October 2011

Benefits and Importance of Physical Fitness in Managing Lower Back Pain


The importance of physical fitness in managing lower back pain is often overlooked. It's not just your heart and lungs that benefit from being fitter. Your muscles, joints and bones all benefit greatly from regular exercise - the human body is designed for movement.


There are two important things to think about here in relation to the importance of fitness in managing lower back pain:


  • If you lack physical fitness you are more likely to have low back pain than someone who takes some regular exercise (3).
  • If you have chronic lower back pain you are probably less fit than someone who doesn't have spine problems(4)


Several recent research reviews show that exercise is effective in reducing symptoms and improving day to day activities in patients with chronic simple lower back pain (one paper looked at 6390 participants in sixty-one different trials which is a huge study )(1)(2).


cycling for back painSo, one of the key ways to manage lower back pain is by improving your general physical fitness with cardiovascular exercise.  This works in a number of ways.


  • Firstly, cardiovascular exercise, or exercise that makes you warm and slightly out of breath is excellent for improving the blood supply to all the tissues in your body. Itís not just your heart and lungs that benefit from this exercise. All the tissues in your body become healthier; this includes the muscles and ligaments in your lower back.  All of these tissues become stronger and more supple.


  • Fitness exercise helps you to keep a healthy weight. There is some evidence that being overweight can increase the chance of of having lower back pain. 
  • Weight bearing exercise increases the strength of your bones and helps prevent osteoporosis, or thin bones.
  • Exercise also has a very positive effect on mood; if you exercise you release endorphins which are the bodies own natural pain killers. Your energy levels rise and you generally feel better. This is a crucial part of managing this problem as low mood and feeling fearful of movement are strongly linked with increased disability.


Because increasing your physical fitness has such a big effect on your whole body you must make sure you are medically well enough to start exercising. You must check with your doctor before embarking on a physical fitness programme.


How much should you exercise?


The amount of exercise you should do is a bit controversial but it seems that for many people performing any kind of exercise three to four times a week seems to be ideal (3). I would suggest 20-30 minutes- 3-4 times a week is a good target to aim for.


WARNING - this will be too much for some of you to start with


walking for back painMany people with chronic lower back pain need to pace their return to exercise in order to gradually build on physical fitness without causing an aggravation, or a flare up, in symptoms which then lays them low for a few days.  I would suggest a gradual paced return to exercise if you feel that increasing your activity levels will lead to flare up of your symptoms.


Some of you will also lack confidence and fear movement in case it makes your symptoms worse.



So what counts as cardiovascular/fitness/ aerobic exercise?


It really isnít as difficult as it seems. There are many things that can be integrated into your daily life that will help you improve your physical fitness. Here are some examples:

  • Walking
  • Swimming and Aqua-aerobics
  • Running
  • Cycling
  • Joining a gym and using the treadmill, cross trainer, stepper or bike
  • Aerobic classes such as step classes
  • Gardening
  • Housework
  • Golf




1.Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005


2.Liddle S D, Baxter G D, Gracey J H. Exercise and chronic low back pain: what works?. Pain. 2004;107(1-2):176-190.


3.Lee;Chung;Yol, Kratter−Renato, Duvoisin−Nicole, Taskin−Aydin, Schilling−Julian. Cross-sectional view of factors associated with back pain.  International archives of occupational and environmental health, May 2005, vol. 78, no. 4, p. 319−24,


4. Smeets-Rob-J-E-M, Wittink-HarriŽt, Hidding-Alita, Knottnerus-J-Andrť. D o patients with chronic low back pain have a lower level of aerobic fitness than healthy controls?: are pain, disability, fear of injury, working status, or level of leisure time activity associated with the difference in aerobic fitness level? Spine, 1 Jan 2006, vol. 31, no. 1, p. 90-7; discussion 98,