Reframe activity advice

People with acute back pain approach physical activity from a risk-benefit framework. Exploring the risks and benefits they are considering and the context within which these decisions are made allows them to make an informed assessment.

Behaviour change is difficult for everyone. However, being active delivers many benefits with relatively little risk.


  • People value the psychological benefits of exercise above the physical benefits, so it is important to highlight these. Physical activity results in the release of serotonin and endorphins which make people feel better. Physical exercise also offers an opportunity for social interaction and regulates stress
  • Being more active allows people to continue with their life roles. This makes them feel more useful and less disabled 
  • Physical activity stimulates descending neural pathways which inhibit nociceptive transmission in the dorsal horn of the spinal cord. This results in less nociceptive information reaching the brain. Consequently, the brain makes less pain
  • Physical activity provides an opportunity to teach the brain that movement is okay, so it can be less protective of the back 
  • Physical activity is good for general health 
  • Physical activity has consistently been demonstrated to improve back pain outcomes. The type of activity which is being undertaken is unimportant. The benefits do not come from strengthening muscles

A focus on the negative effects of rest (like poor healing, weakening, deconditioning) is unhelpful because it reinforces a biomedical model of back pain which has not been supported by research findings. Threatening a poor outcome has not been demonstrated to be an effective way to achieve behaviour change.


  • Physical activity may well be uncomfortable. Patients may worry that this indicates they are causing more damage, and seek reassurance.

“saying that it wasn’t going to damage it any more, I guess ... if I knew that I just wasn’t going to do myself any harm, then I wouldn’t care” 


It is quite safe to experience some pain. 

Patients will not injure themselves further because this pain is so protective.