Pain guide · Back pain

Lower back pain when hiking: the pack, uphill and downhill, the nerve signs, poles and what helps

Lower back pain when hiking is usually ordinary back pain meeting a longer day, a heavier pack or more climbing than your back is used to. A pack makes you lean forward, long climbs with a heavy load work the lower back hardest, and long descents arch it more. Nobody has counted back pain in hikers, so this map rests on lab, modelling and military studies, not on counts. Where and how it hurts is the best clue: an ache across the lower back is usually ordinary back pain, buttock or leg heaviness that eases when you sit or lean forward is the pattern of spinal stenosis, pain down one leg below the knee is sciatica, and an ache across the shoulders is usually the pack straps. A lighter pack packed close to your back, the hip belt done up, a slower pace on climbs and shorter routes usually help, poles make loaded walking easier, and no study shows hiking harms backs.

This guide starts with the signs that need help, from a 999 call for numbness around your genitals or bottom, new bladder or bowel trouble, weakness in both legs or chest pain on a climb, to a same-day check through the National Health Service's 111 line (NHS 111) or a general practitioner (GP) for back pain with a fever, leg weakness that is getting worse or back pain after a fall, and how to call Mountain Rescue. It then maps the causes by where and how it hurts, explains what the studies of packs, hip belts, slopes and poles show, and don't, shows how to change your hikes today, and gives a three-stage plan with a 3D demo of every move, back to the hills with your pack.

3-stage exercise plan When to get help 57 sourcesUpdated 28 October 2026

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Call 999 or go to A&E: loss of feeling or numbness around the genitals or bottom, new trouble peeing or controlling your bladder or bowels, changes in genital sensation during sex or problems with erections or orgasm, or pain, tingling, weakness or numbness in both legs. These are signs of cauda equina syndrome, which needs treating in hospital urgently. Don't drive yourself.
Call 999 or go to A&E: leg pain with numbness around the genitals or bottom, new trouble starting or controlling peeing, not knowing when you need to poo or losing control of it, sciatica in both legs, or weakness or numbness in both legs that is severe or getting worse. These can be signs of cauda equina syndrome, which needs treating in hospital as soon as possible.
Call 999 or go to A&E: back pain with chest pain, or back pain that started after a serious accident, such as a car crash.
Call 999: chest pain that started suddenly, or spreads to your arm, neck or jaw, or your chest feels tight. This could be a heart attack. Do not drive yourself to A&E.
Get help from NHS 111: you're suddenly more short of breath than usual; you have chest pain and you feel sick or are being sick; or you have chest pain and you feel like your heart is racing, going too slowly, skipping a beat or fluttering.
Get help from NHS 111: pain or tightness in your chest, neck, shoulders, jaw or arms that comes and goes, often brought on by exercise, stress, emotion or cold and easing after a few minutes' rest. It can be angina, a sign of a heart problem. If you've been diagnosed with angina, get help from NHS 111 too if it feels worse than before, is happening more often, lasts longer or happens when you're resting.
Someone who faints while exercising, or who has fainted and can't be woken within a minute, has chest pain or a pounding, fluttering or irregular heartbeat, or hasn't fully recovered.
Call 999 or go to A&E if breathing suddenly becomes difficult, if pain in your chest or upper back comes on suddenly with breathlessness or a very fast heartbeat, or if someone passes out. Do not drive yourself. It can be a blood clot that has reached the lungs.
Call 999: sudden, severe pain in the tummy or back, which can come with breathlessness, pale or grey skin, or collapse. It can be a burst abdominal aortic aneurysm, most common in men aged 65 or over and in people who smoke or used to smoke.
Same day (GP or NHS 111): back pain and you feel hot, cold, shivery or generally unwell, or severe pain that starts suddenly or is getting worse quickly.
Ask for an urgent GP appointment or get help from NHS 111 if you think you may have a kidney infection (often pain in your lower back or side, with burning or stinging when you pee or needing to pee more often) and you have a very high temperature or feel hot, cold or shivery, a temperature below 36C, pain in the lower tummy or in the back just under the ribs, blood in your pee, you feel or are sick, you haven't had a pee all day, or you're pregnant. Call 999 or go to A&E if you're confused, drowsy or have difficulty speaking.
Call 999: after a fall, you may have hurt your head, neck, back or hip, or you cannot get up.
Same day (NHS 111): back pain after a new, significant injury in the last 7 days, such as a fall from a height (off a box, a bar or rings) or a direct blow to the back.
Same day: leg weakness that is getting worse; new leg pain with a history of cancer, HIV, TB or inflammatory arthritis; or leg pain with a fever, feeling unwell, loss of appetite, unexplained weight loss or night sweats.
Same day: leg weakness that is getting worse.
Same day (urgent GP appointment or NHS 111): new difficulty lifting the front of your foot or toes (foot drop), or a foot that slaps down or catches as you walk, especially if it is getting worse. Weakness in both legs, or with numbness around the genitals or bottom or bladder or bowel changes, is the 999 emergency above.
Call 999 or go to A&E: a leg that is suddenly cold, pale, numb, weak or very painful. A sudden loss of blood supply to a leg is a vascular emergency.
Contact a GP immediately (or NHS 111 if you can't): burning leg or foot pain that carries on at rest, pale skin, wounds on the feet or legs that do not heal, or toes that go cold, numb, then red or black.
Same day: you have or have had cancer, and new back pain that is severe and doesn't let up, is getting steadily worse, is worse at night and disturbs your sleep, is worse when you cough, sneeze or strain, or comes with tenderness over the spine. Contact your cancer team or GP urgently. With cancer, new weakness, difficulty walking, numbness or bladder or bowel problems are an emergency.
Contact your GP or midwife urgently: back pain in the second or third trimester of pregnancy, or back pain in pregnancy with a fever, vaginal bleeding, pain when you pee, or pain in one or more of your sides (under your ribs). It could be early labour or an infection.
Same day (urgent GP appointment or NHS 111): throbbing pain in one leg (rarely both), usually the calf or thigh; swelling in one leg (rarely both); red, blue or darkened skin around the painful area, which may be harder to see on brown or black skin; or swollen veins. This can be a deep vein thrombosis (DVT). It is more likely after surgery, a hospital stay, 3 or more days in bed, a journey of over 4 hours, pregnancy or a recent birth, cancer, a previous clot, or oestrogen-containing contraception or HRT.
For an injury, illness or someone lost or overdue, dial 999 or 112 and ask for the Police, then Mountain Rescue.

See a doctor or physiotherapist if

Back pain that hasn't improved after a few weeks of looking after it at home, stops you doing day-to-day activities, worries you, or you're struggling to cope.
Pain, tingling or numbness spreading below the knee that isn't settling after a few weeks, is getting worse or stops your normal activities: see a GP.
Pain that is not improving after a few weeks, is getting worse, or is stopping your normal activities.
Leg pain on standing and walking that eases when you sit or bend forward: possible lumbar spinal stenosis, which needs assessing. Exercise is a first-line treatment once it is diagnosed.
Buttock or leg pain, heaviness or tingling that comes on when you stand or walk and only eases when you sit or bend forward, or the distance you can walk keeps shrinking: see a GP or physiotherapist (possible spinal stenosis). Leg weakness that is getting worse, or numbness around your genitals or bottom, is urgent (above).
A change in your ability to walk, including balance problems or weakness or heaviness in your legs: see a GP. If it's new or getting worse quickly, contact your GP practice urgently, or NHS 111 if it's closed.
Leg ache when you walk that goes after a few minutes' rest: possible peripheral arterial disease (narrowed leg arteries), especially if you smoke or have diabetes.
Recurring leg pain when you walk or exercise: see a GP, even if you think it's just your age. The NHS says many people mistakenly think this is part of growing older.
Pain that doesn't improve with rest or is worse at night, or pain that is worse when you sneeze, cough or poo.
Unexplained weight loss, or a lump, swelling or change in the shape of your back.
Pain at the top of the back, between the shoulders, rather than in the lower back.
Sudden new back pain after a minor fall, lift, cough or sneeze, from 50 or past the menopause, or if you take long-term steroid tablets; or height loss, a curved spine or a change in posture: see a GP. It can be a spinal fracture.
Back pain that started before 45 and has lasted more than 3 months, especially if it started before 35, wakes you in the second half of the night, comes with buttock pain, gets better with movement or within 48 hours of anti-inflammatory painkillers, or you have or have had arthritis, pain where a tendon attaches to bone (enthesitis) or psoriasis, or a parent, brother, sister or child with spondyloarthritis. These can point to inflammatory back pain (axial spondyloarthritis, such as ankylosing spondylitis). The National Institute for Health and Care Excellence (NICE) asks GPs to refer people with 4 or more of these 9 features to a rheumatologist, and to do a blood test for the HLA-B27 gene marker if exactly 3 are present, referring if it is positive.
A teenager whose back pain is worse arching back and has lasted more than a couple of weeks: get it checked by a GP or sports physiotherapist. It can be a stress fracture of the spine (spondylolysis).
A strain that is getting worse, or isn't feeling better after looking after it yourself: see a GP or physiotherapist. In many areas you can refer yourself to physiotherapy.
Our suggestion, from the military reviews, which list "rucksack palsy" and nerve injuries among load-carriage injuries: numbness, tingling or weakness in an arm or hand while carrying a pack means taking the pack off, loosening the shoulder straps and using the hip belt. If it hasn't gone by the next day, or you can't grip, see a GP.
An ache across the shoulders or between the shoulder blades that comes only with the pack and goes when it's off is usually the straps. If it carries on without the pack, see a GP (our suggestion): the NHS lists back pain coming from the top of your back, between your shoulders, among its reasons to see one.

Where does it hurt?

Location narrows the likely causes; it does not diagnose.

An ache across the lower back, on one or both sides, that builds through a long day with a pack and eases when you take it off, with no leg symptoms

Ordinary back pain, by far the commonest kind in our reading, though no study counts back pain in hikers. A lighter pack with the hip belt done up, a slower pace on climbs and shorter routes usually help.

Read: Back pain →A sudden catch on one side lifting the pack, climbing a stile or after a slip, sometimes with the muscles locking

Usually a pulled back muscle or a back spasm, which settles over days to weeks.

Read: Back spasm and pulled back muscle →Worse on long descents, standing still or arching back, easing when you lean forward on poles, from mid-life

A back that dislikes arching, often labelled facet joint pain. The lower back arches more going downhill. No test can confirm the facet joints as the source, and it is managed like other back pain.

Read: Back pain bending backwards →Buttocks and legs aching, heavy or tingling as you walk, eased by sitting or leaning forward, usually from 50

The pattern of lumbar spinal stenosis. That it is often easier uphill than on the flat or downhill is our reading of small lab and treadmill studies, not a hiking study.

Read: Lumbar spinal stenosis →Pain down one leg below the knee, with tingling, numbness or weakness

Sciatica, from a nerve in the back; the leg often hurts more than the back.

Read: Sciatica →Low on one side, by the dimple at the back of the pelvis, sometimes into the buttock

Possibly the sacroiliac (SI) joint.

Read: SI joint pain →A deep ache in the groin, buttock or front of the hip on climbs, or a burning patch on the outer thigh under the hip belt

The hip or a squeezed skin nerve rather than the back. Our hip pain when hiking guide covers both.

Read: Hip pain when hiking →An ache in the calf, thigh or buttock after a set distance that goes within a few minutes of standing still

Possibly narrowed leg arteries, more likely if you smoke or have diabetes: see a GP.

Read: Calf pain when walking →Across the shoulders, the top of the shoulders or between the shoulder blades, building through the day with a pack

Usually the pack straps and the muscles holding the shoulders. Numbness or weakness in an arm under the straps needs the pack off and the straps loosened. Pain between the shoulders that carries on without the pack needs a GP.

Read: Upper back pain →A dull ache across both sides of the back the day after a big day out, easing day by day

Usually muscle soreness, which fades within about a week.

Read: Back pain after a workout →The back when you walk on the flat or climb stairs, or the knee or feet on the hill

Our back pain when walking and on stairs guides, and our knee and foot pain when hiking guides, cover each.

Read: Back pain when walking →The shin on long days, descents or with a pack

Our shin pain when hiking guide covers shin splints, a stress fracture, descents, the pack and laces, and a plan back to the hills.

Read: Shin pain when hiking →

Back pain after a fall on the hill

An injury, not overuse: see the warning signs at the top of this page.

Understand it

What nobody has countedEmerging evidence

No study counts back pain in hikers. On the Appalachian Trail, 36% of 280 long-distance hikers reported sudden joint pain and 64% blisters; in a later survey of 1,295, 61% reported muscle, joint or bone complaints and 11% stopped their hike because of them. Neither gives a share for the back. On the John Muir Trail, pack strap pain was the third commonest complaint, in 46% of 771 backpackers.

The nearest count of back trouble comes from soldiers, not hikers: after one hard 20 km march carrying 46 kg, 24% of 335 soldiers were injured, and back problems made up 23% of the injuries. Military reviews call lower back injuries from load carriage not uncommon. Soldiers carry far more than most hikers, for longer, so this page's map is built from those studies, lab and modelling studies of packs and slopes, studies of the conditions, and NHS, NHS inform and NICE pages, and it says so.

Sources 1, 2, 3, 4, 5, 6

What a pack does to the backEmerging evidence

To balance a pack you lean forward. Across 54 studies, carrying a backpack increased trunk lean; in 20 soldiers the trunk bent further forward as the load rose from 8 to 50 kg, with the head pushed forward too; and in infantry soldiers the trunk leaned forward 10 degrees or more with packs of 10.7 to 17.5 kg. In 15 experienced women hikers walking 8 km, a pack of 20% of body weight already changed their trunk posture and raised shoulder discomfort, and the longer they walked, the more their shoulders, neck and upper back ached.

Inside the back, a computer model of 6 Marines carrying 38 kg found higher forces through the lowest lumbar joint with a pack than without, similar whether the load hung from the shoulders or the hip belt. In 6 adults scanned upright, a pack of 10% of body weight squashed the two lowest discs, though it didn't change the overall curve. The back muscles work less than you might expect: a review says their activity is lower with a pack than without until loads pass 30 to 40 kg. None of these studies measured back pain.

Sources 7, 8, 9, 10, 11, 12, 13

How the load is carried: the hip belt and packingEmerging evidence

In 12 Marines scanned upright, an evenly spread load didn't change the shape of the lower back, but with 80% of it at the back, the base of the lower back bent forward more. A hip belt shares the load: in one lab study of 11 men carrying up to 40.8 kg, about 30% of the vertical force went through the belt to the pelvis and the shoulders carried the rest, and the pack pushed forward on the lower back at every step. In a computer model of walking on slopes with a heavy pack, the belt lowered the load on the lower back only on the way down. That one lab study and one model are the whole evidence for the belt's share.

Discomfort follows pressure, and the authors of a pack fitting study found the hips tolerate pressure better than the shoulders. Military reviews say a load close to the body keeps you nearer upright, and that hip belts take pressure off the shoulders and add comfort. So a well-packed bag with the belt done up spreads the load; it doesn't remove it.

Sources 14, 15, 16, 6, 17

Uphill and downhillEmerging evidence

In 8 healthy adults on a treadmill, steeper climbs tipped the pelvis and trunk progressively forward, and descents tipped them back. In 20 healthy women walking on 5 degree slopes, the lower back sat 3 to 4 degrees more arched going down and less arched going up, and it moved through a bigger range downhill; the authors suggested that people for whom arching is a problem avoid long downhill walking, and that level or uphill may be easier.

With a heavy pack, a model of walking on 10 degree slopes with 40% of body weight on the back found the largest forces in the lower back walking uphill with the load on the shoulders, about 1.6 times body weight of shear and 5.2 times of compression, and the authors concluded that walking uphill with heavy loads may raise the risk of overuse injury. That is one modelling study, with no pain measured. Our reading: a long climb with a heavy pack is the hardest work for the back, and long descents arch it more, which matters most if arching is what hurts.

Sources 18, 19, 17

How the causes are told apartEmerging evidence

An ache across the lower back that builds through a long day with a pack and eases when you take it off, with no leg symptoms, is ordinary back pain; NHS inform lists doing more activity than you normally would among the things that bring it on. Pain that is worse on long descents, standing still or arching back, easing when you lean forward, from mid-life, is often labelled facet joint pain, but the label can't be confirmed: in 176 people only 15% responded to a confirming facet injection, no examination test for the facet joints was informative in a review, and facet arthritis on CT scans had no link with back pain in a community study.

Buttock or leg ache, heaviness or tingling that comes on with walking or standing and eases when you sit or lean forward, usually from 50, is the pattern of lumbar spinal stenosis: a review describes pain provoked by arching and relieved by bending forward, and puts it at about 11% of US adults. In a treadmill test of 45 people, those with stenosis walked longer on a slope than on the flat. That climbs suit it better than descents or long flat stretches is our reading, extrapolated from that test and the lab study above, not from a hiking study.

Pain down one leg below the knee with tingling, numbness or weakness is sciatica, which the NHS says usually gets better in a few weeks to a few months. A calf, thigh or buttock ache after a set distance that goes within a few minutes of standing still can be narrowed arteries. An ache across the shoulders or between the shoulder blades that builds through the day is usually the pack straps, and numbness, tingling or weakness in an arm under the straps can be the straps squeezing the nerves to the arm, which a review of soldiers calls rucksack palsy. Chest pain or tightness on a climb that eases with rest is not the back: see the warning signs.

Sources 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33

When a scan helps, and how it usually goesStrong evidence

Not usually. The National Institute for Health and Care Excellence (NICE) says don't routinely offer imaging for low back pain outside specialist care. In scans of 3,110 people without back pain, disc degeneration rose from 37% at 20 to 96% at 80. Stenosis is confirmed with a scan only when treatment depends on it, and the warning signs decide who needs tests.

Across 33 groups of 11,166 people, new back pain fell from 52 to 23 out of 100 by 6 weeks and to 6 by a year; NHS inform says new back problems should begin to settle within 6 weeks. With stenosis followed for up to 3 years without surgery, about a third improved and about half stayed the same. Back pain often comes back, which is why keeping walking going, as in the trial that delayed the next bout, is worth it. No one can promise a date.

Sources 34, 35, 24, 36, 20, 37

What helps, and how strong the evidence is

Changing how you hike: sensible, but untested against back painEmerging evidence

No trial has tested pack weight, the hip belt, packing, poles, pace or route against back pain in hikers. The written steps below are our reading of the lab and modelling studies: forward lean and modelled lower back forces rise with the load; a pack of 20% of body weight already changed posture in women hikers, and the researchers suggested no more than 30% for long walks, a ceiling rather than a target; the belt carried about 30% of the vertical force in one lab study of 11 men; an even load kept the lower back's shape in Marines; a load close to the body keeps you nearer upright; the hardest modelled load was uphill with a heavy pack on the shoulders; and descents arch the lower back more.

Sources 7, 11, 10, 38, 15, 16, 14, 6, 17, 19

Does pack weight cause injuries? The evidence is mixedMixed evidence

A heavier pack for your body weight went with injury in 1,206 mostly teenage trekkers on 12-day treks, but pack weight didn't predict injury in 1,201 people on outdoor leadership courses. In 128 long-distance hikers, a heavier pack went with tingling and numbness but not with long-lasting pain, and a heavier base pack went with illness or injury on the John Muir Trail. No trial sets a safe weight, so lighter is better.

Sources 39, 40, 41, 3

Poles help you walk with a pack, but aren't a cureEmerging evidence

On an uphill treadmill with a 22.4 kg pack (30% of body mass), poles made walking more like walking without a pack, and the climb felt easier, though heart rate was a little higher. Downhill with packs of 15% and 30% of body weight, poles lowered the turning forces at the ankle, knee and hip. A review concludes that poles lower the load on the legs but raise the work for the heart, and may help balance with a heavy pack. None of these measured the back.

For back pain itself, in a trial of 136 people with long-lasting back or leg pain, 8 weeks of supervised Nordic walking twice a week did a little better on average than unsupervised Nordic walking or advice to stay active, but the differences weren't statistically significant, and no side effects were reported. In 20 adults with long-lasting back pain, a short walk with poles was no more comfortable than without. A UK mountaineering body says poles help keep you more upright and can ease some back pain. So use poles because they help you walk with a pack, not as a cure.

Sources 42, 43, 44, 45, 46, 47

Exercise is the treatment for back painStrong evidence

A Cochrane review of 249 trials found exercise reduced long-lasting low back pain against no treatment, usual care or placebo by about 15 points out of 100, a clinically important difference, on moderate-certainty evidence. NICE asks for advice that encourages people to carry on with normal activities, and says consider a group exercise programme for a flare.

Sources 48, 34

Walking, and so hiking, helpsStrong evidence

Across 5 trials, walking did as well as other exercise in long-lasting low back pain. Across 19 trials of 2,362 people, walking or running helped a little more than minimal or no treatment, on high-certainty evidence for short-term disability, but less than other active treatments. In 701 adults who had recovered from back pain, a progressive walking and education programme delayed the next bout (a median of 208 days against 112). No trial has tested hiking for back pain, but walking on paths is walking.

Sources 49, 50, 37

Spinal stenosis: keep walking, with breaksEmerging evidence

First-line care for stenosis is adjusting activity, pain relief and physiotherapy, a review says, and NHS inform says it is safe to keep walking while symptoms remain manageable, with regular breaks if leaning forward helps. Across 13 trials of 1,440 people, successful exercise programmes more often included stretches, strength or trunk exercises and fitness exercises, especially cycling. Poles that let you lean slightly forward, and routes with more climbing than descent, fit the pattern in our reading; no study has tested hiking with stenosis.

Sources 24, 25, 51, 26, 19

Belts and braces, and where popular advice overstates itStrong evidence

NICE says don't offer belts or corsets for low back pain, with or without sciatica; a back brace is not the same as a pack's hip belt, which carries load rather than holding the spine. Reviews found no consensus that posture causes back pain, and people with back pain have the same lower back curve as people without, so a weak core or bad posture under the pack isn't a proven cause. Hip flexor range wasn't linked with back pain once body size was taken into account, so stretching tight hip flexors after climbs isn't a fix. No trial sets a safe pack weight; the 30% ceiling comes from one study of 15 women. Poles make loaded walking more like unloaded walking, but they didn't beat advice to stay active in back pain.

Sources 34, 52, 53, 54, 10, 42, 45

How much pain is OK while you exercise?

Up to about 5 out of 10, settled within an hour, never into a legEmerging evidence

This guide uses the back hub's rule, as our other back movement guides do. Some discomfort during exercise is fine, and it does not mean you are doing damage. Aim for pain you would call mild to moderate, no more than about 5 out of 10. It should settle within an hour or so, and your back should be no worse the next morning. If it is worse, do less next time (fewer reps, a smaller range, a lighter load), not nothing.

Leg symptoms are the exception: stop or shrink any movement that sends pain, pins and needles or numbness further down your leg. If leg symptoms move back towards your spine, that is a good sign, even if your back aches a little more for a while.

If pain climbs day after day, or you notice any warning sign, stop and get it checked. The 5 out of 10 figure matches this site's other pain guides and has not been tested in a back pain trial; in trials of long-lasting muscle and joint pain, exercise that allowed some pain did no harm.

With the stenosis pattern, our spinal stenosis guide's walking rule applies on the hill: Walking is safe if the symptoms are acceptable, says an NHS spinal service. Walk until leg symptoms start to build, then sit or bend forward until they ease, and go again. Track your walking time and distance: that is the measure that should improve.

Calf, thigh or buttock ache that goes when you stand still isn't this rule: get it checked by a GP. Once narrowed arteries are diagnosed, the walking programme deliberately walks into the pain, as our calf pain when walking guide explains.

Chest discomfort that comes on with effort, such as brisk walking or stairs, and eases within a few minutes of rest, or feels tight, squeezing or heavy, or comes with breathlessness, sweating or feeling sick, is not a pain-rule question: that is how angina and heart attacks behave. Stop, and follow the warning signs.

On the hill (our suggestion, built on the same rule): judge each walk by the last hour, by that evening and by the next morning. Choose the distance, climb, descent, pace and pack where your back stays at 5 out of 10 or less, settles within an hour of taking the pack off and is no worse the next morning, aiming for 0 to 3. NHS inform's back exercises use the same limit, and in 7 trials of long-lasting pain, exercise that allowed some pain did no worse than pain-free exercise. Pain that builds steadily through the day is the signal to take a rest with the pack off, loosen and reset it, and go shorter or lighter next time, not to stop hiking. Change one thing at a time: distance first, then climb and descent, then the pack. If a walk breaks the rule, go back to the last walk that was fine, not to none. An arm going numb or weak under the straps, or chest pain or breathlessness on a climb, is never a pain-rule question: see the warning signs.

Sources 55, 56, 25, 24

The exercise plan: 3 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

Settle: short, flat walks, a light pack, and the gentle back moves

About weeks 0 to 2: walking most days, the back moves daily or every other day. Keep walking within the pain rule with the written changes below (short, flat routes, a light pack or none, the hip belt done up, poles), and start the gentle back exercises from NHS inform and our back pain guides. With the stenosis pattern, walk in intervals with the bending-forward rests; with calf, thigh or buttock ache that goes when you stand still, see a GP first. With a diagnosed condition (sciatica or a disc, spinal stenosis, a spinal fracture, pregnancy), that guide's plan, or your team's, comes first.

Treadmill walking demonstrated on the 3D figure

3D demoTreadmill walkingBeginner · Cardio machine

5 to 10 minutes, several times a day, on the flat; with the stenosis pattern, in intervals · As in our back pain and back pain when walking guides (editorial); walking on flat paths outdoors counts the same. The move page gives no dose

Harder: Treadmill jogging

3D demoCat-cowBeginner · No equipment

8 waves, slower than feels natural · The move page's dose. NHS inform's back exercises include the same curl and uncurl on your hands and knees

Harder: Half lord of the fishes (Ardha Matsyendrasana)

Pelvic tilt into bridge demonstrated on the 3D figure

3D demoPelvic tilt into bridgeBeginner · No equipment

The tilt first, holding 2 seconds: 2 to 3 at a time, building to sets of 8 · NHS inform's pelvic tilt, with its pacing, as our elliptical and treadmill back guides use it

Harder: Glute bridge

Single knee-to-chest stretch demonstrated on the 3D figure

3D demoSingle knee-to-chest stretchBeginner · No equipment

Hold 20 to 30 seconds, 2 to 4 times each side · The move page's dose (an editorial starting point). Keep it only if it eases you, and leave it out if bending forward sends pain down a leg, as the move page says

Harder: 90/90 hip lift-off

Double knee-to-chest stretch demonstrated on the 3D figure

3D demoDouble knee-to-chest stretchBeginner · No equipment

Hold 20 to 30 seconds, 2 to 4 times · The move page's dose (an editorial starting point): the bending-forward rest for the stenosis pattern, as our back pain when walking guide uses it. With osteoporosis, avoid deep or repeated rounding, as the move page says

Easier: Single knee-to-chest stretch · Harder: Overhead lat stretch at a bench (elbows on the bench)

Lying sciatic nerve slider (nerve glide) demonstrated on the 3D figure

3D demoLying sciatic nerve slider (nerve glide)Beginner · No equipment

10 repetitions with a 1-second pause, 2 to 3 times a day · The move page's dose, which an NHS musculoskeletal service uses. Only with pain down a leg: try it for two weeks and keep it only if it eases your leg, as the move page says

Harder: Seated sciatic nerve slider (nerve glide)

Move on when: 20 to 30 minutes of walking on the flat passes the pain rule, with poles and a light pack if you use them, and your back is no worse the next morning, for about a week (editorial, as in our back pain when walking guide).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Build: trunk and hip strength, longer walks and gentle hills

About weeks 2 to 6: strength 2 or 3 days a week, walking most days. The trunk and hip strength that lets you carry a pack upright as you tire, the step that every climb repeats, and walks that lengthen with gentle climbs and short descents.

Glute bridge demonstrated on the 3D figure

3D demoGlute bridgeBeginner · No equipment

2 to 3 sets of 10 · As in our back pain guide (editorial); the move page gives no dose

Easier: Pelvic tilt into bridge · Harder: Single-leg glute bridge

Bird dog, one limb at a time demonstrated on the 3D figure

3D demoBird dog, one limb at a timeBeginner · No equipment

2 to 3 sets of 6 to 8 each side, 3 to 5 second holds · As in our back pain guide (editorial)

Easier: Side-lying tummy draw-in · Harder: Bird dog

Knee side plank demonstrated on the 3D figure

3D demoKnee side plankBeginner · No equipment

3 holds of 15 to 20 seconds each side · As in our back pain guide (editorial)

Harder: Side plank

3D demoStep-upBeginner · A step

3 sets of 8 each side, from a low step · As in our back pain guide (editorial): the climb in miniature. Hold a rail while you're learning, as the move page says

Easier: Low step-up · Harder: Dumbbell step-up

Half-kneeling hip flexor stretch demonstrated on the 3D figure

3D demoHalf-kneeling hip flexor stretchBeginner · No equipment

2 to 3 holds of 20 to 30 seconds each side, pelvis tucked, back not arched · NHS inform's stretch holds; the tucked pelvis is our spinal stenosis guide's cue. For comfort at the front of the hip after climbs, not because tight hip flexors cause back pain. Pad the kneeling knee, as the move page says

Harder: Couch stretch

Trail running and walking demonstrated on the 3D figure

3D demoTrail running and walkingBeginner · No equipment

20 to 30 minutes of brisk walking on paths and gentle slopes, with poles and a light pack · Adapted from the move page's dose (its brisk walking part); its short runs wait, and the slopes, poles and pack are our suggestion, as in our hip pain when hiking guide. Its caution says consider walking poles

Harder: Treadmill running

Move on when: An hour's walk with gentle climbs and a light pack leaves your back no worse the next morning, and the strength moves are controlled (editorial).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Back to the hills: the pack, descents and long days

From about week 6, strength twice a week, then ongoing: the hinge, carry and single-leg strength that a loaded pack and rough ground need, and your hikes coming back by the written steps below, with the full pack, the longest descents and back-to-back days last. No study has tested a return to hiking after back pain, so the order is editorial, as in our knee and hip pain when hiking guides.

Hip-hinge practice demonstrated on the 3D figure

3D demoHip-hinge practiceBeginner · No equipment

2 to 3 sets of 10 · As in our back pain guide (editorial): lifting the pack from the ground

Harder: Kettlebell deadlift

Suitcase carry demonstrated on the 3D figure

3D demoSuitcase carryIntermediate · A dumbbell + A kettlebell

3 walks of 20 to 30 metres each side · As in our back pain guide (editorial): carrying upright under an uneven load. If you cannot stay level, the weight is too heavy, as the move page says

Easier: Farmer's carry · Harder: Overhead carry (waiter's walk)

Side plank demonstrated on the 3D figure

3D demoSide plankIntermediate · No equipment

3 holds of 20 to 30 seconds each side · As in our back pain guide (editorial)

Easier: Knee side plank · Harder: Side plank with leg lift

Single-leg Romanian deadlift demonstrated on the 3D figure

3D demoSingle-leg Romanian deadliftAdvanced · A dumbbell

2 sets of 8 each leg, fingertips on a wall at first · As in our knee and hip pain when hiking guides (our hiking training workout's dose, editorial)

Easier: Dumbbell Romanian deadlift

Rucking (loaded walking) demonstrated on the 3D figure

3D demoRucking (loaded walking)Intermediate · Something with weight

20 to 45 minutes with a pack at about 10% of your body weight, adding load or time in small steps, never both at once, staying under about 30% · As in our knee and hip pain when hiking guides (our hill and stair workout's dose, editorial); 30% is the ceiling one study suggested for women hikers. The move page gives no dose

Easier: Treadmill walking · Harder: Sprint intervals

3D demoTrail running and walkingBeginner · No equipment

Your usual hikes, building distance, then climbs and descents, then the pack, one at a time · Editorial, by the written steps below; the move page's starting point is brisk walking with short runs

Harder: Treadmill running

Move on when: Your usual hikes, with your usual pack and descents, pass the pain rule for 2 weeks. Keep two strength days a week, and if a hike flares your back, go back to the last walk that was fine, not to none (editorial).

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

Your hike for now (written steps)

Our 3D figure can't show the pack, the hip belt, poles, pace or the route. These steps come from lab, modelling and military studies, a UK mountaineering body's technique page, NHS pages and our hiking guides; where a step is our suggestion or our reading, it says so. None has been tested against back pain in hikers. Keep what passes the pain rule.

1. Route: shorter, flatter routes and shorter days for now; split a long walk into two (our suggestion, as in our knee and hip pain when hiking guides). With a back that dislikes arching or the stenosis pattern, choose gentle climbs and short descents, since the lower back arches more going down; that this helps is our reading of small lab and treadmill studies.
2. The pack: as light as you can, a day pack rather than a big one where possible. A pack of 20% of body weight already changed posture in women hikers; our rucking guide suggests starting at about 10% of your body weight and staying under about 30% (editorial).
3. Packing: heavy things close to your back, not hanging off the outside, with the load spread evenly so it stays still as you walk. A load close to the body keeps you nearer upright, and an even load kept the lower back's shape in Marines. A military review suggests a higher load for even paths and a low or mid-back load for rough ground.
4. The hip belt: fasten it snugly on the bony rim of the pelvis so the hips take part of the weight, then snug the shoulder straps without them carrying it all. In one lab study of 11 men the belt carried about 30% of the vertical force, and in one computer model it eased the lower back on descents, so keep it done up going down. Loosen or move it if the outer thigh burns or goes numb, as our hip pain when hiking guide says.
5. Poles: two poles, set so your elbow is bent at about 90 degrees on the flat; on steep steps down, put your hands on top of the handles, place the poles below the step, put some weight on them and step down lightly, as the British Mountaineering Council teaches. They make loaded walking more like unloaded walking; with the stenosis pattern they also let you lean slightly forward (our suggestion).
6. Pace: slow down on climbs, where a heavy pack loads the back most in a model; a pace where you can talk but not sing is moderate (our suggestion).
7. Posture: lean forward from the ankles and hips as the pack needs, but don't hunch or crane your head forward; if you are bent over the straps, the pack is too heavy for now (our reading of soldier studies).
8. Rests: take the pack off at each stop, before the back gets sore, not after; with the stenosis pattern, sit or lean forward until the legs ease, as NHS inform suggests for walking breaks.
9. The straps: if an arm or hand tingles, goes numb or feels weak under the pack, take it off, loosen the shoulder straps and use the hip belt; a review of soldiers names the hip belt and padded, well-adjusted straps as the prevention.
10. Lifting the pack: from a bent-knee or hinged position, onto a raised surface or your thigh first, then one arm at a time (our suggestion).
11. Before a big trip: train first, since hikers who didn't train beforehand reported nearly three times the odds of complaints in a survey, and carry the pack you'll use on training walks in the last few weeks.
12. Getting there and sleeping: on long drives, flights or train journeys, get up and move about every hour or so; in a tent, a thicker mat and a rolled jacket under the knees can ease a sore back overnight (our suggestion).
13. The rest of the time: keep active. The NHS says activities like walking, swimming, yoga and pilates may help ease back pain and not to stay in bed for long periods, and NICE asks for encouragement to carry on with normal activities.
14. Safety: carry a phone, tell someone your route, and in an emergency dial 999 or 112 and ask for the Police, then Mountain Rescue.

Sources 19, 26, 10, 6, 14, 15, 16, 17, 47, 42, 8, 9, 25, 31, 2, 32, 34

How hikes come back (written steps)

No study has tested how hiking comes back after back pain, so these steps are our suggestion, following our knee and hip pain when hiking guides' order.

1. Distance on the flat, with poles and no pack or a light one.
2. Gentle climbs at a slow, steady pace.
3. Gentle descents, then longer climbs and descents.
4. Rough ground and stiles.
5. The pack, starting at about 10% of your body weight and adding weight or distance, never both at once, as our rucking and hiking guides say.
6. Back-to-back long days last, as our hike training guide suggests before a multi-day trip. If a hike flares your back, go back a step, not to none.

Positions to swap, and why

Habit or position	Why it matters	Instead
A heavy pack on the first walks back	Forward lean and modelled lower back forces rise with the load.	A light pack, building up in small steps.
The hip belt loose or unfastened, all the weight on the shoulders	The belt carries part of the load, and the hips tolerate pressure better than the shoulders; in one model it mattered most downhill.	Fasten the belt on the rim of the pelvis, then snug the straps.
Heavy things packed low, far back or hanging off the outside	An uneven load bent the base of the lower back forward in Marines.	Heavy things close to your back, the load even and still.
A long, steep climb at your usual pace with a heavy pack	The hardest modelled load on the lower back was uphill with the pack on the shoulders.	A slower pace, poles and rests, with step-ups at home.Try: Step-up
Long descents while arching hurts, or with the stenosis pattern	The lower back arches more going downhill.	Routes with gentle descents, poles, and leaning forward on them at rests.
Pushing on through leg tingling or numbness that spreads	Leg symptoms that spread down the leg are the exception to the pain rule.	Stop, take the pack off, and shorten the walk.
Walking on with an arm going numb or weak under the straps	The straps can squeeze the nerves to the arm.	Take the pack off, loosen the straps and use the hip belt.
Stretching the hip flexors hard to fix the back	Hip flexor range wasn't linked with back pain once body size was taken into account.	Trunk and hip strength first, with a mild stretch for comfort only.Try: Knee side plank
Resting in bed until it stops hurting	NICE and the NHS say keep active, and most new back pain improves markedly within about 6 weeks.	Short, flat walks, little and often.Try: Treadmill walking
A back brace or corset for the trail	NICE says don't offer belts or corsets for low back pain.	Trunk and hip strength.Try: Knee side plank
A big trip with no training or no practice with the pack	Hikers who didn't train beforehand had more complaints in a survey.	Loaded walks before you go.Try: Rucking (loaded walking)
Pushing on through chest pain, chest tightness or breathlessness on a climb	That is a heart or lung warning sign, not the back.	Stop, and act on the warning signs at the top of this page.

Routines to follow

Hiking training workout

A 35-minute strength workout for hikers: step-ups, lunges and calf raises for climbs, slow step-downs for descents, single-leg hinges, carries and balance.

35 minBeginner13 movesA wall, A step

Hill and stair conditioning

Stair or hill climbs with the walk down as recovery, then a loaded walk with your rucksack, building towards the hills, pack and days of your trip.

40 minBeginner5 movesA step, Something with weight

Loaded carry workout: farmer's, suitcase and overhead carries

A 25-minute carry workout with dumbbells or kettlebells: farmer's carries, suitcase carries on each side and an overhead carry, with a safe pick-up first.

25 minBeginner7 movesA kettlebell, A dumbbell

Lower back strengthening workout: bird dogs to supermans, no equipment

A 20-minute floor workout for your back muscles: bird dogs and bridges, then a face-down ladder from the locust to the superman, with side planks and dead bugs.

20 minBeginner13 movesNo equipment

Beginner core workout

A 15-minute beginner core workout on the floor: dead bugs, bird dogs, knee planks, side planks and curl-ups.

15 minBeginner6 movesNo equipment

Lower back stretch routine

Seven gentle stretches and mobility moves for a stiff lower back, done lying and kneeling.

12 minBeginner7 movesA wall

Trail yoga: a 25-minute class for after a hike or a rest day, with a 10-minute standing version

A 25-minute yoga class for hikers: a 10-minute standing stretch for after a hike, then balance, legs and floor blocks for rest days.

25 minBeginner16 movesA wall

More moves for this area

Questions people ask

Why does my lower back hurt when I hike?

Usually ordinary back pain meeting a longer day, a heavier pack or more climbing than your back is used to. A pack makes you lean forward, and heavy loads on long climbs work the back hardest. A lighter pack with the hip belt done up, poles, a slower pace and shorter routes usually help.

Why does my back hurt after hiking?

An ache that comes on that evening or the next morning is usually tired back and hip muscles after a bigger day than usual. It should settle within a day or so and get easier on the next walks; if it's worse the next morning, go shorter or lighter next time. Pain down a leg, or numbness or weakness, isn't ordinary soreness: see the warning signs.

Why does my lower back hurt hiking uphill?

Climbing tips your trunk forward, and in a computer model a heavy pack loaded the lower back most on the way up. Slow down, use poles, lighten the pack and take it off at rests. If uphill is actually easier than the flat, and your legs ache or tingle as you walk, that can be the stenosis pattern.

Why does my lower back hurt going downhill?

Going down, your lower back arches more and moves more, which a back that dislikes arching or spinal stenosis can notice. Keep the hip belt done up, use poles below the step on steep ground, take shorter descents for now, and lean forward on your poles at rests.

Can my backpack cause lower back pain?

It can add to it: a pack makes you lean forward, and a heavy one raises the load on the lower back. Pack it light, keep heavy things close to your back, and do up the hip belt. No study sets a safe weight; our rucking guide suggests starting at about 10% of your body weight.

Does a hip belt help my back?

It helps share the load: in one lab study of 11 men about 30% of the vertical force went through the belt, and the hips tolerate pressure better than the shoulders. In one computer model it lowered the load on the lower back on descents. Fasten it on the bony rim of the pelvis, then snug the shoulder straps.

Do trekking poles help back pain?

They make walking with a heavy pack more like walking without one, and they're safe with back pain. But in a trial of 136 people with long-lasting back pain, Nordic walking was no better than advice to stay active, so use them because they help you walk, not as a cure.

Is hiking good for lower back pain?

Usually yes, if it passes the pain rule. Walking helps long-lasting back pain about as much as other exercise, and a walking programme delayed the next bout of back pain in a large trial. Start with short, flat walks and a light pack, and build up one thing at a time.

Can I hike with sciatica or a herniated disc?

Often yes, if it doesn't send pain, tingling or numbness further down your leg, which is the exception to the pain rule. Start with short, flat walks without a heavy pack, and stop or shorten anything that spreads the leg symptoms. Weakness that is getting worse, or numbness around your genitals or bottom, needs help straight away.

Is hiking OK with spinal stenosis?

Often, with the right route: NHS inform says it's safe to keep walking while symptoms remain manageable. In a treadmill test, people with stenosis walked further on a slope than on the flat, so gentle climbs and short descents may suit you better, though that is our reading rather than a hiking study. Lean forward on poles, and sit until your legs ease before going on.

Do I need a scan?

Usually not: NICE advises against routine scans for back pain, and disc changes are common in people without pain. The warning signs decide who needs one.

When should I see a doctor?

Call 999 for numbness around your genitals or bottom, new bladder or bowel trouble, weakness in both legs, or chest pain on a climb; on the hill, dial 999 or 112 and ask for the Police, then Mountain Rescue. Get help the same day for back pain with a fever or feeling unwell, leg weakness that is getting worse, or back pain after a fall, and see a GP for back pain that isn't better after a few weeks, leg pain on walking, pain between the shoulder blades or unexplained weight loss. In the US, call 911 where this page says 999.

Related exercise guides

Sources

Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.

When to get help first

Get urgent medical help if

See a doctor or physiotherapist if

Where does it hurt?

Understand it

What nobody has countedEmerging evidence

What a pack does to the backEmerging evidence

How the load is carried: the hip belt and packingEmerging evidence

Uphill and downhillEmerging evidence

How the causes are told apartEmerging evidence

When a scan helps, and how it usually goesStrong evidence

What helps, and how strong the evidence is

Changing how you hike: sensible, but untested against back painEmerging evidence

Does pack weight cause injuries? The evidence is mixedMixed evidence

Poles help you walk with a pack, but aren't a cureEmerging evidence

Exercise is the treatment for back painStrong evidence

Walking, and so hiking, helpsStrong evidence

Spinal stenosis: keep walking, with breaksEmerging evidence

Belts and braces, and where popular advice overstates itStrong evidence

How much pain is OK while you exercise?

Up to about 5 out of 10, settled within an hour, never into a legEmerging evidence

The exercise plan: 3 stages

Settle: short, flat walks, a light pack, and the gentle back moves

Build: trunk and hip strength, longer walks and gentle hills

Back to the hills: the pack, descents and long days

What to change for now

Your hike for now (written steps)

How hikes come back (written steps)

Positions to swap, and why

Routines to follow

Hiking training workout

Hill and stair conditioning

Loaded carry workout: farmer's, suitcase and overhead carries

Lower back strengthening workout: bird dogs to supermans, no equipment

Beginner core workout

Lower back stretch routine

Trail yoga: a 25-minute class for after a hike or a rest day, with a 10-minute standing version

More moves for this area

Questions people ask

Related exercise guides

Other pain guides

Sources