Exercise therapy

Exercise is the treatment with the most consistent support for back and neck pain, both for getting better and for staying better. No single type has been shown to be clearly best, so the right programme is mostly the one you will keep doing. The evidence favours building up gradually over weeks and including some strength work.

What the evidence shows

Use	Evidence
Low back pain	Recommended in guidelines; NICE suggests considering group exercise of any type: strengthening, aerobic, mind-body or a mix1
Preventing recurrence	Exercise, alone or with education, is the only intervention with good evidence2
Walking as exercise	A progressive walking programme reduced back pain recurrences3
Neck pain at work	Neck and shoulder strengthening reduced pain, with a medium effect4
Forward head posture with neck pain	Exercise improved posture, pain and disability; programmes of 8+ weeks did better5
Increased upper back rounding in older adults	Six months of spine strengthening and posture training reduced the curve6

Which exercise?

• Strength: for the neck, shoulders, back and hips. See strength training.
• Aerobic: walking, cycling, swimming. See walking for back pain.
• Mind-body: yoga, Pilates, tai chi. See yoga and Pilates.
• Specific movements: for example chin tucks for the neck or thoracic extension for the upper back.

Choose what you enjoy and can fit into your week.

How much and how long

• Start below the level that flares your pain, and increase gradually.
• Expect changes over weeks: in forward head trials, programmes of eight weeks or more did better.⁵
• Short sessions count. In office workers, one hour of strength training a week split into short sessions worked. See strength training.
• Some soreness after a new exercise is normal and settles within a day or two.

Exercising when it hurts

Moving with some pain is usually safe for common back and neck pain. A rule of thumb many physiotherapists use is that pain during exercise is acceptable if it settles back to your usual level within about a day. If pain keeps building, cut back rather than stop. See graded activity.

Stop and get assessed if exercise brings on numbness, weakness, pain spreading down a limb, dizziness or any red flag.

Footnotes

1. Low back pain and sciatica in over 16s: assessment and management (NICE guideline NG59). 2026. ↩

2. Prevention and treatment of low back pain: evidence, challenges, and promising directions. 2018. ↩

3. Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence (WalkBack). 2024. ↩

4. Workplace-based interventions for neck pain in office workers: systematic review and meta-analysis. 2018. ↩

5. Therapeutic exercise for forward head posture in neck pain patients: a systematic review and meta-analysis. 2025. ↩ ↩²

6. Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults (SHEAF RCT). 2017. ↩