A sore back: rest or move?

You bent down for something on the floor, something caught, and now standing up straight is a negotiation. The instinct is to lie down and wait it out. That instinct is usually wrong.

Move, mostly

For the ordinary sore back, the kind with no leg symptoms and no red flags, staying active is better than rest on almost every measure we have. People who keep moving get out of pain sooner, lose less strength, and are less likely to still be dealing with it six months later.

That does not mean training through it. It means walking, standing up regularly, doing the parts of your day you can do. The bar is movement, not performance.

What resting actually costs

Two days of bed rest is not neutral. Back muscles decondition quickly, the whole area gets stiff and guarded, and you start to move as though the spine is fragile. That guarding outlasts the original problem and is often what people are still carrying months later.

There is also the belief cost. Lying still for a week teaches you that your back is dangerous. It is very hard to unlearn that, and it changes how you move long after the tissue has healed.

The exception

The first day or two can genuinely be miserable, and if the only position you can tolerate is lying with your knees bent, take it. Nobody is asking you to be heroic in the first 48 hours.

The rule is that rest is a short-term comfort measure, not a treatment. Get back to normal movement as soon as you can, even in small amounts, and even if it is uncomfortable. Uncomfortable is fine. Sharply worse is not.

When it is not just a sore back

Call your doctor, not us, if you have any of these: numbness around the saddle area, trouble controlling your bladder or bowels, weakness in a leg that is getting worse, unexplained weight loss, fever, or a back that started hurting after a real fall or crash. Those are uncommon, but they are not physio problems.

Pain down the leg past the knee is worth getting assessed, though it is usually still manageable without anything dramatic.

What we do with it

Mostly we work out which movements you have stopped doing and get you doing them again, in an order your back will accept. Some hands-on work if it helps you move sooner. A small number of exercises you will actually do, rather than a sheet of twelve you will not.

Most simple back pain improves substantially within a few weeks. The point of coming in is to make that happen without the fear, and without it becoming the thing you organise your life around.