Lower Back Pain and Exercise: What a 249-Trial Cochrane Review Found

Low back pain is pain in the area between the bottom of the ribs and the buttocks. Most people will have some at some point in life.

"Non-specific" means a clear structural cause is not identified on exam. "Chronic" means the pain has lasted 12 weeks or longer. A doctor or physiotherapist makes that assessment. You cannot reliably sort your own pain into these categories at home.

This article is about lower back pain. ShoulderBack Pro is aimed at shoulder and upper-back movement, so the fit is different. We cover that below.

• Exercise probably helps chronic low back pain. The review included 249 trials and 24,486 participants. It found moderate-certainty evidence that exercise probably reduces chronic, non-specific low back pain compared with no treatment, usual care or placebo [R05].
• The size of the benefit is modest. The average difference was about 15 points on a 0 to 100 pain scale at the earliest follow-up. Averages hide a lot of variation, so your result may be bigger or smaller [R05].
• Exercise probably beats advice alone. The review found exercise probably works better than advice or education by itself [R05].
• There is no clear winner among exercise types. The authors suggest choosing exercise you enjoy and will keep doing [R05].
• General activity guidance is similar. The WHO guidelines suggest adults do muscle-strengthening activity at least two days a week. Adults 65 and older should also add balance and functional strength work at least three days a week [R07].

1. Keep moving within comfort. Gentle walking, short walks around the house or a few minutes of easy movement are something many people find easier than staying still. Seated option: Sit tall in a chair and do gentle seated marching, lifting one knee at a time.
2. Pick something you enjoy. Walking, swimming, cycling, dancing or gardening all count. The review suggests the best exercise is the one you keep doing [R05]. Seated option: Use a stationary bike at a gentle pace, or do chair-based movement at home.
3. Build leg, hip and core strength gradually. Simple strength work two days a week fits the WHO guidance [R07]. Start with light loads and increase slowly. Seated option: Seated leg extensions, with your back supported and your knees slowly straightening.
4. Keep the upper back mobile. Gentle rotation and reaching, within comfort, can keep the upper body moving alongside your lower back work. Seated option: Sit tall, turn gently to each side, and return to centre.
5. Plan a routine you can repeat. Choose two or three activities. Add a little more as you feel ready, and stop if pain increases sharply.