Are you wondering why rest makes lower back pain worse? It seems counterintuitive, because if something hurts, resting should help you recover right? It may surprise you to hear that absolute rest is usually a bad idea.
If you have an acute injury, relative rest is a good idea, but that doesn’t mean do nothing – it just means do a little less than usual to allow recovery. For chronic lower back pain however, most people will benefit from doing more, not less. Keep reading for a full guide on when and how much to rest.
Contents
- Rest vs. movement
- Risks of inactivity
- Active recovery methods
- Self‑management tips
Disclaimer:
You should consult with a healthcare provider before starting any new physical activity. This article is for educational purposes and is not meant to replace an assessment, diagnosis, or treatment from a qualified professional. Note; no doctor patient relationship has been formed.
Rest vs. Movement
There are very few cases in which absolute (bed) rest is necessary. Some examples would be after major trauma and/or surgery, or during life threatening illness. In those cases the amount of stress on the body is so great that adding more stress in the form of activity or exercise might delay the recovery process.
Sometimes you may want to rest or you might feel like rest would be better and that is fine, but don’t confuse that with the idea that you need to rest. Most of the time lots of rest makes lower back pain worse.
If you are not in one of the situations described above you know you should not be avoiding all activity. But that still leaves the matter of how much and what types of activity to do. Let’s talk about a few categories.
Specific Localized Injury
Depending on the severity you might take a few days of rest, but then it’s time to get moving. For example, if you had even a severe shoulder injury you can still walk. So walking would be a no brainer, but then after some brief rest you could start doing some harder cycling workouts or machine based leg strengthening. There is no point in resting everything if only one area is injured.
One caveat in this scenario is that you shouldn’t train so hard and/or so much that it interferes with recovery. This amount or intensity of training is extremely unlikely in the general population, but it is possible and is much more likely if you are a competitive athlete.
With lower back pain it can be a little bit trickier to decide what to do because the lower back is more central and can limit many movements. So you will likely need to do some experimentation to find out what you can tolerate. If you have not had a traumatic injury, it is safe to try different movements to see what feels good and what doesn’t. Just start easy and take notes so you don’t forget.
Some things that are very likely to be well tolerated are walking, cycling, easy swimming, arm and leg machine/isolation strength exercises, and potentially even some upper body compound exercises like pullups/pulldowns, machine rowing variations or bench press.
If you want to get movements specifically tailored to your pain pattern, take the qualification quiz now to find out if you qualify for the LBPfix program. After the self assessment, you will get the exercises and stretches that will help you the most so you can skip the experimentation stage.
Extreme (debilitating) pain or severe pain worsening with any and all activity
If the pain is intense with every movement and posture, or everything you try makes it significantly worse you probably should go for an assessment with a good chiropractor or physiotherapist. Often the problem is not as bad as it feels, but better safe than sorry. After you get some answers you can decide whether or not you need to rest. Again, in most cases the answer will be no.
Moderate-Severe pain, stable with activity
If there are some activities that you can do without pain worsening, then focus on those. If running makes your back pain much worse, but walking or cycling is alright – double down on those temporarily. Give it a week or two depending on severity, then try an easy run again.
One of the many benefits of being very active with different types of exercise is you will learn more about your abilities and tolerance so you can have more confidence in being active during future episodes. If you are used to doing lots of exercise, it won’t be so scary to do it while you are in pain. The fear and uncertainty can actually make pain worse too!
Mild-moderate pain stable with activity or severe pain improving with activity
This category is similar to the previous one, but you can be a little bit more liberal without your experimentation. Mild lower back pain is rarely something that you should be really worried about, and most often it gets better with activity. Still practice some caution by not doing anything totally novel or inherently risky.
Start with the activities that are most comfortable and do lots of those. Then gradually introduce new or previously painful activities or exercises one at a time and see how you respond.
Risks of Inactivity
The risks of inactivity are not the same types of risks as they are for activity, but they will sneak up on you and are actually much worse for your long term health. The risks of activity include injuries which are obviously something everyone wants to avoid. But especially with exercise (as opposed to sport) the risk of injury is very low.
The risks of inactivity don’t include injury per se, until you inevitably try to return to activity. With inactivity you will lose your fitness and eventually your good health. The longer the period of inactivity, the more you will lose. Then when you try to return to activity you will be weaker, more easily fatigued, less flexible etc. All of this amounts to a greater injury risk.
Even without causing injury, rest can make pain worse for several reasons. First, if you end up sitting much more than usual in the name of rest, that can absolutely worsen lower back pain (and potentially contribute to injury).
Even if you don’t sit more than usual, you will likely start to feel stiffer and more sensitive with prolonged rest. More stiffness and sensitivity layered on top of a condition (chronic lower back pain) that is partly characterized by a disruption of normal healthy pain signalling is a recipe for disaster.
Other risks of inactivity include not only all of the most common chronic diseases like obesity and type 2 diabetes but also the most deadly like cardiovascular disease and dementia.
These diseases take a long time to develop compared to most injuries though so you don’t need to do anything drastic or sudden like a 30 day challenge or a crash diet. Just get moving and be consistent. These are preventable issues!
Active Recovery Methods
If you are too tired or sore to do strength training or a difficult cardio session, just go for a walk. It really can be this simple. As we discussed in our article about walking for lower back pain, the benefits of walking are numerous. Other types of exercise can be good for active recovery too, but make sure they are fairly easy, otherwise it’s not recovery it’s just more training.
If you are very familiar with weight training, you could do a very easy workout in the gym for active recovery. Again, make sure it is easy! Something like 3-5 sets of 3-5 reps with 50% of your 1RM would be a good place to start.
Cycling, hiking, rowing, paddling are other options too depending on what you are used to. If you have not done it before, it will likely make you sore. If you get sore or tired from an activity it is not active recovery, it’s just activity.
Self Management Tips
The first thing we recommend in the LBPfix program is starting a journal. At least to track pain levels, but potentially also for things like exercise, nutritional changes etc. This is an undervalued practice because most people trust their memory too much. Start keeping track of pain levels and look back in the journal once in a while to see if you notice a pattern.
Other things to be diligent with are sleeping well, eating healthy, and managing stress levels. It can be tough to understand the value of these for recovery from lower back pain because the effect is less direct than movement, at least for mechanical lower back pain. As we say time and time again here at LBPfix, chronic lower back pain is often much more complex than it seems.
So prioritize good quality sleep, and set aside at least 7-8 hours per night for it. Eat mostly nutrient dense foods like fruits and vegetables, lean meats, whole grains and limit highly processed ‘junk’ food to help with maintaining a healthy body weight.
Last but not least, try to have some fun and do things you enjoy. Your mood and stress levels absolutely have an effect on your pain levels, suffering at a given pain level and perceived disability. Having some stress relieving activity built into your schedule is a very good idea. This could just be a fun activity with friends or family, or a practice like yoga or meditation.
Our Framework: How LBPfix Can Help
1. Identify Your Pain Driver: We classify your pain into one of four movement intolerance types
2. Prescribe the Right Movement Strategy: Once we know your pain type, we match it with corrective movements
3. Build Long-Term Resilience: As pain settles, we help you:
Move confidently without flaring up
Rebuild core control and lifting mechanics
Return to work, sport, or life without setbacks
Ready to Fix Your Low Back Pain?
Take our 2-minute quiz to find out if you’re a good candidate to our program – no strings attached!
