Last week I gave you five things to do. Now here are six things to avoid.
These are the six biggest back pain mistakes I see, and the swap I'd make for each one.
TLDR
- Keep moving and keep walking, as much as your pain allows.
- Learn your pain pattern: what makes your back feel better or worse.
- Have a plan, then stick to it.
- Exercise plus education cut the risk of a new back pain episode by 45%.
1. Resting instead of moving
A lot of people, when their back is sore, think they should just wait it out. A study in the 90s compared resting with carrying on with your normal routine. At 3 and 12 weeks, carrying on led to better back pain recovery [1].
I have a PhD in spine biomechanics. Here's my worst back pain mistake.
It was the final year of my undergrad. I'd wake up every morning in pain, afraid to roll out of bed. So I stopped exercising and stopped doing anything I thought would make my back hurt.
After resting for months, my back pain did get better, but I came out of it weaker and, I think, more prone to future bouts of pain. For years after this, I would tiptoe around my back pain, avoiding the exact things I needed to do to get stronger.
The saying goes, use it or lose it. A 2008 study found that 8 weeks of bed rest in 20 healthy men led to a decrease in the size of their multifidus (a muscle close to the spine that helps stabilize it) [2]. And in the men who didn't exercise during bed rest, the multifidus was still smaller up to three months after they got up [2].
So I spent years protecting and studying the back, but training it is what really helped me get better. Now, even when my back pain flares up, I would call it a 1 out of 10.
So what should you do instead?
- Keep your normal day as close to normal as possible: walking, chores, exercising, playing with your kids. Avoid the postures that cause you extreme pain, but keep going [1].
- In my experience, if your back is really flaring up, it's okay to do less for a couple of days, as long as you keep walking and moving how you can.
- As your back calms down, bring back one movement you've been avoiding. If bending over hurts, start with a seated good morning (sit on the edge of a chair and lean forward from your hips, back neutral), then build up. This is called graded exposure.
- My rule of thumb: some discomfort and pain is normal, but if you keep getting worse over time, that's a signal to scale it back.
2. Chasing a diagnosis
In my opinion, chasing a diagnosis and waiting for confirmation wastes valuable time that we could be using to rebuild your back. Once anything serious has been ruled out, all we really need to know is what provokes your pain, and we can get moving from there.
A 2018 paper looked at what back pain is. The overwhelming majority of people with low back pain have what's termed non-specific low back pain [3]. This means the source isn't easily identifiable [3].
A 2009 meta-analysis compared getting a scan straight away with usual care without an immediate scan, in people with no signs of anything serious [4]. With over 1,800 people, they found no difference in pain or function, either in the first 3 months or at 6 to 12 months [4].
3. Not knowing your pain pattern
A pain pattern is what makes your back feel better or worse, not what a scan shows.
A 2004 study looked at matching people's exercises to the direction of movement that eased their pain [5]. For every single outcome they measured, the matched group did better, including a three-fold decrease in the use of medications [5].
The six patterns:
- Bending sensitive: bending to pick things up or tie your shoes hurts, and mornings are often the worst.
- Prolonged sitting: long sitting is the main trigger, and you feel stiff when you get up.
- Lifting and load: it flares up when you lift heavy things, especially from the floor, and carry them.
- Extension sensitive: standing, walking or reaching overhead makes it worse, and it often feels better when you sit down.
- Nerve mobility: pain or tingling that travels from your low back into your glute and down your leg. Deep hamstring stretches and toe touches can make it worse.
- Foundations: no specific trigger to your back pain. It comes and goes with no pattern.
4. Not having a plan
Not having a plan means that you lack structure and progression. In my opinion, a plan takes all the guesswork out of recovery. You just have to follow it.
Please stick to the plan.
5. Searching for quick fixes
A lot of people think that there's a stretch, gadget or pill that they can take to magically improve their back pain and to fix it permanently.
In a triple-blinded, randomized controlled trial, 347 adults with recent low back or neck pain (12 weeks or less) took either an opioid or a placebo for up to 6 weeks, on top of usual care [6]. After six weeks, there was no difference in the pain experienced by the two groups [6].
If you're on a prescribed medication, don't stop it on your own. Talk to your doctor or pharmacist.
6. Lacking consistency
In my experience, a plan that takes a few minutes and gets done most days beats an impossible routine. Don't stop until it becomes a habit.
A 2025 review looked at how sticking to an exercise plan related to pain [7]. In trials where people did 80% or more of their exercise, pain was about 14 points lower out of 100 than with no exercise, compared with about 5 points lower when they did less than 60% [7]. That's a link between trials, so it can't prove that sticking with it caused the drop.
And a 2016 review of 21 trials looked at whether exercise prevents a new episode of back pain [8]. Exercise plus education cut the risk of a new pain episode by 45% [8].
So find out what you need to do to keep your back feeling good. If you want somewhere to start, check out my 5 things that I would do for every type of back pain.
As always, have a great weekend.
Best,
Mitch
Want to know which back pain pattern matches you? Take my free 2-minute quiz and find out.
My free Back Again Basics programs have a plan for each pattern.
References
[1] Malmivaara et al., 1995. The treatment of acute low back pain: bed rest, exercises, or ordinary activity? N Engl J Med 332(6):351-355. doi:10.1056/NEJM199502093320602
[2] Belavý et al., 2008. Resistive simulated weightbearing exercise with whole body vibration reduces lumbar spine deconditioning in bed-rest. Spine 33(5):E121-E131. doi:10.1097/BRS.0b013e3181657f98
[3] Hartvigsen et al., 2018. What low back pain is and why we need to pay attention. Lancet 391(10137):2356-2367. doi:10.1016/S0140-6736(18)30480-X
[4] Chou et al., 2009. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet 373(9662):463-472. doi:10.1016/S0140-6736(09)60172-0
[5] Long et al., 2004. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine 29(23):2593-2602. doi:10.1097/01.brs.0000146464.23007.2a
[6] Jones et al., 2023. Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. Lancet 402(10398):304-312. doi:10.1016/S0140-6736(23)00404-X
[7] Jones et al., 2025. Exercise adherence is associated with improvements in pain intensity and functional limitations in adults with chronic non-specific low back pain: a secondary analysis of a Cochrane review. J Physiother 71(2):91-99. doi:10.1016/j.jphys.2025.03.004
[8] Steffens et al., 2016. Prevention of low back pain: a systematic review and meta-analysis. JAMA Intern Med 176(2):199-208. doi:10.1001/jamainternmed.2015.7431
Disclaimer: this content is educational only and does not constitute medical advice. See a practitioner if you suspect serious spinal trauma from a fall or accident, or if you experience any of the following red flag symptoms: loss of bowel or bladder control, numbness in the groin or saddle area, rapidly worsening leg weakness, back pain with fever or feeling generally unwell, or unexplained weight loss with back pain.