Before starting any exercise programme for back pain: If you have new or worsening leg pain, numbness or tingling, weakness in a leg or foot, or any changes in bladder or bowel function, see a physiotherapist or doctor urgently before exercising. These symptoms may indicate nerve involvement that requires specific assessment.
Lower back pain is one of the most common conditions worldwide, affecting 80% of adults at some point in their lives. The good news is that the evidence for exercise as treatment for back pain is very strong — movement, not rest, produces better outcomes. This guide explains what exercises a physiotherapist would prescribe at each stage, what to avoid, and when to seek professional help.
Rest or Exercise? What the Evidence Says
Bed rest for back pain is now actively discouraged by clinical guidelines. Research has consistently shown that prolonged rest worsens back pain — it leads to muscle deconditioning, joint stiffness, increased pain sensitisation, and psychological deconditioning (fear of movement). Current NICE guidelines recommend staying active, using over-the-counter analgesia if needed, and seeing a physiotherapist if pain does not improve within 2–4 weeks.
Phase 1: Acute Back Pain (Days 1–14)
In the acute phase, the goal is not to rehabilitate — it is to restore normal movement and prevent protective muscle spasm from becoming chronic stiffness. Keep moving gently. The exercises below are low-load, non-threatening movements that maintain mobility without stressing the painful structures.
Pelvic Tilt
Lying on your back with knees bent, gently flatten the lower back against the floor by tightening the lower abdominals. Hold 5 seconds, release. 10 repetitions. Restores lumbar motor control without loading the spine.
Knee-to-Chest Stretch
Lying on your back, pull one knee gently toward your chest. Hold 20–30 seconds each side, 3 repetitions. Gentle mobilisation of the lower back and hip flexor stretch.
Cat-Cow Stretch
On all fours, alternate between arching the back up (cat) and letting it sag down (cow). Slow, rhythmic movement through the full range that is comfortable. 10 repetitions. One of the most effective acute back exercises.
Walking
Short, frequent walks (10–20 minutes) on a flat surface are valuable — walking loads the spine in a functional pattern and maintains cardiovascular fitness. Start short and gradually increase.
Phase 2: Subacute Phase (Weeks 2–6)
Once acute pain is settling, begin adding more structured core exercises. The goal now is rebuilding the muscular support system of the lower back.
Glute Bridge
Lying on your back, feet flat on floor, lift the hips until a straight line forms from knees to shoulders. Hold 5 seconds, lower slowly. 3 sets of 10. Activates gluteus maximus and reduces load on the lower back muscles.
Bird-Dog
On all fours, extend one arm forward and the opposite leg back simultaneously. Hold 5 seconds, alternate sides. 3 sets of 10 each side. One of the best evidence-based exercises for lumbar spine stability — trains the multifidus and opposite gluteus with minimal spinal loading.
Dead Bug
Lying on your back, arms pointing to the ceiling, knees bent to 90°. Slowly lower one arm overhead and straighten the opposite leg toward the floor, keeping the lower back pressed into the floor. Return and alternate. 3 sets of 8 each side. Excellent for deep core activation.
Side Plank (Knees Bent)
On your side, balanced on your forearm and bent knees, lift the hip. Hold 20–30 seconds each side. Builds lateral trunk stability — the quadratus lumborum, which is frequently weak in back pain patients.
Phase 3: Strengthening and Prevention (6 Weeks+)
Once the acute episode has resolved, the goal shifts to preventing recurrence through progressive strengthening. The muscles most important for lower back pain prevention are the deep abdominals (transversus abdominis), multifidus (deep back muscle), glutes, and hip flexors.
Full Plank
Progress from forearms and bent knees to full plank position (forearms and toes). Maintain a neutral spine throughout. Build from 20 seconds to 60+ seconds. 3 repetitions.
Romanian Deadlift
Using a moderate weight, hinge at the hips with a neutral spine to lower a barbell or dumbbells to mid-shin height. 3 sets of 10. One of the most functional lower back and glute strengthening exercises when performed with correct technique.
Hip Flexor Stretch (Kneeling)
Half-kneeling position, lunge forward to stretch the hip flexor of the rear leg. 3 × 30 seconds each side. Tight hip flexors increase lumbar lordosis and back pain risk.
What to Avoid With Lower Back Pain
- Full sit-ups and double leg lifts. These place high compressive and shear forces on the lumbar discs. Curl-ups and dead bugs are safer alternatives.
- Heavy lifting with spinal flexion. Rounding the lower back under heavy load is high-risk during an acute episode.
- Prolonged rest. As discussed — movement is medicine for back pain.
- Exercises that consistently reproduce or worsen leg pain. This warrants assessment before continuing.
When to See a Physiotherapist
- Pain not improving after 2–3 weeks despite gentle exercise
- Pain spreading into the leg (possible disc or nerve involvement)
- Numbness, tingling or weakness in the leg or foot
- You are unsure whether exercise is appropriate for your type of back pain
- First significant back pain episode — getting the right diagnosis early prevents chronicity
Lambert Sports Clinic offers physiotherapy for lower back pain at our clinic in Surbiton, KT6. Same-week appointments. All major health insurers accepted — Bupa, AXA Health, Vitality, Aviva, WPA, and Healix. Call 020 8133 5694 or book online.
Frequently Asked Questions
Physiotherapy for Back Pain in Surbiton
Same-week appointments · All insurers · CQC-registered · 380 Ewell Road, KT6 7BE
Book Online 020 8133 5694