Should I rest or keep moving when my back hurts?

What health bodies say

The NHS lists "stay active and try to continue with your daily activities" under things to do for back pain, and lists "do not stay in bed for long periods of time" under things to avoid. NIAMS, a US National Institutes of Health institute, also advises avoiding bed rest. It suggests limiting activities or exercise that cause pain and gradually increasing physical activity as tolerated.

MedlinePlus, from the US National Library of Medicine, calls the idea that you need long rest "a common misbelief". It says bed rest is not recommended and that staying in bed for more than 1 or 2 days can make back pain worse. The NICE guideline NG59 asks clinicians to encourage people to continue normal activities as part of self-management advice, and to promote a return to work or normal daily activities.

What the research shows

A Cochrane review is a systematic summary of the best available trials. This one, by Dahm and colleagues, covers 10 randomized trials with 1,923 people with acute low back pain, meaning pain lasting under 6 weeks, with or without sciatica. It found moderate-quality evidence that people with acute low back pain may get small improvements in pain relief and in the ability to do everyday activities when advised to stay active instead of resting in bed. For people with sciatica (pain traveling down the leg from an irritated nerve), there was little or no difference between the two kinds of advice.

The review also reports that, around the turn of the millennium, it became evident that extended bed rest was potentially harmful because it may lead to deterioration of muscles and body functions. The authors note that further research could change their confidence in these estimates, and that the evidence comparing staying active with exercises or physiotherapy was low quality and showed little or no difference. The gains from staying active are described as small.

A short easing-off period

Sources differ slightly on the first few days. MedlinePlus says to stop or reduce normal physical activity for the first few days, then slowly return to usual activities. It adds that heavy lifting and twisting of the back are best avoided for the first 6 weeks, and that after 2 to 3 weeks people can gradually start exercising again, beginning with light aerobic activity such as walking, riding a stationary bicycle or swimming. It warns that starting stretching and strengthening exercises too soon after an injury can make pain worse, and says a physical therapist can advise when to begin. The NHS says to stop an exercise if the pain gets worse and to see a GP for advice.

Details of comfortable positions at night are covered in How should I sleep with back pain? and the role of structured exercise in Does exercise help back pain? For the usual recovery timeline, see How long does back pain usually last? or the wider Back pain basics collection.

When to get help

MedlinePlus says the advice to stay as active as possible applies when there is no sign of a serious cause, such as loss of bowel or bladder control, arm or leg weakness, weight loss or fever. The NHS says to call 999 or go to A&E for back pain with pain, tingling, weakness or numbness in both legs, loss of feeling around the genitals or anus, bladder or bowel changes, chest pain, or a start after a serious accident (see When is back pain an emergency?). It advises seeing a GP when pain does not improve after a few weeks of home care, does not improve after resting, is worse at night, or stops you doing daily activities. Advice and services differ between countries and between clinicians. This page is general education and is not personal medical advice, and it does not tell you what activity is safe for your own back.