27/01/2014 Gavin

When is exercise bad for lower back pain?

The short answer, somewhat predictably and annoyingly, is… “it depends”.  You didn’t expect it to be straight-forward did you?  😉

As ever, the info here is gleaned from a review of the latest research in the field of lower back pain.

Whether exercise is bad for lower back pain or not, depends on:

  • What you mean by “bad for”
  • How long you’ve had it

What you mean by “bad for”?

By “bad for” a lot of people think of “will it make my pain worse”.  That’s a good guide if you have short-term pain, but not so good in the long-term, particularly if you’ve had pain for a long time (more than 3 months as a rough guide).  Pain doesn’t always mean harm; due to complex changes in the nervous system (see below), many people with longer lasting pain suffer pain without the pain signally actual harm.  So, if we take the notion “bad for” as meaning “leads to a worsening of your condition”, then it’s easier for me to answer the question; although not necessarily easier for you, because if you can’t be guided by pain, what can you be guided by?  If you can’t rely on your own pain experiences, I happily turn to the scientific research 😉

So, what types of exercise do we know tend to lead to more lower back pain in the long-term in groups of people?

Contact sports, golf, cycling, bowls, horse riding, rowing, long-distance running, heavy weight-training… the list goes on.  So, is all sporting exercise bad for lower backs?  No! There’s a “dose-response” relationship here i.e. it’s OK if you do a bit of it, but if you do a lot, you’re more likely to get lower back pain.  In fact, when we look at what’s good for avoiding lower back pain, physical fitness comes out at the top of the pile.

Importantly, some types of strenuous activity at work tend to be “bad for” your back too.  People in jobs that have high physical demands – especially with heavy lifting/shifting – tend to suffer more.

How long you’ve had it

As indicated above, the duration of your pain has an impact on how you’ll respond to exercise.  This is because your central nervous system can remodel (neuroplasticity), potentially leading to pain when there is no actual harm occurring.  Additionally, pain isn’t just a physical thing – your expectations have a big impact on how you feel pain.  Unfortunately, having pain for longer tends to lead people to have more negative expectations, which means movement/exercise often causes more pain to be experienced (often without actual harm).  So, for those with long-term pain, exercise is more likely to feel like it’s bad for your back pain, but in most cases it does not “lead to a worsening of your condition”.  There’s actually a lot of evidence that exercise generally is good for lower back pain; more on this in another article.


, ,