While researchers found that certain movements did raise the chance of a flare happening within 24 hours, those motions and temporary bouts of pain didn’t predict if people would have worse back-related physical function one year later.
The results reinforce long-standing guidance that staying active is generally helpful for lower back pain, even though some movements may temporarily aggravate symptoms, the authors wrote.
“The takeaway here is that movement may sting your back today, but it doesn’t ruin you for tomorrow,” says Nick Shamie, MD, a spin surgeon and professor of orthopaedic surgery and neurosurgery at the UCLA School of Medicine in California, who wasn’t involved in the study.
Does Lifting, Twisting, or Sitting Increase Low Back Pain?
To find out more about which physical activities are linked with short lived (lasting less than 24 hours) low back pain and long-term disability, investigators followed more than 400 people who had recent appointments at a Veterans Affairs health clinic for their back pain. Participants were 47 years old on average, and 75 percent were male.
Over a full year, the group completed nearly ten thousand daily surveys that tracked whether they were experiencing a low back pain flare and how many hours they spent doing 10 common activities, including bending, lifting, twisting, pushing or pulling, squatting, sitting, standing, walking, climbing, and crawling.
Researchers examined the data in two ways:
- Whether more time in any of the above activities increased the likelihood of a flare within 24 hours
- Whether those same activities predicted worse back-related function one year later
This design allowed the team to evaluate both short-term symptom triggers and long-term outcomes in the same group (something earlier studies had not done).
Movements That Increased Flare Risk Did Not Lead to Worse Functioning One Year Later
The study data linked several everyday activities with a slight increase in the odds of experiencing a flare the following day, including:
- Bending
- Twisting
- Squatting
- Pushing or pulling
- Lifting more than 10 pounds
Each additional hour spent bending, twisting, or pushing or pulling increased flare likelihood by about 6 percent. An hour of lifting or squatting raised it by roughly 5 percent.
These patterns match what many people with back pain notice in daily life — certain movements can cause short-term pain, says Dr. Shamie.
But researchers found no evidence that any of the movements led to worse back-related function one year later.
“The flares of pain reflect temporary irritability rather than structural harm or progression of disease. That’s why movement can hurt but still be recommended,” says Shamie.
Why Back Pain Flares Happen
Low back pain flares don’t usually come from one single cause. Instead, research shows they often happen when several factors pile up at the same time.
Everyday movements — especially if done with poor posture, sudden force, or more intensity than usual — can irritate the muscles, joints, or ligaments of the lower back and can cause acute lower back pain.
- Muscle fatigue, stiffness from sitting too long, or lifting in a way that overloads the back
- Muscles spasm or overly tight muscles
- Facet joints (joints along the spine) becoming irritated and nerves becoming sensitive when nearby tissues are inflamed
- Fascia, the thin layer of connective tissue over the muscles, becoming irritated by micro-injuries, which can also heighten pain sensitivity
- Myofascial trigger points (tight knots in the muscles) having a flare after strain or overuse
Physical stresses are only part of the low back pain equation. Sleep problems, stress, extra weight, and low activity levels can all make the back more reactive.
Study Limitations
The authors note a few limitations. Because participants estimated their daily activities, the data may not be perfectly precise. The study did not use motion sensors, so actual movement could differ from what people recalled. Because most participants were middle-aged male veterans, the results may not reflect younger adults or women.
Still, the overall message remains consistent with current understanding: Pain during movement often reflects sensitivity, not damage.
How to Prevent Back Pain Flares
“Practically, these findings reinforce current recommendations: stay active, use pacing and gradual exposure rather than avoidance. Movement remains beneficial for long-term outcomes even if it hurts in the short term,” says Shamie. He recommends:
- Warm up before activity; gentle stretching reduces strain.
- Pace activities that involve bending or lifting and don’t try to do too much at once.
- Use good lifting form: Bend your knees, keep items close, tighten your core, and avoid twisting.
- Get exercise through activities like walking, swimming, and Pilates, which will support your spine by strengthening core, hip, and back muscles.
- Avoid long periods of sitting or standing. Change positions often and take short movement breaks.
- Maintain a healthy weight; excess weight increases pressure on the lower back.
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