Back pain can be difficult to treat, but moving can help, if you do it right.
I struggle with lower back pain. I have heard that "motion is lotion", but I am worried that the wrong type of exercise could make the pain worse. What is the most effective - and safest - way for me to work out?
When you are in pain, exercising may feel like the last thing you want to do. But a growing body of research suggests that, while it is not a cure, physical activity may be a useful tool for managing chronic lower-back pain. And, over time, inactivity may make symptoms worse.
It may feel counter-intuitive, but in most cases, "the best thing for you to do is actually to keep on moving", said Dr Edward Phillips, an associate professor of physical medicine and rehabilitation at Harvard Medical School.
Exercise can help to relieve pain by stretching and strengthening the muscles that support the back. For some, it can also improve one's perception of the pain and reduce chronic stress.
Still, studies suggest that one of the main reasons people with back pain do not exercise is because they fear they will make their pain worse.
Whether you are looking to move more, or you are already active and want to keep working out despite your back pain, The New York Times asked doctors to share their dos and don'ts for exercising safely and effectively.
Because back pain can have different causes, check with your healthcare provider before getting started, or if your pain worsens.
Prolonged sitting, particularly in the same position, presents a triple whammy for back pain. It puts excessive pressure on your discs, weakens your core and glute muscles, and decreases the flexibility of your legs, said Dr Carolyn Chudy, director of physical medicine and rehabilitation at the virtual orthopaedic care provider Vori Health. And when you stand up, your back muscles may strain to compensate.
If you spend most of your time sedentary, start by taking short movement breaks throughout the day, Dr Chudy said. Every 30 minutes, stand up, walk around your home or office, or do a few air squats or sit-to-stands.
Stretching can also help. When you sit for long periods, your leg, hip and core muscles can become tight, which can lead them to tug on your back muscles and spine, she added.
Experts suggest pausing throughout your day to do child's pose and cat-cow stretches, figure-four stretches for your hips, and hamstring stretches.
When your core muscles become weak, your spine and discs are forced to absorb more pressure when you move, which can lead to pain or injury.
Think of your core like a corset made of muscle, Dr Phillips said. The stronger and more supportive it is, the less your spine and discs will have to endure.
Building strength in your quads, glutes and hamstrings - which help to support your trunk - can also help ensure that your core muscles do not become strained. "Everything is connected," Dr Phillips said.
He recommends doing a routine of planks, side planks and glute bridges two to three times a week. Superman exercises can help, too. But avoid crunches and sit-ups, which can aggravate your back.
During your strength-training sessions, experts also recommend doing a few functional resistance exercises, since these movements can help you to move through daily life in proper form, lowering your risk of pain and injury. Think squatting or curtsying to pick things up (as opposed to bowing), and regularly taking the stairs.
Research suggests that yoga and pilates can also help to manage back pain, thanks to their focus on strengthening and stretching the core and surrounding areas.
If you are concerned about hurting yourself while strength training, the experts recommend getting an evaluation from a physical therapist, who can offer personalised guidance.
If you are new to exercise or have not worked out in a while, the safest forms of aerobic exercise are low-impact workouts such as walking, using an elliptical machine, cycling and swimming, since they put less pressure on your back than other forms of aerobic activity, said Dr Andrew Sama, co-chief of spine surgery at the Hospital for Special Surgery in New York City.
One study published in 2024 found that walking can be especially beneficial for preventing a recurrence of back pain.
But if you can tolerate it, higher-impact cardio workouts can be helpful, too, depending on your fitness level.
One recent, small study found that people with back pain who did a 12-week run-walk programme experienced less intense pain and disability than a control group who did not participate in the programme.
If you choose to run or do higher-impact workouts, wear supportive shoes and opt for even terrain to help avoid injury, Dr Sama said. Stretching and icing your back afterwards can help to keep pain at bay.
Generally, a good litmus for determining whether a workout is safe for you is asking yourself: Does this make my back pain worse, either during or afterwards?
If the answer is no, Dr Sama said, you can keep moving the way you have been moving without fear. NYTIMES