19/05/2014 Gavin

Should I exercise with low back pain/sciatica?

Low back pain and sciatica are extremely common, and tend to recurr.  If you’re worried that you may do yourself more harm than good by exercising, read the facts below.  These (as ever) are based on the scientific research, but also with comments on my own experiences personally (as a back pain sufferer) and professionally (as an osteopath for 23 years).

“To exercise or not?”  That is the question

Yes” is the answer.  All the clinical guidelines say it’s important to stay active if you have a bout of back pain or sciatica.  My own experience is that doing nothing simply means it takes longer to get better (and I get grumpy because I’m not getting the level of exercise and endorphins that I’m used to)  🙁

If it hurts, should I carry on?

It depends“.

If your pain started fairly recently – let’s say less than 3 months ago (“acute”) – then you’d be better not to push it.  Take it up to the point that it gets uncomfortable, then back off.  If your pain worsens after you’ve done something then don’t do it as much again.

If you’ve had pain for more than 3 months (“chronic”), or keep getting recurring bouts of it, then you should probably exercise despite some pain.  This can be a tricky balance (one that I struggled with in the past); it’s about pacing yourself.  If you’re the sort of person who does Iron Man triathlons for fun, then you should probably go easy on the “use it or lose it” principle; however, if your idea of fun is watching movies, reading books and eating, then you should probably push yourself a bit harder – despite some pain.  I know that this can be a really hard thing to get right.  If you do get a bit more pain, it’s unlikely that you’re actually making the problem worse – with chronic pain pain rarely means that you’re damaging something, it’s just due to the sensitisation of your nerves.  So remember – pain does NOT equal harm if you’ve had it for more than 3 months.

What sort of exercise?

It depends” (again).

If you’ve had pain for less than 3 months, there’s little evidence that doing specific exercises is good for you.  Try and do whatever you would normally do, without making the pain worse – “use it or lose it, but don’t abuse it.”

If you’ve had pain for more than 3 months, there’s plenty of evidence that structured exercise can help (although this is compared with doing no structured exercise).  There isn’t a lot of evidence for one type of exercise over another, though personally I’ve had a lot of patients benefit from controlled body-weight exercises (like yoga and pilates).  I like to give a range of exercises to help improve strength and endurance of muscles as well as encouragement to work on improving over all fitness levels (low levels of fitness is one of the strongest predictors of future back pain).

More on exercise for lower back pain…

We’ve developed exercise routines based on the scientific evidence and on the experience of thousands of low back pain and sciatica sufferers.  If you’d like more specific guidance, just give me a call or email

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