Back Pain and Strength Training: Why Avoiding Movement Can Delay Recovery

When back pain strikes, it’s natural to become cautious — to avoid lifting, bending, or loading the area for fear of doing further harm. While this protective instinct is understandable, avoiding movement altogether can actually contribute to longer-term issues. In many cases, progressive strength training is not only safe — it’s essential for improving function and reducing recurrent flare-ups.

When back pain strike avoiding movement altogether can actually contribute to longer-term issues.

When Back Pain Isn’t Always Linked to Structural Damage

Research consistently shows that imaging findings such as disc degeneration, bulging discs, or facet joint arthritis are often present in individuals with no symptoms at all (Brinjikji et al., 2015). This highlights a critical distinction: pain is not always directly linked to structural pathology. Pain in the lower back is more often influenced by:

• Reduced load tolerance

• Deconditioning of postural and trunk muscles

• Sensitisation of the nervous system

• Altered movement or compensation patterns

  
  

Resting for too long — or avoiding specific movements — can lead to further reductions in strength and stability, making the back more vulnerable over time (Steiger et al., 2012).

Strength Training Is a Clinically Supported Approach for Back Pain

Far from being risky, resistance-based rehabilitation is strongly supported in the clinical literature as a safe and effective intervention for people with chronic or recurrent low back pain. Benefits of strength training include:

• Improved tissue capacity, enabling your back to tolerate more stress without reacting

• Reduction in pain sensitivity over time

• Increased movement confidence

• Enhanced support from the hips, glutes, and trunk muscles

• Greater control under load and fatigue

  
  

A 2019 systematic review confirmed that resistance training reduces pain and improves function in individuals with chronic low back pain (Steele et al., 2019).

Progressive Loading Matters — and It Needs to Be Individualised

That said, strength training for back pain should not follow a one-size-fits-all approach. Effective rehabilitation requires:

• A clear assessment of movement capacity and strength

• Understanding the source of sensitivity or load intolerance

• Gradual, progressive loading — tailored to the person’s baseline and goals

• Full-body integration, not just isolated “core work”

• Clinical reasoning to guide the pace and progression of rehabilitation

  
  

In practice, this may include movement retraining, resistance-based rehab exercises, and strength development targeted at both the spine and surrounding areas such as the hips, pelvis, and thoracic spine.

 Resistance-based rehabilitation is strongly supported in the clinical literature as a safe and effective intervention for people with chronic or recurrent low back pain.

Understanding the Flare-Up Cycle

Many people with low back pain experience a cycle of:

1. Pain flare-up

2. Rest and passive management (e.g. massage, medication, stretching)

3. Temporary relief

4. Return to normal activity

5. Re-aggravation

6. Repeat

   
   

This often occurs when the root cause — such as poor load tolerance, movement inefficiencies, or muscle deconditioning — has not been adequately addressed.

Symptom management without capacity building rarely leads to long-term resolution.

What a Strength-Based Rehab Approach Looks Like

A structured rehabilitation plan for back pain may include:

• Clinical assessment of joint range, movement control, and postural strength

• Education around pain science and the role of strength

• Gradual exposure to spinal loading, within safe and tolerable ranges

• Strengthening of surrounding muscle groups — hips, glutes, abdominals, thoracic extensors

• Hands-on support if indicated, to reduce sensitivity and restore movement confidence

• A clear progression pathway from rehabilitation to return to full activity

Key Takeaways

• Most back pain is not caused by serious injury or structural damage

• Prolonged rest and avoidance can contribute to worsening symptoms and reduced capacity

• Hands-on techniques can provide immediate relief during the acute stage of back pain, providing the initial relief to then progress to effective rehabilitation via strength training.

• Strength training is a well-supported strategy for reducing pain and preventing recurrence

• Effective rehab requires assessment-led, individualised programming that addresses the whole person — not just isolated symptoms

References

Brinjikji, W., Luetmer, P. H., Comstock, B., et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173

Steiger, F., Wirth, B., de Bruin, E. D., & Mannion, A. F. (2012). Fatigue of the trunk extensor muscles in patients with subacute and chronic low back pain. European Spine Journal, 21(4), 778–785. https://doi.org/10.1007/s00586-011-1989-0

Steele, J., Bruce-Low, S., & Smith, D. (2019). A review of the clinical value of resistance exercise for patients with chronic low back pain: A systematic review. Journal of Back and Musculoskeletal Rehabilitation, 32(5), 625–638. https://doi.org/10.3233/BMR-181254