I'm Scared to Bend, Lift or Exercise: A Practical Guide to Moving Again With Chronic Back or SIJ Pain
Move Sports Physiotherapy & Pilates Geelong
Are you a chronic 'core-bracer' for every day-to-day task, as simple as picking up the laundry basket. Maybe you bend your knees for a dropped sock, cancelled the gym or haven't been back to the garden in months fearing the smallest wrong movement will cause a flare.
It's not being dramatic, and you're not imagining it. Being careful after months or years of chronic pain is a completely normal and understandable response.
This post is for people who want to move more but are scared of making things worse. We'll look at where that fear comes from, what the research actually says about bending and lifting, and a practical way to start building back up, flare-ups included.
Why being scared to move makes complete sense
Fear of movement is one of the most common experiences in chronic back pain. Many people with long-term back pain avoid exercise, work tasks or particular activities because they expect them to cause more pain. That isn't a character flaw. It's your protective system doing its job, maybe a little too well.
Fear beliefs may also deepen as a result of common beliefs reiterated throughout life:
"Always bend your knees and keep your back straight."
"Sit up straight or you'll ruin your back."
"Brace your core to protect your spine."
"Don't lift anything heavy with a bad back."
Well-meaning employers, manual handling courses, family members and health professionals have repeated these messages. Together they paint a picture of the spine as fragile, something you have to guard all the time.
Then there's lived experience
If bending once triggered a bad flare, the brain will remember this as a dangerous position or movement. The next time you go to bend, it may dial-up the pain or the tension before anything has actually happened. That can feel like proof your back is damaged, when often it's a sign your system has become sensitive and protective.
It also makes sense if part of you thinks, "Yes, but my back is different." Australian researchers who interviewed people with chronic back pain heard exactly that. Many understood that pain involves the nervous system but still wondered about structural causes. Others weren't sure how to apply any of it to their daily life. If that sounds familiar, this post is meant to bridge that gap.
What the research says about bending and lifting with back pain
Rounding your back isn't as dangerous as you've been led to believe
In 2019, researchers at Curtin University in Perth pooled the available studies. They found no evidence that people who lift with a rounded back are more likely to develop back pain, or to keep it. The authors noted the studies were mostly low quality, but there was still no support for the straight-back rule.
People with back pain often already lift the "correct" way
A follow-up study looked at people who had done manual lifting at work for more than five years. Those with back pain were more likely to lift slowly, squat and keep their back straight. Those without pain mostly didn't follow that advice. The researchers concluded that a one-size-fits-all lifting technique probably doesn't exist.
Posture isn't the villain either
Research from the University of Limerick has questioned how much posture really matters in back pain. It also found there is no single "safe" or "proper" way to sit. As many physios say, your best posture is your next one.
Moving consistently comes up as No.1 for treatment
A 2021 Cochrane review pooled 249 trials. It found moderate-certainty evidence that exercise probably reduces pain in chronic low back pain compared with no treatment, usual care or placebo. No single type of exercise came out clearly on top, highlighting the best exercise is the one you enjoy, you'll keep doing, and/or believe in.
Building confidence works as well as building strength
In the RESTORE trial, run across 20 Australian physio clinics and published in The Lancet in 2023, physios used an approach called cognitive functional therapy. It helped people understand their pain, gradually face feared movements and get back to valued activities. People improved more than with usual care, and a three-year follow-up found the benefits lasted.
None of this means lifting never matters. Frequent, repetitive lifting, fatigue and an unconditioned body all count.
The takeaway is simpler: your back is strong and adaptable. It's built to bend, twist and carry. What it needs is to be built up gradually, not wrapped in cotton wool.
Hurt doesn't always mean harm
This is probably the most important idea in this post, and the hardest one to believe when you're in pain.
In chronic back pain, the amount of pain you feel often doesn't match the amount of damage in your tissues. After months or years, the nervous system can become really sensitive, a bit like a smoke alarm set to go off at burnt toast. It's still a real alarm and real pain, but the alarm isn't a reliable measure of how much harm is happening.
This is why scans so often don't line up with symptoms. Disc wear, bulges and arthritis show up on scans of many people with no pain at all, as they become more common with age.
How to tell the difference between a "sore-day" vs damage.
Some discomfort during or after activity is OK. Mild to moderate pain that settles back to your usual level within about 24 hours generally means you're in a reasonable zone.
Pain that builds and stays up for days suggests you did too much, too soon. That's useful information, not a disaster. Ease back a little next time and build up more gradually.
Stiffness and soreness the next morning are common when you start something new, especially if you've been avoiding it.
Tension, bracing and holding your breath often make movement feel worse. Seeing if you can soften and breathe through the movement can make a real difference.
Your physio can help you find your own thresholds, because everyone's are different.
How to start moving again, without overdoing it
Pick something that matters to you
Lifting your grandkids, getting back to the gym, playing nine holes or gardening without paying for it the next day. A meaningful goal makes the work feel worth it.
Find your starting point
Work out what you can do today without a big flare: a 10-minute walk, bending to a knee-height shelf, or lifting a light shopping bag. Start just below that, not at where you used to be. Chat to a physio about baseline testing / pain scales / symptoms trackers. These measures are valuable tools to track your progress, especially when improvements are often slow.
Build up in small steps. Add a little every few days: a few more minutes, a slightly lower reach, a slightly heavier load. Perseverance is key. Gradual small wins can become life-changing over time.
Practise the movement you're scared of
If bending scares you, bending is what to practise, gently and gradually. Start with something easy, like reaching towards your knees, then shins, then a low step. Each successful repetition helps your nervous system recalibrate its expectations.
Relax into it
Try moving without bracing or holding your breath. Many people find that softening their body and breathing out makes movement feel easier. Again, pick a simple movement you can do confidently first, then begin practicing with 'harder' movements.
Choose exercise you'll actually do
Walking, Pilates, strength training, swimming, yoga or dancing can all help. Consistency and joy matters way more than the perfect program.
Expect ups and downs. Progress is rarely a straight line. A bad day doesn't erase the good weeks before it.
Working with a physio or other physical therapist can help you set your starting point, pick the right progressions and keep you steady when your confidence wobbles.
Your flare-up plan
Flare-ups happen to almost everyone with chronic back pain, even when they're doing everything right. They're frightening, but most are a temporary spike in sensitivity, not a new injury.
Having a plan ready means you can respond calmly instead of fearing the worst.
Remind yourself you've been here before - Flares usually settle, often within days.
Scale back, don't stop - Drop to an easier version of your activity or switch to a more gentle movement such as short walk. Try not to break the routine.
Pick your fav calming protocol - Heat, a warm bath, gentle stretches, relaxation or breathing exercises, pain relief if needed.
Sleep & stress management - Chronic stress and poor sleep will significantly dial-up pain sensitivity. Make your bedtime routine and sleep environment a priority. And get the right support you need to reduce stress / improve stress resiliency.
Get back on track gradually - Once things settle, return to your plan a step or two below where you were and build up again.
Learn from it, without judgement - Was it a big jump in activity, a stressful week or poor sleep? This helps inform your risk assessment for next time.
When to get checked
Serious causes of back pain are rare, but they matter. Knowing the warning signs means you can move with confidence and know when to act.
Seek urgent medical care (emergency department or 000) if you notice:
New difficulty controlling your bladder or bowels, or being unable to pass urine
Numbness around your groin, genitals or buttocks (the "saddle" area)
Rapidly worsening weakness in one or both legs
See your GP promptly if back pain comes with:
Fever or feeling generally unwell
Unexplained weight loss
A history of cancer
A significant fall or accident
Constant pain that doesn't change with position or movement, or is worse at night
If your pain has changed in a way that worries you, it's always OK to get it checked. Being reassured by a professional is a good reason to book an appointment in its own right.
You don't have to figure this out alone
Chronic pain can be a debilitating and lonely state of living. Sometimes riffing your situation with someone else can actually help you answer your own questions, and give clarity to the future you want. At Move, we'll listen to your story, understand what's going on for you, and build a plan around the things that matter to you.
References
Saraceni N, et al. To flex or not to flex? Is there a relationship between lumbar spine flexion during lifting and low back pain? A systematic review with meta-analysis. JOSPT, 2020. Summary
Saraceni N, et al. Exploring lumbar and lower limb kinematics and kinetics for evidence that lifting technique is associated with low back pain. PLOS ONE, 2021. Paper · Curtin University summary
Hayden JA, et al. Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews, 2021. Abstract
Kent P, et al. Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE). The Lancet, 2023. PubMed
Hancock M, et al. RESTORE 3-year follow-up. The Lancet Rheumatology. Summary
Rizzo RRN, et al. Why might fears and worries persist after a pain education–grounded multimodal intervention for chronic back pain? PAIN Reports, 2024. Abstract
University of Limerick. Research on sitting posture and back pain. Summary
Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR, 2015. Summary via Spine-health
This article is general information and doesn't replace individual advice from your health professional.
