Staying active and walking

Staying active means keeping up your normal life as much as you comfortably can while your back or neck recovers. That includes moving around, doing everyday tasks, and returning to work and hobbies.

It is the opposite of resting in bed for days, which was once common advice for back pain. Walking is one of the simplest ways to stay active. It needs no equipment, and you can start small and build up.

This approach is advised for both neck and back pain. Most of the research is on low back pain. You can do it on your own or with help from your clinician or a physical therapist.

Most back pain is not caused by serious damage. For most people, no single specific cause can be found, and serious causes such as a broken bone, an infection or cancer are uncommon.

Moving helps you keep your strength, fitness and flexibility while you recover. Researchers think regular movement may also turn down the volume on pain signals and help you feel more confident using your back or neck. How it works is not fully understood.

For most people, everyday movement is safe. Pain while you recover does not usually mean you are doing damage. Changes on scans, such as worn or bulging discs, are common in people with no pain at all. Pain that keeps getting worse, or that comes with the warning signs listed below, is different and needs a clinician’s attention.

Getting started

A common approach is to start with an amount you can manage even on a bad day, such as a few minutes of walking, and add a little every few days. It also helps to mix activity with rest, change position often, and break big jobs into smaller pieces.

Aim for steady progress over weeks. Doing much more on a good day and then needing days to recover is a common trap.

Walking

A walking plan can be as simple as a short walk each day that gets a little longer or brisker over time. If walking brings on leg pain that eases when you sit or lean forward, tell your clinician. That pattern can have a different cause and may need a different plan.

How it may feel

Some stiffness or soreness as you get moving is common. If pain is much worse the next day, ease back a little and tell your clinician if it keeps happening.

Flare-ups

Flare-ups are common and usually settle. A simple plan helps: ease back for a bit, keep moving gently, then build up again. Some people use heat to ease a flare while they keep moving.

New back pain

For new low back pain, advice to stay active gave slightly better pain relief and function than advice to rest in bed. For sciatica, pain that travels down a leg, the two gave about the same results, so there was no advantage to bed rest. [1]

Back pain guidelines encourage people to keep up or return to normal activities and exercise, rather than rest. A Canadian neck pain guideline also stresses reassurance and keeping active and moving. [4] [11] [17]

Most new back pain improves a lot within the first 6 weeks. Some people still have some pain a year later, especially if their pain had already lasted a long time. [18]

Back pain often comes back. In one study of people who had recovered, about 2 in 3 had back pain again within a year, and about 4 in 10 had an episode that limited their activities. [15]

Walking

A large Australian trial tested walking to prevent back pain from coming back. It included 701 adults who had recently recovered from an episode of low back pain. People who got a walking plan that built up gradually, plus 6 sessions with a physical therapist over 6 months, went longer before their next episode that limited their activities. [3]

The trial tested walking to prevent pain from coming back. It did not test walking as a treatment for pain you have right now. For long-lasting low back pain, a few small studies found that walking helped pain and function about as much as other exercise. [3] [5]

Beyond your back

Regular activity helps well beyond your back. It can help you sleep, feel and function better, and it lowers the risk of many long-term diseases. US guidelines suggest adults work up to at least 150 minutes a week of moderate activity, plus muscle-strengthening activity on 2 or more days. Even small increases help, especially for people who are least active. [7]

These are long-term health goals, not a starting point during a flare. Your clinician can help you set targets that fit your situation.

Common and short lived

• Sore muscles or a flare of pain from doing too much too soon.
• In the Australian walking trial, the walking group reported more leg and foot problems than the group that did not walk.

Extra care

Talk with your clinician before starting a new walking plan if you have heart or lung disease, balance problems or recent falls, or if your pain started after a fall or an accident. If your pain started after a serious fall or a car crash, get emergency care.

Other downsides

• It takes time and patience, and progress is often up and down rather than a straight line.
• Staying active does not prevent every flare-up. Back pain can come back even when you do everything right.

When to get help

See the warning signs.