Back Pain

How To Move With Chronic Back Pain

When a person suffers from chronic back pain, often the last thing on their mind is exercise. Back pain can keep you from leading an active lifestyle that helps you stay healthy and feeling your best. You might worry that exercise will make matters worse, but in most cases you can and should keep moving to help reduce chronic back pain. Here we explain how Pilates and other exercises can keep you moving safely to reduce ongoing pain. (1)

Pilates May Help With Chronic Back Pain

Pilates is a method of exercise that can assist with pain management. The movements focus on mobility and stability, especially of the core, spine and pelvis. According to studies, you can reduce the intensity of pain you experience by performing Pilates exercises regularly. The precise movements help strengthen your entire body, providing an excellent option for chronic back pain sufferers intent on managing their pain. (1)

The study combined the results of multiple clinical trials looking at people suffering from long-term back pain and exercise therapies. Some evidence indicated Pilates exercise could help reduce pain intensity. (1)

Fear And Chronic Back Pain

If the idea of exercise strikes a note of fear in you, you aren’t alone. Unfortunately, this mindset can often make chronic back pain issues worse. According to Dr. Matthew Vagg, a physiotherapist and pain scientist at Curtin University, pain doesn’t mean your entire body is giving out on you. “Regardless of how they feel, they are not broken, damaged or falling apart,” he says of back pain sufferers. “If it hurts to do something, people are likely to do less of it.” (1)

However, it is the people who keep active who have better long-term outcomes when it comes to their back pain. “Even when we experience back pain, it doesn’t mean that we shouldn’t be moving,” he says. Dr. Vagg’s views are shared by musculoskeletal physiotherapist Dr. Rob Laird. However, he also feels if pain increases with exercise, you should be concerned. “Exercise should reduce, not increase, pain,” he warns. (1)

How To Move With Chronic Back Pain

The challenge is finding an exercise method you enjoy, that makes you feel better and doesn’t increase pain. “The best exercise is one that you will keep doing and enjoy,” says Dr. Vagg. (1)

According to Dr. Laird, if you suffer from chronic back pain your exercise should focus on three areas: (1)

  1. Strength
  2. Mobility
  3. Cardiovascular fitness

You should also understand the causes of your pain and speak to your doctor to make sure the exercise program you choose is right for you. (1)

“Neutral Spine”

Dr. Vagg also believes managing back pain is more effective when you take a multidisciplinary approach. And that includes exercise. “…exercise is a fundamental part of recovering from low back pain and managing it if it becomes persistent,” he explains.

Pilates exercises use the “neutral spine position” which emphasizes the natural curves in your spine. This position provides stability and mobility, so you manage to take the pressure off your body. The neutral spin position and exercises also help strengthen legs and gluteal muscles, shoulders and arms balancing your weight and reducing back strain. 

Strengthening Muscles

Dr. Laird points out that strengthening lower limb and gluteal muscles is important because these areas are key to bending, moving and shifting from a sitting to standing position. When these muscles are underworked, the back muscles have to work harder. But if you exercise your legs and glutes you don’t put too much pressure on the back muscles, which means you might feel safer focusing on these areas when exercising.

Pilates Exercise Tips

Dr. Laird suggests you start with the classic Pilates roll down and progress to single knee squats like this:

  • Picture yourself standing against a wall, and that you are pulling your spine away from the wall one vertebra at a time
  • Tuck your chin in and roll your neck slowly down going towards your pelvis
  • Keep your knees slightly bent
  • Come back up by rolling your pelvis first, then your spine, again concentrating on one vertebra at a time ending with your neck and then head
  • Next, roll down again one vertebra at a time with one hand on a chair to keep your balance
  • Lift one foot off the ground and bend the knee of your standing leg
  • Push through your heel and come back up repeating five to 10 times
  • Repeat on the other leg

You can also try cat-cow stretches if you want to help improve back mobility like this:  

  • Get on all fours with your hands under your shoulders and knees under your hips
  • Breathe in and let your back sway, tilt the tailbone up and send the gaze up
  • Exhale and round the spine like a cat, pushing the floor away, tucking the tailbone

This offers a nice relief from back pain, helping your entire back feel stretched.

Good Activities For Chronic Back Pain

If you aren’t too keen on Pilates, back friendly activities like walking, cycling, or swimming can help too. This provides the cardio Laird recommends in his three elements of exercise for back pain. “Cardiovascular fitness is essential. If you are not fit enough to walk around the block easily, you are going to struggle with life in general, and pain is still going to be a real problem,” he says. Where he draws the line is running. “Running is not recommended at the start of a recovery plan but can be used in younger patients towards the middle to end of their recovery plan,” he advises. “It’s less useful in older patients – over 60 approximately, although there are always some exceptions – because of the impact loading when there is significant degenerative change already present.”

If you’ve adapted a sedentary life to accommodate your chronic back pain, you’re actually making things worse. These tips can help you slowly ease yourself into more activity to strengthen your muscles so your back doesn’t work so hard. 

For more information on chronic pain relief, click here to watch our video on the 12 second Neural Pain Switch.


  1. https://www.theguardian.com/lifeandstyle/2022/jan/04/how-to-move-with-chronic-back-pain

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