Lower back pain exercises: what the NHS and Arthritis UK say, and the signs to check first

Before you exercise: the signs that mean get help first

Most back pain is not serious. Arthritis UK says up to 6 in 10 people in the UK will have it at some time in their lives, and the NHS says it usually improves within a few weeks.¹² But a few symptoms mean the right step is a phone call, not an exercise. The NHS sorts them by how fast to act, and this table follows that page.

If one of the top six rows applies to you, do not read on and do not exercise. If one of the next two applies, call 111 or ask your GP surgery for an urgent appointment. The rest of this page is for ordinary back pain that has none of these signs.

What the NHS and Arthritis UK say about staying active

The NHS advice for back pain you manage yourself is to stay active and try to carry on with your daily activities. It says not to stay in bed for long periods.¹ Arthritis UK goes further: in the past people were told to rest in bed, but we now know this does more harm than good, and staying active is the most important way you can help yourself.²

The NHS says there are specific exercises and stretches for back pain, and also that walking, swimming, yoga and pilates may help ease it. Its limit is clear: stop if your pain gets worse and see a GP for advice.¹ Arthritis UK says regular exercise is linked with shorter and less frequent episodes of back pain.²

Exercise can make your back feel a bit sore at first. Arthritis UK says that does not usually mean you are harming your back, and advises starting gently and building up gradually.²³ Soreness is not the same as pain that is getting worse, and only you can tell the difference. When in doubt, stop.

What NICE adds

NICE guideline NG59 covers low back pain and sciatica in people aged 16 and over. It advises self-management advice that includes encouragement to continue with normal activities, and says to consider a group exercise programme for someone with an episode or flare-up of low back pain.⁴ It also advises against offering belts or corsets for low back pain.⁴

That guideline is written for the people who assess and manage back pain. Read it as the backdrop to what the NHS says to you directly: keep moving, within what your back allows.

Ten of the twelve exercises from Arthritis UK, with the counts it gives

Arthritis UK publishes a page of exercises for the back. The table below keeps the hold times and repeats it gives, and shortens the instructions.³ These are not NHS instructions: the NHS back pain page points to exercises and stretches but does not itself describe a set of them.¹ Counts for each exercise are the ones on the Arthritis UK page. This page does not add its own.

A worked example: how long are you really holding?

The holds look short, so it is easy to do the arithmetic and see what a session involves. A pelvic tilt held for 5 seconds and repeated 5 times is 5 x 5 = 25 seconds of holding. Knee rolls at 10 seconds, 3 times on each of 2 sides, are 10 x 3 x 2 = 60 seconds. Knees to chest at 5 seconds, 5 times each side, are 5 x 5 x 2 = 50 seconds.

The back stabiliser is the longest: 10 seconds, 10 times on each side, is 10 x 10 x 2 = 200 seconds, which is 3.3 minutes of holding for one exercise.³ That is why Arthritis UK says to start slowly. Doing the full ten exercises in one go is a lot for someone new to exercise, and the page does not say you have to.

The NHS also describes flexibility and sitting exercises. Its “sideways bend” is described as helping to restore flexibility to the lower back, and its seated upper-body twist as keeping the upper back flexible.⁷⁹ The NHS also has a page of exercises for sciatica, which says to stop the exercise immediately if you feel any pain or become unwell.⁸ If you have sciatica, start there rather than with the table above.

What the research says, and where it stops

A Cochrane review by Hayden and colleagues, published in 2021, looked at exercise therapy for chronic non-specific low back pain, meaning pain that has lasted more than 12 weeks and has no specific cause found. We read the review abstract on PubMed.⁶

It found moderate-certainty evidence that exercise was better than no treatment for pain. The mean difference was -15.2 points on a 100-point scale, with a 95% confidence interval of -18.3 to -12.2.⁶ The harms reported in the trials were mostly minor, such as muscle soreness.⁶ The review notes that the trials have limits, including risk of bias.

So the honest summary is modest. Moving is better than staying still, the exercises on this page are gentle and widely used, and the evidence is stronger for long-lasting pain than for a sudden flare-up. A Chutex page cannot tell you which exercise suits your back.

Turning it into a week, using the NHS activity figures

No British source we read gives a timetable of back exercises, for example by five-minute slots, so this page does not invent one. What the NHS does give is a weekly activity guide for adults aged 19 to 64: at least 150 minutes of moderate intensity activity a week, and muscle-strengthening activities on at least 2 days a week.⁵

The NHS lists walking, swimming, yoga and pilates as activities that may help ease back pain.¹ Choosing one you enjoy makes it more likely you will keep it up. Arthritis UK advises the same, and says to build up a little each day.²

If you keep a note of your resting pulse while you build up activity, our guide to normal resting heart rate explains how to take it by hand. For the strength side, see strength training guidelines.

Back pain and sitting: what to change at your desk

Arthritis UK says to avoid staying in the same position for too long, whether you are sitting at home, at work or in the car.² For work at a screen it suggests keeping your lower back well supported and your feet on the floor, with a footrest if they do not reach, and setting a timer on your phone or computer so you get up at least once an hour.²

The Health and Safety Executive (HSE) lists being in one position for a long time, and working at a screen with poor posture, among the tasks that can cause back pain or make it worse.¹⁰ Our guides to back pain from sitting, correct sitting posture and ergonomic desk set-up cover the set-up in detail.

If back pain keeps you from work for two weeks, Arthritis UK advises talking to your GP and your employer.²

How long does back pain last, and when should you see a GP?

The NHS says back pain usually improves within a few weeks but can sometimes last longer.¹ It does not give a longer figure, and neither does Arthritis UK, so this page does not either.

The NHS says to see a GP if the pain has not improved after a few weeks of treating it at home, if it stops you doing your day-to-day activities, or if you are worried or struggling to cope.¹ In many areas you can also refer yourself to NHS community musculoskeletal (MSK) services without a referral from a GP.¹

Painkillers are a question for a pharmacist or GP. The NHS says paracetamol on its own is not recommended for back pain.¹

Frequently asked questions