“Exercise is medicine” for arthritis and back pain: separating myth from evidence

Exercise really can act like medicine for arthritis and long‑standing back pain. It is not about pushing through agony, but about using the right kind of movement, at the right level, to calm pain and keep you independent.

“My joints are worn out – won’t exercise make them worse?”

This is probably the most common worry. If you have “wear and tear” arthritis or back pain, it is completely understandable to fear that each step is grinding away what is left of your joints.

However, large studies and treatment guidelines tell a different story. In osteoarthritis (especially knees and hips), people who follow structured exercise programmes usually report less pain, better movement and better daily function than those who stay inactive. Exercise strengthens the muscles that support your joints and helps them share the load, so your cartilage and other tissues are under less strain.

Think of your joints less like a car tyre that wears down with every mile, and more like a living garden. A garden that is never used becomes overgrown and neglected; one that is used gently and regularly tends to stay healthier. Movement brings blood flow, nourishes the tissues inside the joint and keeps the muscles, tendons and ligaments around it strong.

You may feel more achy when you first start or when you change your exercises. That does not automatically mean you are doing damage. Mild to moderate pain that settles within a day or so is usually a normal response as your body adapts. If pain is sharp, severe or lingers for days, that is a sign to ease back or change what you are doing, not to give up altogether.

“Don’t I need a scan before I can exercise safely?”

Many people feel they need an X‑ray or MRI to “see what’s going on” before they dare to move. In most cases of osteoarthritis and non‑specific back pain, that simply is not necessary.​

UK guidance for osteoarthritis says doctors can diagnose it based on your age, symptoms and examination, without needing a scan. The same guidance makes it clear that exercise, weight management and good information are the main treatments, not repeated imaging or quick‑fix procedures. For low back pain, national advice is similar: exercise and self‑management come first, and scans are kept for the small number of people who show warning signs such as serious injury, infection or nerve problems.

One reason is that scan results often sound scary but do not match how you actually feel. Many people with completely no back pain have bulging discs or “wear and tear” on their scans. Hearing those labels can make you more fearful and less willing to move, which ironically can increase pain and disability over time.​

A helpful way to think about it is that scans are like a “wrinkle detector” for your joints and spine. They show age‑related changes that are often normal. The decision to exercise is usually based on your symptoms and what you can do, not just what a picture shows.

“Don’t I need injections or strong painkillers first?”

When you are in pain, it is natural to want something that works immediately: a tablet, an injection, anything that promises quick relief. These treatments can have a place for some people, but they are rarely the whole answer.

Guidelines for osteoarthritis recommend things like gels or simple painkillers in the lowest dose and for the shortest time, mainly to help you stay active. Strong painkillers, particularly opioids, are not recommended for long‑term use because the benefits are small and the risks (side effects, dependence) are real. In back pain, medicines and injections may help some people some of the time, but they generally do not beat a good exercise and self‑management plan in the long run.

Big research reviews in chronic low back pain show that people who exercise regularly have, on average, less pain and slightly better function than those who do not exercise, or who only receive usual care. The improvements are not magic, but they are meaningful – and they come with extra benefits for your heart, mood and sleep that injections cannot provide.

One simple way to explain it is: medication can turn down the volume on pain for a while, but exercise changes the sound system. It helps your whole body cope better, so pain bothers you less and you can do more.

So what does “exercise as medicine” actually look like?

You do not need to join a gym or become a runner for exercise to help your joints or back. What matters most is that you find activities you can stick with.

For arthritis in knees or hips, research and national guidance suggest combining three main types of movement:

• Strength exercises to target key muscles, such as the thigh and hip muscles, two or three times per week.

• General aerobic activities like walking, cycling or swimming on most days, starting with short bouts and building up gradually.

• Gentle range‑of‑movement exercises to keep joints from getting too stiff, such as knee bends, leg lifts or hip circles.

For long‑standing low back pain, almost any form of regular exercise can help – walking, Pilates, yoga, swimming, simple home routines or group classes. The key is to start at a level you can manage and to progress slowly. Many people find it easier, and more enjoyable, when they do it with a friend, a group or the support of a physiotherapist.

A useful rule of thumb is: some pain during or after exercise is okay if it is mild to moderate and settles within about 24 hours. If it flares for longer, reduce how hard, how often or how long you are exercising. Over time, as your strength and confidence grow, you can usually do more with less pain.

Three messages to remember

• Movement is usually safe and helpful, even if you have “wear and tear” on your joints or spine.

• You do not normally need a scan before you start moving more; in fact, getting going often helps faster than waiting for tests.

• Injections and strong painkillers can sometimes help, but they cannot replace the long‑term benefits of becoming stronger, fitter and more confident in your body.