Three things get called arthritis in the lower back: facet joint change, disc degeneration and spinal stenosis. The position that eases it tells you which. Leaning forward helps stenosis, standing helps disc-related pain, sitting helps facet pain. Five treatments help across all three, and walking and trunk strengthening carry most of the weight between them.
Where symptoms travel down the leg rather than staying in the back, what that means and the rehabilitation that follows are set out in PhysioHub’s guide to nerve root problems.
The most useful question in a degenerative lower back is which position makes it better, rather than what the scan shows. That separates the three patterns quickly, and each one responds to different exercise.
| Pattern | Worse with | Better with | Exercise bias |
|---|---|---|---|
| Facet joint change | Standing tall, arching back, twisting | Sitting, leaning slightly forward | Pelvic tilts, knee to chest, trunk endurance |
| Disc degeneration | Prolonged sitting, bending forward under load | Standing, walking, gentle extension | Walking intervals, bird dog, hip hinging |
| Spinal stenosis | Walking distance, standing still | Sitting, leaning on a trolley, cycling | Flexion-biased work, cycling, graded walking |
These overlap frequently, because one degenerative process produces all three. Where two patterns compete, the one that limits what you can do decides where the programme starts.
This is a documentary review of published guidance and trial evidence rather than a treatment plan for your back. The five treatments here are the ones most consistently supported for degenerative low back pain. Considered and left out because the evidence is weaker or the pathway is different: traction, TENS, ultrasound, acupuncture, spinal injections, back braces for routine use, and surgery, which is reserved for specific nerve compression.
The order reflects how much each contributes across all three patterns above, weighed against how easily it can be kept up.
The sources read were NICE guideline NG59 on low back pain and sciatica, the 2016 Cochrane review of motor control exercise covering 29 trials and 2,431 participants, and NICE guideline NG226 on osteoarthritis. Evidence checked in August 2026.
What could not be checked: most low back pain trials do not separate people by which degenerative pattern they have, so the exercise biases described here rest on clinical reasoning rather than on trials of that subgroup. Structural change on imaging correlates poorly with symptoms. Progressive leg weakness, steadily shrinking walking distance, night pain, fever, unexplained weight loss, or any change in bladder or bowel control all need medical assessment rather than an exercise programme.
Find your relieving position first. Whether you feel better sitting, standing or leaning forward tells you more about what to do than any scan report will.
Measure walking in minutes, not in feelings. Where stenosis is in the picture, walking tolerance is the number that tracks progress. Knowing it is currently eight minutes gives you something to build.
Build endurance rather than strength. The trunk muscles supporting the spine are high-endurance muscles, so long holds and higher repetitions serve them better than heavy short efforts.
Do not chase the structural change. Nothing on this list reverses facet wear, a dehydrated disc or a narrowed canal. What changes is capacity, tolerance and how much of your life the back takes up.
What it is
Regular walking on level ground, built up in planned increments rather than by feel.
Who it suits
Everyone with a degenerative lower back, including most people with stenosis once the increments are set sensibly.
How to do it
Establish what you can currently do comfortably, then walk slightly less than that, several times a day. Add a minute or two every few days. Where leg symptoms limit you, walk to just before they arrive, sit for a minute, and go again, which builds far more total distance than one long attempt.
What the evidence supports
Staying active and self-management sit at the centre of NICE guidance on low back pain, and exercise is the core treatment NICE recommends for osteoarthritis at any joint. Walking also maintains the endurance the trunk muscles need and the general health that a painful back tends to erode.
Limits and cautions
Walking distance that is shrinking week on week, rather than fluctuating, is worth reporting rather than pushing through. Hills and uneven ground are considerably harder than they look with a stiff back.
Why it ranks first
It is free, it works across all three patterns, and it is the habit that most reliably determines how much trouble an arthritic back causes over a year.
What it is
Endurance work for the muscles that hold the spine steady, using positions that load them without loading the spine heavily.
Who it suits
Everyone, and it is particularly valuable where the back feels unreliable rather than simply sore.
How to do it
The bird dog, the modified curl-up and the side plank on the knees, done as holds rather than fast repetitions. Three sets of six to ten on each, three times a week. Progress by holding longer and by moving to the full version rather than by adding speed.
What the evidence supports
The 2016 Cochrane review of motor control exercise, covering 29 trials and 2,431 participants, found medium-sized improvements in pain and disability compared with minimal intervention, and results broadly similar to other forms of exercise. That last part matters: trunk training works about as well as other exercise, so the version you will actually keep doing is the right one.
Limits and cautions
Speed turns these into different exercises entirely, and the back arches. The range in which you can hold the spine still is the range that trains it, and early on that range may be small.
Why it ranks second
It has the clearest trial evidence on this page, and it requires more discipline than walking, which is what places it just below it.
What it is
Restoring movement and strength at the hips so they supply the range and power that a stiff lower back otherwise has to.
Who it suits
Anyone who sits for long periods, and anyone who bends from the back rather than the hips when picking things up.
How to do it
A daily hip flexor stretch in a half-kneeling position, 30 seconds each side. Glute bridges, three sets of twelve. Sit-to-stands from a chair, three sets of ten. Then practise hinging: pushing the hips backwards to reach the floor with the back staying long.
What the evidence supports
The hips and lower back share the work of every bend, lift and step, and hip strengthening features in most comprehensive back programmes. Trials isolating the hip component specifically are limited, so this rests on mechanical reasoning and clinical practice.
Limits and cautions
Stretching a hip aggressively while the back is in a flare-up often irritates the back instead. Keep it gentle until symptoms are settling.
Why it ranks third
It changes the demand on the back at every bend of the day, and it is the component most commonly missing from a back programme.
What it is
Using the position that relieves your particular pattern, and breaking up the positions that provoke it.
Who it suits
Everyone, and it produces the fastest change of anything here.
How to do it
For facet-pattern pain, sit or lean forward for relief and break up long periods of standing. For disc-pattern pain, stand and walk regularly and break up long periods of sitting. For stenosis, plan walks with somewhere to sit, and use a bike for distance. In every case, change position every 30 to 40 minutes.
What the evidence supports
Activity pacing and self-management sit at the centre of NICE guidance for low back pain. This is symptom management rather than tissue change, and it is what makes the rest of the programme possible.
Limits and cautions
Avoiding the provoking position entirely and permanently narrows what the back tolerates over time. The aim is to interrupt it, not to eliminate it.
Why it ranks fourth
It works immediately and it builds nothing, which is exactly the right position on a list that is otherwise about capacity.
What it is
Heat for stiffness, and appropriate pain relief where it enables activity.
Who it suits
Anyone whose morning stiffness or evening ache is the barrier to doing the other four things.
How to do it
A wheat bag or heat pack for 15 to 20 minutes, particularly first thing. Pain relief discussed with a pharmacist or GP, used to enable movement rather than to allow more sitting.
What the evidence supports
NICE recommends considering oral NSAIDs for low back pain at the lowest effective dose for the shortest time, alongside self-management, and is clear that medication is an adjunct to activity rather than a replacement for it. Heat is comfort with good tolerability and no structural effect.
Limits and cautions
Anti-inflammatories carry real risks with the stomach, kidneys, liver and heart, particularly with age and other medication, so this is a conversation with a pharmacist or GP rather than a default.
Why it ranks fifth
It changes nothing about the back, and it is what lets some people start the four things that do.
| Treatment | Builds capacity | Helps same-day | Works for stenosis | Weekly effort | Evidence |
|---|---|---|---|---|---|
| Walking | Yes | Somewhat | Yes, in intervals | Most days | Central to guidance |
| Trunk strengthening | Yes | No | Yes | 3× weekly | Cochrane, 29 trials |
| Hip mobility and strength | Yes | No | Yes | 3× weekly | Practice-based |
| Position and pacing | No | Yes | Yes, essential | Continuous | Central to guidance |
| Heat and pain relief | No | Yes | Partly | As needed | Adjunct only |
Three of these five build something. Two make the day tolerable. A plan built only from the second group feels better and changes nothing over a year.
If leaning on a trolley makes it better and walking makes your legs heavy, that is stenosis. Walk in intervals with somewhere to sit, use a bike for distance, and build from a number you have measured.
If standing tall and arching backwards is the problem and sitting helps, that fits facet joint change. Pelvic tilts, knee-to-chest and trunk endurance work suit it.
If long sitting is the problem and walking helps, break up the sitting every half hour and prioritise walking and hip hinging.
If mornings are the barrier, use heat first and do the trunk work later in the day when the back has loosened.
If a scan report is what is worrying you, remember that degenerative change is present in a large proportion of people with no back pain at all.
If walking distance is shrinking week by week, a leg is weak, or there is any change in bladder or bowel control, that needs assessing rather than exercising, and the bladder or bowel change needs A&E the same day.
The most reliable diagnostic tool for a stiff lower back in this town is a supermarket trolley. People arrive describing a back that stops them walking into Uckfield High Street, then mention in passing that they can do a full shop at the Tesco or the Waitrose without much trouble. That contrast is not a coincidence and it is not a lack of willpower. Leaning forward on a trolley opens the space the nerves travel through, which is why a mile behind a trolley is comfortable and two hundred yards upright is not.
The clinical value of noticing it is that it changes the programme immediately. A back that feels better leaning forward wants flexion-biased work, interval walking and a bike for distance, and it does badly with the standing extension exercises that suit a different pattern entirely. Uckfield’s topography makes this easy to test, because the High Street is a genuine hill and the Cuckoo Trail is flat, so comparing ten minutes on each tells you a great deal in one afternoon.
Where a lower back has been stiff for months and you want a programme built around your pattern rather than a generic sheet, our musculoskeletal pain and injuries service sets out how it is assessed.
Why does leaning on a shopping trolley make the pain go away?
That is the classic sign of lumbar spinal stenosis. Leaning forward bends the lower spine slightly, which opens up the canal the nerves run through and takes the pressure off them. People notice they can walk the length of a supermarket behind a trolley but not the length of a street without one. It is one of the most useful pieces of information you can give a clinician.
Is walking good for arthritis in the lower back?
Yes, and it is the single most useful daily habit for it. Walking does not reverse the structural changes and it does improve pain, function and general health, and it maintains the muscular endurance the spine relies on. Where walking distance is limited by leg heaviness rather than by back pain, that pattern points at stenosis and a cycling alternative usually works better while the walking is built up.
Should I wear a back brace?
For short periods during genuinely heavy tasks, yes, and not all day every day. Continuous use over weeks lets the deep trunk muscles weaken, which leaves the spine less supported when the brace comes off. Think of it as a tool for a specific job rather than as a treatment.
What is the difference between facet arthritis and spinal stenosis?
Facet joint change usually hurts more with standing tall, arching backwards and twisting, and eases with sitting. Stenosis produces heaviness, cramping or tiredness in the legs on walking, relieved within a minute or two of sitting or leaning forward. They often coexist, because the same degenerative process produces both.
Does an X-ray showing lumbar spondylosis explain my pain?
Often not on its own. Degenerative change in the lower spine is extremely common in people with no back pain at all, and it becomes more common with every decade. A report describing wear and tear rarely changes the treatment, which is why imaging is not recommended in the early stages of ordinary back pain.
What exercises are safest for lower back arthritis?
The trunk exercises with the best evidence base are the bird dog, the modified curl-up and the side plank, which build endurance without loading the spine heavily. Alongside those, walking and hip strengthening do most of the work. NICE recommends a group exercise programme as the core treatment for low back pain and sciatica.
When should lower back arthritis be checked?
If pain travels below the knee, if a leg is numb or weak, if walking distance is dropping steadily, if the back is worse lying down at night than during the day, or if there is unexplained weight loss or fever. Any change in bladder or bowel control, or numbness around the saddle area, is an emergency and needs A&E the same day.
PhysioHub – Empowerment through Evidence-Based Education.
Every body is different. Book a thorough assessment and get advice that is specific to you and your goals.
Book an Appointment