Lower Back Pain From Sitting: Causes, Chairs and Exercises

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: back pain with chest pain, or back pain that started after a serious accident, such as a car crash.
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.
Call 999 or go to A&E: pain spreading from the tummy to the back, with vomiting.
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.
Same day (GP or NHS 111): pain in the lower back or side with a high temperature, burning or stinging when you pee, or needing to pee more often. It can be a kidney infection.
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.
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.
Same day (GP or NHS 111): back pain in the second or third trimester of pregnancy, or back pain in pregnancy with a fever, vaginal bleeding or pain when you pee. It could be early labour or an infection.

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, or worries you.
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.
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.
Back pain that started before 45 and has lasted more than 3 months, especially if it wakes you in the second half of the night, comes with buttock pain, eases with movement or within 48 hours of anti-inflammatories, or you have psoriasis or a parent, sibling 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) refers people with four or more of these features to a rheumatologist.
Unexplained back pain with muscle spasms, loss of height, or a curved spine or change in posture: a possible osteoporotic spinal fracture, more likely with older age or long-term steroid tablets.
Pain right at the base of your spine that is worse sitting, leaning back or standing up, and hasn't improved after a few weeks of a coccyx cushion and shorter spells of sitting: see a GP or physiotherapist. Our tailbone pain guide has the full list.
Sitting keeps getting harder week after week despite breaks, changes to your chair and the plan: our suggestion is to see a GP or physiotherapist. In many areas you can refer yourself to NHS physiotherapy.

Where does it hurt?

Location narrows the likely causes; it does not diagnose.

The low back, across or to one side, building through a long sit

Easing when you stand up and move: ordinary low back pain that a long, still spell brings on. This guide covers it, and our back pain guide goes further.

Read: Back pain →Low back pain worse sitting slumped or bending forward, easing when you stand or arch back

Sometimes into the buttock or leg. Often called disc-type pain: favour the direction that eases it for now. Our herniated disc guide explains what a scan report about discs does and doesn't mean.

Read: Herniated or bulging disc →Pain, tingling or numbness down one leg below the knee, often worse sitting

And worse when you cough or sneeze: sciatica, often from a disc.

Read: Sciatica →Low back pain that eases when you sit or bend forward, and builds when you stand or walk

Often into the buttocks and legs, usually from 50: the pattern of spinal stenosis, the opposite of sitting pain.

Read: Lumbar spinal stenosis →Right at the base of the spine, worse sitting, leaning back or getting up

Often after a fall, childbirth or long spells of sitting: tailbone (coccyx) pain.

Read: Tailbone pain →A deep ache low in the buttock, at the sitting bone

Worse sitting on hard seats and running uphill: high hamstring tendon pain.

Read: High hamstring tendinopathy →Low on one side, by the dimple at the back of the pelvis

Worse standing on one leg, on stairs or turning in bed: possibly the sacroiliac (SI) joint.

Read: SI joint pain →The groin or buttock, stiff after sitting, from mid-life

Socks and getting out of a car are hard: possibly the hip joint.

Read: Hip arthritis →Low back pain worse arching back or twisting, from mid-life

Often labelled facet joint pain, and managed like other back pain.

Read: Facet joint pain →Buttock pain worse sitting, sometimes into the thigh, without back pain

Often blamed on the piriformis muscle, though buttock pain can also come from the back, the hip or a tendon.

Read: Piriformis syndrome and buttock pain →Back pain for more than 3 months, with good and bad days

Long-lasting (chronic) back pain.

Read: Chronic low back pain →The neck and tops of the shoulders after a day at a screen

Desk neck.

Read: Tech neck →Between the shoulder blades after long sits

Upper back pain. The NHS asks for a GP check for pain between the shoulders.

Read: Upper and mid back pain →The back of the pelvis or the pubic bone, in pregnancy or after birth

Worse turning in bed and on stairs: pelvic girdle pain.

Read: Pelvic girdle pain (SPD) →

Back pain and stiffness that started before 45, worst in the second half of the night or first thing

Easing with movement, so sitting still makes it stiffer: possibly inflammatory back pain. See the see-a-GP signs.

Understand it

Sitting hasn't been shown to cause back painStrong evidence

Back pain is common whether people sit a lot or not. Across 10 studies that followed people over time, how long people sat didn't predict a new episode of low back pain: the risk was the same, on moderate-certainty evidence. In 16 longitudinal studies of 100,002 people, sitting 3 to 8 hours a day wasn't linked with developing back pain either, though people who sat 3 hours or more a day reported more back-related disability. Older reviews agree: in 24 studies, five of them high quality, sitting at work wasn't linked with back pain, and in 35 reports, all but one found no positive link.

Studies that measure sitting and back pain at a single point in time do find a link: prolonged sitting went with about 42% higher odds of back pain, and driving with about twice the odds. But they can't show which came first, and a sore back may make people sit more. The studies that followed people over time are the better test.

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

So why does sitting hurt?Emerging evidence

Long, unbroken spells bring on short-lived back pain in many people. In 9 of 10 studies that measured sitting time directly, pain rose during the sit, to a level that matters in six of them. In office workers, how people sat (few breaks, little shifting) was linked with back pain more consistently than how long they sat, and in a lab study, shifting position 20 to 30 times an hour gave less low back discomfort over an hour than 10 times. A sore back tolerates staying still badly; that doesn't mean it is being damaged.

Sources 7, 8, 9

No single sitting posture is bestStrong evidence

Physiotherapists don't agree on a best sitting posture: 295 in four countries mostly chose one of two very different ones, and 544 more picked three different ones. In a lab study of 10 men, an "ideal" lower-back curve was hard to copy without feedback; a review of 41 reviews found no consensus that posture causes back pain, and people with and without back pain have the same lower-back curve and pelvic tilt on average. A physiotherapy journal editorial called "sit up straight" advice time to re-evaluate.

Sources 10, 11, 12, 13, 14, 15

But your own posture may matter to youEmerging evidence

In 33 people with long-lasting back pain, sorted into groups by clinicians and compared with 34 people without pain, one group sat more slumped and another more arched than the pain-free group. So some backs hurt more slumped and ease sitting upright or standing, and others the reverse. Notice which position eases yours, and use it, for now, alongside moving often. This is one small study, but it fits with the direction-based advice in our back pain guide.

Source 16

Discs and sittingEmerging evidence

The often-quoted claim that sitting loads the discs far more than standing came from measurements made in the 1960s, and newer ones don't bear it out. In one person with a pressure sensor in a healthy disc, pressure was a little lower sitting upright without support than standing relaxed, lower still sitting relaxed, and highest sitting bent fully forward. A review concluded that disc pressure is often similar sitting and standing, and that sitting is no worse than standing for disc wear or back pain. The NHS still lists long spells of sitting or driving among the causes of a slipped disc, so treat long, unbroken spells as something to break up, not something to fear.

Sources 17, 18, 19

DrivingMixed evidence

A review of 7 studies of people who drive for work found that sitting posture while driving hasn't been shown to cause back pain; the 4 studies that found a link used measures that hadn't been tested for accuracy. The NHS lists long spells of driving among the causes of a slipped disc. The Highway Code recommends a break of at least 15 minutes every 2 hours of driving, for tiredness; using those breaks for a sore back is our suggestion.

Sources 20, 19, 21

When a scan helpsStrong evidence

Not for back pain that comes and goes with sitting. The National Institute for Health and Care Excellence (NICE) says not to offer imaging routinely outside specialist care, and the NHS notes that not all slipped discs cause symptoms. A scan is for the warning signs, or for leg symptoms that aren't settling or a leg that is getting weaker, as our sciatica guide explains.

Sources 22, 19

How it usually goesEmerging evidence

The NHS says back pain usually improves within a few weeks but can last longer or come back, and NHS inform expects most back problems to improve within 6 weeks, with the biggest change in the first couple of weeks. The Chartered Society of Physiotherapy (CSP) says the exact cause usually can't be pinned down, and that sleep, stress and activity levels play a part. No one can promise a date.

Sources 23, 24, 25

What helps, and how strong the evidence is

Breaking up sitting: sensible guidance, weaker trial evidenceMixed evidence

The Health and Safety Executive (HSE) says short, frequent breaks are better than long, rare ones: 5 to 10 minutes every hour is better than 20 minutes every 2 hours, ideally getting up and moving, or at least stretching and changing posture. That is a workplace standard, not a trial result. NHS inform says change positions regularly and find one that eases your pain.

A review of 11 trials found low-quality, conflicting evidence on breaks in general, but moderate-quality evidence that active breaks with a change of posture reduce pain and discomfort, without costing productivity.

Sources 26, 27, 24

Prompted breaks in office workers: big effects from one research groupEmerging evidence

Three trials in office workers at high risk of back pain in Bangkok, all from one research group, which we read as abstracts, found large effects. Prompts to take active breaks or shift posture cut new low back pain over 6 months (9% and 7% against 33%), sped recovery and cut recurrences over a year, and a seat cushion that encouraged shifting cut new back pain from 59% to 10%, though it didn't ease pain in people who already had it. The comparison groups had dummy seat pads.

A small Japanese trial of frequent stand-up breaks and brief exercise, in 29 office workers with long-lasting back pain, found no effect, though people took only 1 or 2 of the 5 planned breaks a day. Until other groups repeat the big numbers, treat them with caution.

Sources 28, 29, 30, 31

Exercise has the best evidenceStrong evidence

Across 249 trials, exercise reduced long-lasting low back pain by about 15 points out of 100 against no treatment, usual care or placebo, on moderate-certainty evidence, and no type clearly beat another. To stop it coming back, exercise with education roughly halved the chance of a new episode, while education alone, back belts and insoles didn't help. In 701 people who had recovered, a walking programme with education nearly doubled the time to the next episode (a median of 208 days against 112).

NICE says consider a group exercise programme, and the World Health Organization (WHO) recommends exercise programmes for long-lasting low back pain.

Sources 34, 35, 36, 22, 37

Exercise in office workers: one trial, from the same groupEmerging evidence

In 563 office workers with a stiff back or low trunk endurance, daily stretching plus endurance exercise twice a week cut new back pain over a year from 19.7% to 8.8%. The trial came from the same Bangkok research group as the break trials, and we read it as an abstract, which doesn't list the exercises, so our plan uses the trunk endurance moves from our back pain guide.

Source 32

Sitting time and the pain coming back: one cohortEmerging evidence

In one cohort of 250 people who had just recovered from low back pain, 69% had another episode within a year, and sitting for more than 5 hours a day was one of the things that predicted it, along with awkward postures and more than two earlier episodes. It's one study, so it can't show that cutting sitting time stops the pain coming back, but it fits with the longer studies, where sitting 3 hours or more a day went with more back-related disability, and with breaking sitting up.

Sources 33, 2

Chairs, lumbar rolls and cushions: thin evidence, for comfortMixed evidence

The direct evidence on chair supports is one trial and one lab study. In the trial, from 1991, 210 people with back pain, some with pain into the leg, who sat with a lumbar roll for 24 to 48 hours had less back and leg pain than people given a flat cushion; it didn't help people with spinal stenosis or a slipped vertebra (spondylolisthesis). In the lab study, a lumbar pillow changed the lower-back angle by about 3 degrees, and people didn't feel more comfortable.

The Cochrane review of "lumbar supports" is about braces and corsets worn on the body, not chair supports, and found they don't prevent back pain. NICE says don't offer belts or corsets, and the WHO advises against lumbar braces, belts and supports.

Sources 38, 39, 40, 22, 37

Sit-stand desks help a little; standing all day doesn'tEmerging evidence

Across 8 studies, mostly in workers without back pain, sit-stand desks reduced low back discomfort slightly, by roughly 0.3 to 0.5 points on a 10-point scale. In one small trial of 46 people with long-lasting back pain, a sit-stand desk eased pain over 3 months. But standing for long spells at a desk wasn't less painful than sitting in 3 lab studies, and standing for more than 4 hours a workday went with more low back symptoms (about a third higher odds). Exercise balls and moving seats haven't been shown to treat back pain on their own.

Sources 41, 42, 43, 44, 45

How much pain is OK while you exercise?

The back pain rule, and judge sitting by timeEmerging evidence

For the exercises, this guide uses the back hub's rule. 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. NHS inform's back exercise advice uses the same limit: 0 to 3 out of 10 is minimal, 4 to 5 acceptable and 6 or more too much, and your pain should be no worse the morning after. The limit hasn't been tested in a back pain trial; in trials of long-lasting muscle and joint pain, exercise that allowed some pain did no harm. The NHS says to stop exercises that make your pain worse and see a GP, which means pain climbing day after day, not the passing discomfort this rule allows.

For sitting (our suggestion, built on an NHS occupational therapy leaflet's pacing and the HSE's advice on breaks): judge sitting by time, not by pain. Find how long you can sit before the ache starts to build, and stand up and move a little before that point, every time. When that spell has passed the next-morning check for 3 or 4 days, add a few minutes. While you're building back, don't go past an hour without getting up: the leaflet says no one should sit for more than an hour.

Sources 46, 47, 48, 26, 23

The exercise plan: 3 stages

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

Stage 1

Settle: break up the sitting and keep moving

The first days to about 2 weeks. Stand up and move before the ache builds, every time; walk every day; and do gentle moves little and often, keeping whichever ease your pain: the knee to chest if bending forward eases it, the press-up if arching back eases it. You don't need both. With any warning sign, get checked first. Doses are editorial unless a source is named.

Treadmill walking demonstrated on the 3D figure

3D demoTreadmill walkingBeginner · Cardio machine

5 to 10 min, several times a day · As in our back pain guide. Walking outdoors counts; the NHS lists walking among activities that may help

Harder: Treadmill jogging

Standing pelvic tilt demonstrated on the 3D figure

3D demoStanding pelvic tiltBeginner · No equipment

5 to 10 slow tilts, up to 3 times a day, and as a break from sitting · The move page's dose, from an NHS standing pelvic tilt. Skip the forward tilt, or keep it very small, if arching sends pain down a leg, as the move page says

Harder: Half lord of the fishes (Ardha Matsyendrasana)

3D demoCat-cowBeginner · No equipment

8 waves, slower than feels natural · The move page's dose. NHS inform's back exercises include a similar all-fours movement

Harder: Half lord of the fishes (Ardha Matsyendrasana)

Hip windshield wipers demonstrated on the 3D figure

3D demoHip windshield wipersBeginner · No equipment

2 to 3 slow rolls each side at a time, building to sets of 8, 2 to 3 times a day · NHS inform's knee rolls, with its pacing

Easier: Supine heel slide · Harder: 90/90 switch

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

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

Short holds at first, then 20 to 30 s, 2 to 3 times, 2 to 3 times a day · NHS inform's knee to chest, with its stretch dose. Keep it only if it eases your pain, and leave it out if bending forward sends pain down a leg, as the move page says

Harder: 90/90 hip lift-off

Prone press-up (McKenzie press-up) demonstrated on the 3D figure

3D demoProne press-up (McKenzie press-up)Beginner · No equipment

10 slow reps, 3 to 5 times a day, while it helps · The move page's dose, an editorial starting point. Keep it only if arching back eases your pain; skip it with spinal stenosis or if arching brings on leg symptoms, as the move page says

Easier: Sphinx pose (Salamba Bhujangasana)

Move on when: You can sit for 20 to 30 minutes at a time with a break, walk for 15 to 20 minutes, and your back is no worse the next morning (editorial).

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

Stage 2

Build: trunk and hip strength, and longer spells of sitting

About weeks 2 to 6. Strength work 2 or 3 days a week, walking on most days, and sitting spells lengthened by a few minutes every few days, with a break or a change of position at least every 30 to 60 minutes (the written steps below). The moves and sets are our back pain guide's; the office-worker trial that cut new back pain combined daily stretching with endurance training twice a week.

3D demoBird dogBeginner · No equipment

2 to 3 sets of 6 to 8 each side, 3 to 5 s holds · As in our back pain guide. Start with one limb at a time if you need to

Easier: Bird dog, one limb at a time · Harder: Bear crawl

3D demoDead bugBeginner · No equipment

2 sets of 6 to 8 each side · As in our back pain guide. Heel taps first if you need to

Easier: Dead bug heel taps · Harder: Forearm plank

Knee side plank demonstrated on the 3D figure

3D demoKnee side plankBeginner · No equipment

3 holds of 15 to 20 s each side · As in our back pain guide

Harder: Side plank

Glute bridge demonstrated on the 3D figure

3D demoGlute bridgeBeginner · No equipment

2 to 3 sets of 10 · As in our back pain guide

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

Sit to stand from a chair demonstrated on the 3D figure

3D demoSit to stand from a chairBeginner · A bench or box

3 sets of 8 to 10 · As in our back pain guide. It practises getting up from a chair: edge forward and push up through your thighs or the chair arms, as NHS inform describes

Easier: Sit to stand, pushing on the thighs · Harder: Bodyweight squat

3D demoTreadmill walkingBeginner · Cardio machine

Build towards 30 min on at least 5 days a week, or a 20-minute walk twice a day · The end target in the WalkBack trial; NHS inform suggests a 20-minute walk twice a day for people who sit for long periods

Harder: Treadmill jogging

Move on when: Your usual sitting spells, with breaks, leave the ache mild and settling within a few minutes of standing; every set feels controlled; and your back is no worse the next morning (editorial).

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

Stage 3

Strengthen, and sit as long as you need to

From about week 6, two strength days a week, and ongoing: heavier strength for the back and hips, while a full day of sitting with breaks comes back by the written steps below. Keep it going after the pain has gone: exercise with education roughly halved the chance of a new episode, and walking delayed the next one.

Kettlebell deadlift demonstrated on the 3D figure

3D demoKettlebell deadliftBeginner · A kettlebell

3 sets of 8 to 10, light to start · As in our back pain guide

Easier: Hip-hinge practice · Harder: Dumbbell Romanian deadlift

Dumbbell goblet squat demonstrated on the 3D figure

3D demoDumbbell goblet squatIntermediate · A dumbbell

3 sets of 8 to 10 · As in our back pain guide

Easier: Bodyweight squat · Harder: Barbell front squat

Side plank demonstrated on the 3D figure

3D demoSide plankIntermediate · No equipment

3 holds of 20 to 30 s each side · As in our back pain guide

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

Suitcase carry demonstrated on the 3D figure

3D demoSuitcase carryIntermediate · A dumbbell + A kettlebell

3 walks of 20 to 30 m each side · As in our back pain guide

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

Back extension on a 45-degree bench demonstrated on the 3D figure

3D demoBack extension on a 45-degree benchIntermediate · A bench or box

2 to 3 sets of 8 to 12 · As in our back pain guide; at home, the locust pose (3 holds of 3 to 5 breaths) is its option. Move slowly if arching aggravates your back, as the move page says

Easier: Ball back extension · Harder: Horizontal back extension (hyperextension, Roman chair)

3D demoStep-upBeginner · A step

3 sets of 8 each side · As in our back pain guide

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

Move on when: Our suggestion: full working days, a film or a train journey, with a break or a change of position every 30 to 60 minutes; then longer drives, stopping at least every 2 hours. If it flares, go back to the stage 1 moves and shorter spells for a few days, not to bed, then build again.

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

What to change for now

What to change while you sit (written steps)

Our 3D figure can't show these changes. They come from the HSE, the CSP, NHS inform, an NHS occupational therapy leaflet and a few small studies, and where a step is our suggestion, it says so. Our sitting posture guide has the full desk set-up.

1. Move little and often. NHS inform says change position regularly and find one that eases your back. The HSE says short, frequent breaks beat long, rare ones: 5 to 10 minutes every hour is better than 20 minutes every 2 hours, getting up and moving or at least stretching and changing posture. The CSP suggests breaking up sitting every 30 minutes: "your best posture is your next posture".
2. Our starting point: shift position whenever you notice the ache building, and stand up and move for a minute or two every 30 to 60 minutes.
3. Sit in the position that eases your back, then change it. If slumping hurts, sit back against the backrest with your lower back supported, or stand for a while; if sitting upright hurts, a slightly more relaxed recline may help (our wording of the direction advice in our back pain guide).
4. Set the chair up for comfort, as the HSE describes: feet flat on the floor or a footrest, thighs supported, the backrest or a cushion supporting your lower back, a gap of 2 to 3 cm between the front of the seat and the back of your knees, and the screen and keyboard straight in front of you so you don't twist.
5. Sit right back in the chair: the NHS leaflet says putting your bottom to the back of the chair stops your pelvis tipping back.
6. A lumbar roll or a small rolled towel at the bottom of your back, if it helps. In one 1991 trial it eased back and leg pain over a day or two, though not in people with spinal stenosis, and a lab study found only a small change in the back's curve. Worth trying; not a treatment on its own.
7. Pain right at the base of the spine: the leaflet suggests sitting with your hips a little higher than your knees on a wedge cushion, and the NHS suggests a coccyx cushion for tailbone pain.
8. A sit-stand desk, if you have one: switch every 30 to 60 minutes rather than standing all day. Sit-stand desks eased back discomfort a little, standing for long spells wasn't less painful than sitting, and more than 4 hours of standing a day went with back symptoms.
9. The sofa: the leaflet says very soft chairs encourage a C-shaped curve in the back. A firmer seat with a cushion behind your lower back, or lying down or walking for part of the evening, is our suggestion.

Sources 24, 26, 49, 50, 48, 38, 39, 51, 41, 43, 44, 16

In the car (written steps)

Driving posture hasn't been shown to cause back pain, but a long drive is a long, still spell of sitting. These steps are mostly our suggestions.

1. Set the seat so the backrest supports your lower back, your knees are a little lower than your hips, and you can reach the pedals without stretching (our suggestion, mirroring the desk advice). NHS inform says improving your driving position can help.
2. Stop and walk on long journeys. The Highway Code recommends a break of at least 15 minutes every 2 hours of driving; that's for tiredness, and stopping sooner while your back is sore is our suggestion.
3. To lower the risk of a blood clot, the NHS advises not sitting still for long periods (get up and move around every hour or so), and walking around when you can on journeys of 4 hours or more.
4. Start with short journeys, and build up as the plan does (our suggestion).

Sources 52, 21, 53, 20

Sitting comes back (written steps)

No trial has tested how fast sitting time should come back after back pain. These steps borrow an NHS occupational therapy leaflet's pacing and the HSE's breaks; the amounts are our suggestion.

1. Stage 1: sit for the time you can manage before the ache builds, then stand and move: a minute or two of walking, the standing pelvic tilt, or the seated twist (5 turns each side, held about 5 seconds, the NHS dose on its move page).
2. Stage 2: once a sitting spell has passed the next-morning check for 3 or 4 days, add a few minutes. Keep a break or a change of position at least every 30 to 60 minutes, and don't go past an hour without getting up while you're building back.
3. Stage 3: full working days, a film or a train journey, with breaks; a sit-stand desk if you have one, switching every 30 to 60 minutes rather than standing all day.
4. If it flares: back to the stage 1 moves and shorter spells for a few days. Don't take to bed: the NHS says not to stay in bed for long periods, and not to sit or lie down for long with sciatica.

Sources 48, 26, 49, 41, 43, 23, 54

Belts, painkillers and other treatments

NICE says don't offer belts or corsets for low back pain, the WHO advises against lumbar braces, belts and supports, and they don't prevent back pain. The NHS suggests an anti-inflammatory such as ibuprofen if it's suitable for you, says paracetamol on its own isn't recommended for back pain, and suggests heat for stiffness. NICE says offer manual therapy only alongside exercise; our back pain guide covers the other treatments.

Sources 22, 37, 40, 35, 23

Positions to swap, and why

Habit or position	Why it matters	Instead
Sitting for an hour or more without getting up	Long, unbroken spells bring on back pain in many people, and an NHS occupational therapy leaflet says no one should sit for more than an hour.	Stand and move every 30 to 60 minutes, and shift position whenever the ache builds; the standing pelvic tilt makes a good break.Try: Standing pelvic tilt
Holding yourself bolt upright to "sit properly"	No sitting posture has been shown to be best, and some people's backs hurt more sitting upright.	The position that eases yours, using the backrest, and change it often.
A soft, low sofa for the whole evening, if slumping hurts	Very soft seats encourage a C-shaped slump, the NHS leaflet says, and slumping is the problem position for some backs.	A firmer seat with a cushion behind your lower back, or lie down or walk for part of the evening (our suggestion).
Perching on the front edge of the seat	The HSE's set-up uses the backrest to support your lower back, and the NHS leaflet says to sit right back in the chair.	Sit back, with a cushion or rolled towel at the bottom of your back if the chair has no support.
A back belt or corset to get through the day	NICE says don't offer them, the WHO advises against them, and they don't prevent back pain.	Breaks, walking and the exercise plan.
Lying in bed or on the sofa for long spells	The NHS says don't stay in bed for long periods, and not to sit or lie down for long with sciatica.	Walk every day.Try: Treadmill walking
Standing at a standing desk all day instead	Standing for long spells wasn't less painful than sitting, and more than 4 hours a day of standing went with back symptoms.	Switch between sitting and standing every 30 to 60 minutes.
Hours of driving without a stop	The Highway Code recommends a break of at least 15 minutes every 2 hours (for tiredness), and the NHS lists long spells of driving among the causes of a slipped disc.	Stop and walk at least every 2 hours, sooner while your back is sore (our suggestion).
Seated forward folds and toe touches, if bending forward sends pain down a leg	Deep forward bending is the direction that aggravates disc-type pain, as our back pain guide's stretch table cautions.	Whichever eases your back: the press-up if arching eases it, the knee to chest if bending does.Try: Prone press-up (McKenzie press-up)
The sphinx and other arching stretches, if arching back brings your pain on or you have spinal stenosis	Arching is the direction that aggravates some back pain, and the move page says to skip it with spinal stenosis.	A gentle knee to chest within comfort.Try: Single knee-to-chest stretch
A ring (doughnut) cushion for pain at the base of the spine	It can press on the coccyx, as our tailbone pain guide explains.	A wedge or cut-out coccyx cushion.
Asking for a scan to find out what's wrong	NICE advises against routine imaging, and not all slipped discs cause symptoms.	Get checked if a warning sign appears.

Routines to follow

3-minute desk movement break

A 3-minute standing break to repeat every 30 to 60 minutes at your desk: sit-to-stands, calf raises, marching, an upper-back turn and chin tucks.

3 minBeginner5 movesA bench or box, A wall

5-minute desk stretches

A quick stretch break you can do beside your desk: neck, back, chest, wrists, hips and quads.

5 minBeginner7 movesA wall

10-minute walk and move after meals

A 10-minute routine for straight after a meal: an easy walk, a few simple standing moves from blood sugar trials, then a short walk to finish.

10 minBeginner6 movesCardio machine, A bench or box

Pilates for back pain (gentle routine)

A gentle 15-minute Pilates-based routine for ongoing low back pain, built from neutral-spine moves with options for backs that dislike bending or arching.

15 minBeginner10 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

McGill big 3 core routine

The McGill big three for the core: curl-ups, side planks and bird dogs, each held for 10 seconds at a time in falling sets of 5, 3 and 1 reps.

12 minBeginner3 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

More moves for this area

Questions people ask

Why does my lower back hurt when I sit?

Long, unbroken spells of sitting bring on back pain in many people, and it usually eases when you get up and move. Sitting hasn't been shown to cause back pain in the first place, but a sore back tolerates staying still badly. Change position often, and stand up before the ache builds.

Why does my back hurt sitting but not standing?

Sitting, especially slumped, bends the lower back forward, and some people's back pain is worse in that direction and eases standing or arching back. If that's you, sit back with your lower back supported, try a lumbar roll, break the sitting up and favour the press-up in the plan. Pain down one leg that is worse sitting points to a disc and sciatica.

Is sitting bad for your back?

Not in itself: people who sat more weren't more likely to develop back pain in studies that followed them over time, and reviews of sitting at work agree. Long spells without a break are a common trigger once your back is sore, so break them up and stay active.

What is the best sitting position for lower back pain?

There isn't one: physiotherapists can't agree on a best posture, and the CSP says "your best posture is your next posture". Sit in the position that eases your back, with your feet supported and your lower back against the backrest or a cushion, and change it often.

Why does my back hurt when I sit up straight?

Holding yourself upright keeps the back muscles working and the lower back arched, and some people's back pain is worse that way. Sitting up straight isn't required: lean back against a supportive backrest, use a lumbar roll if it helps, and move between positions.

How often should I get up from my desk?

No study has found the right interval. The HSE says short, frequent breaks are better (5 to 10 minutes every hour beats 20 minutes every 2 hours), the CSP suggests breaking up sitting every 30 minutes, and an NHS leaflet says don't sit for more than an hour. Every 30 to 60 minutes, and whenever the ache builds, is our starting point.

Do lumbar support pillows help?

Sometimes, for comfort, but the evidence is thin: one trial from 1991 found a lumbar roll eased back and leg pain over a day or two, though not in people with spinal stenosis, and a lab study found a lumbar pillow made only a small change to the lower back's curve. The HSE suggests a cushion if your chair doesn't support your lower back. A back belt is different: NICE says don't offer one.

Will a standing desk help my back pain?

A little, if you switch: sit-stand desks reduced back discomfort slightly in a review, and eased long-lasting back pain in one small trial. Standing all day isn't better than sitting and is linked with back symptoms of its own, so change between the two every 30 to 60 minutes.

What exercises help lower back pain from sitting?

Walking and gentle movement first, then trunk and hip strength: exercise eases long-lasting back pain by about 15 points out of 100, and with education it roughly halves the chance of another episode. The plan builds from NHS inform's back exercises to strength work, with a 3D demo of every move.

Why does my lower back hurt when I stand up after sitting?

Stiffness after a still spell is common with ordinary back pain and usually eases after a few steps; edge forward and push up with your legs and arms, as NHS inform describes. Pain right at the base of the spine when you stand up is often the tailbone. Pain and stiffness that is worst in the morning and eases with movement, starting before 45, can be inflammatory back pain and needs a GP.

My back hurts after sitting in the car. What can I do?

Set the seat so your lower back is supported and you can reach the pedals without stretching (our suggestion), and stop to walk on long journeys: the Highway Code recommends at least 15 minutes every 2 hours, for tiredness, and sooner is our suggestion while your back is sore. Driving posture hasn't been shown to cause back pain.

When should I worry about back pain from sitting?

Call 999 or go to A&E for numbness around your genitals or bottom, new bladder or bowel problems, or weakness or numbness in both legs. Get an urgent GP appointment or call NHS 111 if you feel feverish or unwell, or the pain is severe and getting worse quickly, and see a GP if it hasn't improved after a few weeks, is worse at night, or comes with weight loss.

When to get help first

Get urgent medical help if

See a doctor or physiotherapist if

Where does it hurt?

Understand it

Sitting hasn't been shown to cause back painStrong evidence

So why does sitting hurt?Emerging evidence

No single sitting posture is bestStrong evidence

But your own posture may matter to youEmerging evidence

Discs and sittingEmerging evidence

DrivingMixed evidence

When a scan helpsStrong evidence

How it usually goesEmerging evidence

What helps, and how strong the evidence is

Breaking up sitting: sensible guidance, weaker trial evidenceMixed evidence

Prompted breaks in office workers: big effects from one research groupEmerging evidence

Exercise has the best evidenceStrong evidence

Exercise in office workers: one trial, from the same groupEmerging evidence

Sitting time and the pain coming back: one cohortEmerging evidence

Chairs, lumbar rolls and cushions: thin evidence, for comfortMixed evidence

Sit-stand desks help a little; standing all day doesn'tEmerging evidence

How much pain is OK while you exercise?

The back pain rule, and judge sitting by timeEmerging evidence

The exercise plan: 3 stages

Settle: break up the sitting and keep moving

Build: trunk and hip strength, and longer spells of sitting

Strengthen, and sit as long as you need to

What to change for now

What to change while you sit (written steps)

In the car (written steps)

Sitting comes back (written steps)

Belts, painkillers and other treatments

Positions to swap, and why

Routines to follow

3-minute desk movement break

5-minute desk stretches

10-minute walk and move after meals

Pilates for back pain (gentle routine)

Beginner core workout

McGill big 3 core routine

Lower back stretch routine

More moves for this area

Questions people ask

Related exercise guides

Other pain guides

Sources