In the first two weeks of a sore back, five things help: short walks little and often, pelvic tilts, cat-cow, slow breathing lying down, and single knee-to-chest. Walking is the one that matters most. Heavy lifting, sit-ups, loaded twisting and hard hamstring stretching are better left until week three, once the spasm has settled.
Where the ache runs up into the mid-back and neck as well as the lower back, the reasons those areas flare together are set out in PhysioHub’s guide to head, neck and back pain.
Back pain in the first fortnight has one job, which is getting normal movement back before stiffness and guarding settle in. This is the standard progression, and it moves faster or slower depending on how the pain responds.
| Stage | What helps | What can wait |
|---|---|---|
| Days 1–3 | Short indoor walks, slow breathing lying down, gentle pelvic rocking | Bed rest beyond a few hours, sit-ups, bending to touch toes |
| Days 4–7 | Cat-cow, knee to chest, longer walks, glute bridges | Loaded squats, heavy lifting, twisting under load |
| Days 8–14 | Bird dog, side plank on the knees, 20 minute walks | End-range heavy loading, running on hard ground |
| Week 3 onwards | Rebuilding strength: goblet squats, light hinging, carries | Long stretches of sitting without moving |
The five exercises below are the ones that fill the first fortnight. They are ranked by how much difference each makes to how quickly the back settles.
This is a documentary review of published guidance and trial evidence rather than a programme prescribed for your back. Around fifteen approaches commonly recommended in the first fortnight were considered, including the five here plus prone press-ups, standing extensions, child’s pose, piriformis stretches, bird dog, dead bug, side planks, glute bridges, nerve gliding, heat, ice and bed rest.
Three criteria decided the ranking: how well the approach is supported for acute back pain specifically, how many people can do it while in real pain, and how much it contributes to getting normal movement back.
The sources read were NICE guideline NG59 on low back pain and sciatica, the Cochrane review of advice to rest in bed versus advice to stay active, and the 2016 Cochrane review of motor control exercise covering 29 trials and 2,431 participants. Evidence checked in August 2026.
What could not be checked: the trial evidence for individual exercises in the first fortnight is thin, because most back pain trials recruit people who have had symptoms for months. Much of what follows is standard clinical practice supported by the broader guidance rather than by a trial of that specific movement. Pain below the knee with numbness or weakness, a back that is worse at night, unexplained weight loss, fever, or any change in bladder or bowel control all need assessing rather than exercising.
Frequency beats duration. Six short walks beat one long one in the first week, because the back stiffens during rest and the aim is to interrupt that repeatedly.
Pick movements that go both ways. Cat-cow and pelvic tilts move the spine into bending and arching, and most people find one direction eases things more than the other. Working out which one is yours is more useful than any single prescribed exercise.
Judge by the trend, not the session. A movement that hurts a little during and leaves you the same or better an hour later is fine. One that leaves you worse for the rest of the day comes out for a few days.
Keep doing something you already do. Whatever training, walking or work you can still manage is worth keeping, at a reduced level. The gap between stopping everything and stopping a few things is where most of the slow recoveries happen.
What it is
Walking on flat ground for five to ten minutes at a time, repeated several times a day.
Who it suits
Almost everyone, from day one, including people who cannot yet get down onto the floor.
How to do it
Five to ten minutes, three or four times a day, on level ground and at a comfortable pace. Extend by a couple of minutes each day as long as you are no worse the following morning. By the end of the second week, most people are managing 20 minutes in one go.
What the evidence supports
The Cochrane comparison of bed rest with staying active found small improvements in pain and function for people advised to stay active, on moderate quality evidence. Staying active is also the position NICE takes in NG59, where self-management and continuing normal activity are the starting point for low back pain.
Limits and cautions
Long walks too early are the usual overshoot, and the cost is a day back. Hills and uneven ground are harder than they look in week one. Where walking itself reproduces leg symptoms that build the further you go, that pattern is worth having assessed.
Time and effort
Thirty minutes across the day, spread out, with no equipment.
Why it made the list
It ranks first because it has the best evidence behind it, it is available from the first hour, and it does more than any floor exercise to stop the back stiffening.
What it is
Lying on your back with the knees bent, gently rocking the pelvis to flatten and then arch the lower back.
Who it suits
Anyone in the first few days, including people whose back is in obvious spasm.
How to do it
Knees bent, feet flat. Gently tilt the pelvis so the lower back presses towards the floor, hold two seconds, then let it rock the other way into a small arch. Ten to fifteen slow rocks, two or three times a day. The range is small and that is deliberate.
What the evidence supports
The value here is in restoring small, controlled movement to a segment that has locked down protectively, and in showing the nervous system that movement is available and safe. It is a standard early intervention rather than one with its own trial evidence.
Limits and cautions
Pushing into the direction that clearly hurts is not the point. Most people find one way comfortable and one way sharp in the first days, and working the comfortable direction is fine.
Time and effort
Three minutes, on the floor or a bed.
Why it made the list
It is usually the first floor exercise a painful back tolerates, which makes it the bridge between walking and everything else.
What it is
On hands and knees, alternately arching and rounding the whole spine.
Who it suits
Anyone from around day three or four who can get onto hands and knees comfortably.
How to do it
Hands under shoulders, knees under hips. Slowly round the back upwards, letting the head drop, then reverse into a gentle arch. Move segment by segment rather than as one block. Ten slow cycles, twice a day, within a comfortable range.
What the evidence supports
It takes the spine through both directions of movement with body weight supported on four points, which lowers the demand compared with doing the same standing. It is a mobility exercise, and the case for it rests on restoring normal movement rather than on a specific trial.
Limits and cautions
Rushing turns it into a rocking motion that moves the hips rather than the spine. Anyone with sore knees or wrists can do the same movement seated on a chair. Where one direction is sharply painful, stay in the other for a few days.
Time and effort
Three minutes, on a mat or carpet.
Why it made the list
It covers more of the spine than the pelvic tilt does, and it is the first movement most people can use to work out which direction their back prefers.
What it is
Lying on your back with the lower legs resting on a chair or sofa so the hips and knees are both bent to right angles, breathing slowly.
Who it suits
Anyone in the first few days, particularly people whose back muscles are visibly braced and who cannot find a comfortable position.
How to do it
Rest the calves on a chair seat with the hips and knees at right angles. Breathe in through the nose for four seconds, out for six, letting the ribs and belly move rather than the shoulders. Five minutes, as often as it helps.
What the evidence supports
The position takes tension off the muscles running down the back of the spine and off the hip flexors, which is why it is often the most comfortable position available in the first days. Slow breathing shifts the balance of the nervous system away from the fight-or-flight state that sustains muscle guarding. The evidence here is mechanistic rather than from back pain trials.
Limits and cautions
It relieves rather than rehabilitates, so a fortnight of this without the walking would leave you stiffer. Fifteen minutes at a time is plenty.
Time and effort
Five minutes, and a chair or sofa.
Why it made the list
It ranks fourth because it changes nothing structurally, and it stays on the list because it is often the only comfortable position in the first 48 hours, and comfort is what makes the rest possible.
What it is
Lying on your back and drawing one knee gently towards the chest, one leg at a time.
Who it suits
People whose back eases when they curl up, which is a large minority rather than everyone.
How to do it
Knees bent, feet flat. Bring one knee towards the chest with both hands behind the thigh, hold for 20 to 30 seconds, then lower and swap. Three each side, twice a day. Keep the other foot on the floor.
What the evidence supports
Bending the spine forwards opens the small joints at the back of the vertebrae, which is why this position helps people whose pain comes on with standing and arching and eases with sitting. For people whose pain worsens with sitting and bending, it often does the opposite, which is why it sits last on this list rather than higher.
Limits and cautions
Pulling both knees up at once loads the lower back more on the way in and out, so one leg at a time is the safer version early on. Anyone whose leg symptoms increase during the stretch should leave it out.
Time and effort
Three minutes, on the floor or a bed.
Why it made the list
It helps a substantial group of people a lot and a similar group not at all, and it takes one session to find out which you are.
| What to do | Main effect | Available from | Needs floor space | Equipment | Evidence strength |
|---|---|---|---|---|---|
| Short walks | Keeps the back moving, lifts mood | Day 1 | No | None | Moderate quality, direct |
| Pelvic tilts | Restores small controlled movement | Day 1 | Yes | None | Clinical practice |
| Cat-cow | Range through the whole spine | Day 3–4 | Yes | Mat | Clinical practice |
| 90/90 breathing | Comfort, reduces guarding | Day 1 | Yes | A chair | Mechanistic |
| Single knee to chest | Eases one pattern of pain | Day 2–3 | Yes | None | Depends on the pattern |
Only the first has direct trial evidence behind it for acute back pain, which is worth knowing when deciding what to prioritise on a bad day.
If it happened in the last 48 hours and you cannot get comfortable, use the 90/90 position and short indoor walks. That is the whole programme for now.
If your back eases when you sit or curl up, add single knee to chest and cat-cow early, and keep walks shorter and more frequent.
If your back eases when you stand and walk and hurts when you sit, prioritise walking and leave knee to chest out for the first week.
If you train regularly, keep training at reduced load rather than stopping. Carries, supported rows and single-leg work are usually available in week one.
If pain travels below the knee, or the leg feels numb or weak, get it assessed before building a routine around it. That pattern needs identifying rather than exercising through.
If there is any change in bladder or bowel control, or numbness around the saddle area, treat that as an emergency and go to A&E the same day.
The Cuckoo Trail is the most useful piece of infrastructure in the area for a sore back. It runs from Heathfield down towards Polegate on the old railway line, which means it is flat, surfaced and almost entirely free of stiles, gates and hills. That matters in the first fortnight because the advice to walk regularly falls apart when the only route available is a rutted footpath across a field. Access points at Horam and Hellingly make short out-and-back walks easy to measure, so ten minutes out and ten minutes back is a real plan rather than an estimate.
What the trail does not solve is knowing when an ordinary back is behaving unusually. Most episodes settle substantially inside six weeks and need no investigation at all. The ones worth flagging early are pain travelling below the knee, weakness in a leg, a back that is worse lying down at night than during the day, and symptoms that have not begun improving by the six-week mark. Those four are the reason a self-management plan should still have a review point in it.
Where you are unsure whether what you have needs physiotherapy at all, a free discovery and triage call is the quickest way to find out.
Why is bed rest bad for back pain?
It slows recovery slightly rather than helping it. A Cochrane review comparing advice to rest in bed with advice to stay active found that people with acute low back pain who stayed active had a little less pain and a little better function, on moderate quality evidence. For sciatica specifically there was little or no difference between the two. Lying down for a few hours when the pain is at its worst is reasonable; lying down for days is not.
Which exercises should I avoid in the first two weeks?
Heavy deadlifts and loaded squats, full sit-ups and crunches, loaded twisting, toe touches, and aggressive hamstring stretching. These are not permanently off the list. They come back in week three or later, once the protective muscle spasm has settled and normal movement has returned.
How do I know if my back pain is a disc or a muscle strain?
Discogenic pain typically worsens with bending forwards, prolonged sitting, coughing and sneezing, and may send symptoms down the leg past the knee. A muscle strain is usually more localised, tender to press on, and spikes during transitions such as rolling over in bed or standing up from a chair. Both settle with much the same early management, which is why the distinction matters less in week one than people expect.
How long should back pain last before I get it checked?
Six weeks of sensible activity without improvement is the usual trigger for an assessment. Sooner than that if there is pain travelling below the knee, numbness or weakness in the leg, a back that is worse at night, or any change in bladder or bowel control, which needs seeing the same day.
Is walking good for lower back pain?
Yes, and it is the single most useful thing in the first fortnight. Short walks repeated through the day are better tolerated than one long one. Five to ten minutes, three or four times a day, is a realistic starting point, building the length as the back allows.
When can I go back to the gym after back pain?
Most people can keep training something from day one, and can return to loaded lifting from around week three. Carries, machine rows and single-leg work are usually available even in the first week. What changes is the load and the choice of exercise rather than whether to train at all, which is the approach NICE guidance takes for low back pain.
Do I need a scan for back pain?
Almost never in the first six weeks. Imaging in the early stages of ordinary back pain rarely changes what is done, and it commonly shows age-related findings that are also present in people with no pain at all. Scans matter where there are signs pointing to something specific, which is what an assessment is for.
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