be traced to one specific structure, and it usually eases noticeably within a few weeks.

That does not mean the pain is “all in your head”. Pain is real and it can make everyday life hard. It simply means that how much something hurts is not always a measure of how much damage there is.

Why long bed rest is no longer recommended

Current clinical guidelines do not recommend bed rest for low back pain. Instead, they advise staying as active as you reasonably can, and scaling activities down for a while if you need to.

When we stay still for long periods:

• Muscles start to lose strength and endurance quite quickly.
• Joints stiffen, and moving becomes harder still.
• It becomes easier to focus on the pain and to worry about making things worse.
• Sleep, mood and overall energy can suffer.

Movement, on the other hand, supports circulation and keeps muscles and joints working. Just as importantly, it shows you that you can trust your body again.

Staying active does not mean doing everything

“Keep moving” does not mean carrying on exactly as before, whatever the pain. Easing off a movement that clearly makes things worse for a while is very different from stopping movement altogether.

A few ideas that often help in daily life:

• Take short, frequent walks. Several short walks spread across the day are usually easier to manage than one long one.
• Avoid staying in one position for too long. If you work at a desk, getting up for a few minutes every so often can make a difference.
• Find the positions that feel comfortable. There is no single “correct” posture for everyone. Changing position often matters more than finding a perfect one.
• Build up gradually. Doing a little more tomorrow than you managed today is safer than jumping straight back to your usual pace.
• Look after your sleep and stress levels. Both influence how we experience pain.

Feeling mild, short-lived discomfort while moving does not necessarily mean you are doing harm. That said, if your pain rises sharply with every movement, do mention it to your doctor or physiotherapist.

Myths I hear often

“If it hurts, something must be damaged.”

Pain is not a direct measure of tissue damage. Tiredness, poor sleep, stress and fear of movement can all change how we feel pain. So the intensity of pain alone does not tell us how much “damage” there is.

“My MRI showed a disc bulge, so I should stop moving.”

Disc changes on a scan are also found in many adults who have no back pain at all. It is worth talking to your doctor about what a finding means for you specifically. For many people with a disc problem, appropriate and gradual movement is part of recovery.

“To protect my back, I should never bend.”

Avoiding certain movements all the time can feed a fear of movement. Everyday tasks such as bending and lifting can be rebuilt step by step, at the right dose. The aim is not to wrap your back in cotton wool but to keep it strong and flexible.

“Exercise can only start once the pain has gone.”

In many cases, suitable exercise can begin while you still have some pain. What matters is the type of exercise, the dose and how quickly it progresses. That needs to be tailored to you.

Which exercise is right for you?

There is no single exercise that suits everyone with back pain. Walking, strength training, clinical Pilates or exercise in water can each help the right person.

The main things that shape the choice are the nature of your pain, your general health, your previous exercise habits and, perhaps most importantly, whether it is something you enjoy enough to keep doing. A steady, moderate routine is usually easier to sustain than occasional intense sessions.

How I approach it in physiotherapy

Diagnosis is made by your doctor. My assessment focuses on movement and function: how your pain started, which movements make it better or worse, and what it makes difficult in your daily life.

Based on that, and in line with your doctor’s diagnosis and recommendations, we put together a plan. It usually includes:

• Exercises that suit you and that you can also do at home
• Manual therapy where it is appropriate
• Practical advice on work, sleep and daily activities
• Realistic goals that progress step by step

My aim is not only to ease today’s pain but to help you feel confident about moving again.

If you have not yet seen a doctor about your pain, I recommend a medical assessment before you start physiotherapy. I describe how I work with back pain in more detail on the orthopaedic rehabilitation page.

When to see a doctor without delay

Although most back pain is not dangerous, some symptoms need prompt medical attention. If you notice any of the following, see a doctor straight away, or go to an emergency department if needed:

• Problems controlling your bladder or bowels (leakage, or being unable to pass urine)
• Numbness around the groin, genitals or inner thighs
• Weakness in the legs that is getting worse, or spreading numbness
• Back pain that comes with a fever
• Pain that started after a fall, accident or other injury
• Unexplained weight loss
• A previous history of cancer
• Severe pain that is getting worse, does not ease with rest and continues at night

Even without these signs, if your pain is not easing after a few weeks, or keeps getting worse, it is sensible to see a doctor.

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If you have a question about back pain, you are welcome to call me or send a message on WhatsApp. I will be happy to talk it through with you.