Ask a physio: The best exercise for pain isn’t the one you think

“What’s the best exercise for my back?”

I get some version of that question almost every week. People want the name of the one movement, the one stretch that will finally sort things out. It’s a fair thing to want. If pain has a cause, surely it has a matching fix.

So here is the honest answer, and it surprises people every time: There isn’t a best one.

We have a lot of research on this, especially for low back pain that has hung around for months. Study after study has lined the options up against each other. Walking against running. Strength training against yoga. Tai chi, pilates, swimming, a general fitness class. Head-to-head, no single option comes out ahead for easing pain or getting people back to their lives.

That can sound like bad news. It’s the opposite. It means you don’t have to find the one right answer before you can start moving. The field is wide open.

Think of it the way we now think about diet. For years people chased the perfect one.

What the evidence keeps showing is that the best diet is mostly the one a person can actually live with. Exercise for pain works much the same way. The best exercise is the one that gets done.

Which points at something we don’t talk about enough. Pain has a way of shrinking a life. A movement hurts, so you do less of it. That is sensible at first. But when doing less stretches into months, the not-moving can start to feed the very problem you want gone.

Here is a distinction worth sitting with. What starts a problem is often not what keeps it going. You tweak your back lifting a box, and three months later it still nags. What may be keeping things sore is all the bending and reaching you have carefully avoided since, and the worry that has grown up around it.

None of this means a daily walk cures everyone’s pain. It doesn’t. But most people can name something they used to do and have drifted away from. A walk with a friend along the Coquitlam River. A swim. The garden. The bikes in the garage.

That thing you already know, and maybe even enjoy, is usually the best place to start.

Not because it is magic, but because you will actually do it. The trick is how you come back. Not all at once. You start a little under what feels possible, and you add a bit as the weeks go on. Clinicians call this graded activity, a formal name for a simple idea: a small amount, then slightly more, then more again. You show your body that the movement is safe by doing it, gently and often, rather than waiting to feel ready first.

And targeted exercise still matters. A specific movement for a cranky knee, a stiff shoulder, or a back that has lost its confidence can absolutely help. It just tends to work best alongside the general activity you will actually keep up, rather than instead of it.

Pair those with some skilled hands-on care and a clear plan from a provider you trust, and you are no longer chasing a single fix. You are setting yourself up well to recover.

So the real question isn’t “what’s the best exercise for pain.” It’s “what is something I’m willing to do, most days, starting smaller than I think I need to?”

Pick that. Give it a few weeks. Add to it slowly. The goal was never to find the perfect exercise. It’s to become someone who moves a little more this month than last. That, far more than the name of any single exercise, is what tends to turn pain around.

Sean Overin is a registered physiotherapist who coordinates the Chronic Pain Program at Tall Tree Health, which has a clinic in Port Coquitlam. This column is general information, not a substitute for individual medical advice.