Getting cardio exercise–even when you have neck or back pain


Better cardio exercise options during low back pain


Exercises where caution should be used with low back pain


Exercises to avoid with an injured back


Exercises to avoid with neck pain


Better cardio exercise options during neck pain


Managing body weight when one’s back or neck is injured presents some significant challenges, but is very important for our long-term health. Weight gain that often occurs during periods of pain, disability or reduced physical activity can be hard to shed, and can compound the original injury.


Long-term reductions in phyiscal activity often leads to a de-conditioning/weight gain degenerative cycle that weakens muscles, tendons, joints, and bones. Lack of regular exercise can not only worsen back pain, but also increases the risks of arthritis, cardiovascular disease, diabetes, sleep apnea, osteoporosis, depression, and other major medical conditions.

Following an acute, traumatic or unstable injury (such as a sprain, fracture, or dislocation), avoidance or caution regarding physical activity is indeed often crucial to prevent worsening of the condition.


However, when injuries have stabilized but chronic pain remains, it is often possible to resume physical activity, maintain cardiovascular fitness, and keep body weight down with careful selection and performance of exercises. In fact, many kinds of cardiovascular exercise are safe, or even beneficial, for neck and back pain!

Below you’ll find my assessment of some the of the activities that my Santa Cruz-area patients most commonly ask me about. And because no list of exercises can be all-inclusive or cover every individual or scenario, I’ve provided an overview of the biomechanics of the spine to help differentiate the types of exercises that are unlikely to worsen neck or back pain, from the kinds of exercise that are more risky.


The following guidelines are provided as general education and are not intended as a complete list, nor as specific exercise prescription for specific individuals and conditions. Persons suffering from pain or injury before, during or after exercise are advised to consult with a primary health care professional (physician or acupuncturist) prior to beginning or continuing an exercise program.

Biomechanics of spinal injury:


The spine is at greatest risk of injury from repetitive, forceful, sudden, or extreme:

  • bending (forward, backward or side-bending, and rotation or twisting). This holds true whether bending the spine is done actively (by yourself, as in a stretch or activity), or passively (by someone else or something else to you, as in a fall, collision, etc.).
  • axial loading or vertical compression, as occurs when carrying a heavy load, prolonged sitting, falling or landing on one’s feet, or being struck on top of the head.
  • holding one’s breath during exertion, which dramatically increases pressure on the spinal disc and the risks of disc injury! Remembering to breathe evenly during any exertion is important to avoid spine pain.

With this understanding of the biomechanics of the spine, we can see why certain types of cardiovascular exercise are generally safe, versus those where more caution needs to be applied, and those that are likley to worsen a neck or back inury.


Better cardio exercise options during low back pain:

  • The human spine has evolved for walking, not for prolonged sitting or bed-rest. Walking is generally safe and can actually improve many types of back pain. A brisk pace on level surfaces is best–steep hills or uneven, unstable surfaces, stop-and-start strolling, or stair-climbing may cause more pain temporarily (but is unlikely to further injure the spine). The benefits of walking for spinal health are cumulative–more is better. If you feel tired or the pain seems to be increasing, brief rests may help you resume walking at a brisk pace.
  • The biomechanics of elliptical trainers, and nordic-style skiing machines are similar enough to walking that they can generally be safely performed during back pain.
  • Swimming and water aerobics are generally quite safe and even therapeutic for low back pain. An exception is the butterfly stroke which can worsen mechanical back pain because of the foreceful, repetitive flexion and extension of the spine.
  • Dance and martial arts styles where the spine generally remains stable and upright, such as waltz, ballet, salsa, swing, or taiji, are generally safe and can be therapeutic.

Exercises where caution should be used with low back pain:

Let pain be your guide for the following activities:

  • Low-impact land aerobics and jogging on smooth, stable surfaces may be okay with many kinds of back pain, but some sacro-iliac and disc injuries may be flared up by the greater impacts, in which case walking is preferable.
  • Stair-climbing machines may worsen back pain from disc injuries, but are otherwise unlilkey to affect back pain.
  • Cycling can be problematic with back pain, but if it doesn’t hurt to ride a bike, there is no particular reason to hang back. But be wary of off-road biking–the vertical jarrring can worsen back pain. Also, dropped handlebars that force the spine to bend forward, as well as recumbent bikes where the hips are flexed, can worsen back pain that stems from disc injuries.
  • Skating may be tried carefully and is not likely to worsen most kinds of back pain–unless you fall. So skate below rather than above your level of skill, go for endurance, not speed or sharp turns.
  • Paddling while lying prone on a surfboard can alleviate disc-related back pain, but can also exacerbate facet joint back pain. A flare-up in low back pain during or after surfing is a reliable indicator that it should be postponed until recovery is complete. However, if your back feels better after paddling–go for it!
  • Paddle-boarding, canoeing and kayaking may be safe for low back pain, although proper technique, training and guidance are important to maintain neutral, upright spine position during the activity.

Exercises to avoid with an injured back (partial list):

  • Lifting, pulling, carrying, swinging, or throwing heavy objects, especially at the end of your arms (discus, shot-put, or kettle bell-type exercises) or worse, a lever arm (such as using a shovel or pitchfork–digging is the most dangerous!)
  • The butterfly stroke during swimming.
  • Rowing generally involves too much repetitive spinal flexion and extension to be appropriate for back pain.
  • Dance and martial arts styles which may involve sudden, repetitive, extreme or forceful bending of the spine, such as capoeira, kick-boxing, zumba, some African and Caribbean dance styles, tango, and extreme dips during other ballroom styles.
  • High-impact or unpredictable activities such as running on rough trails, and raquet, team or contact sports.

Exercising during neck pain:

The considerations for neck pain are similar to those for low back pain, with a few exceptions noted below.

Exercises to avoid with neck pain (partial list):

  • avoid the forward crawl/freestyle swim stroke (which includes paddling while lying prone on a surfboard). Repetitve neck twisting and turning is likely to aggravate most types of neck pain. The breastroke and side-stroke may also aggravate neck pain.
  • avoid riding a bike with dropped handlebars, which put the neck in extremes of extension.
  • avoid sudden, repetitive, or ballistic neck motions, or where there is a risk of impact, such as contact/team sports, some martial arts, and tango, zumba, Afro-Caribbean and capoeira dance styles, and extreme dips during other ballroom styles.
  • avoid sports that often require severe neck angles, such as climbing and racket sports


Better cardio exercise options during neck pain:

  • Walking and running on any surface (hills and stairs don’t generally aggravate neck pain).
  • Aerobics on land or water.
  • Skating.
  • Swimming the back-stroke or back-crawl.
  • Paddle-boarding, canoeing, kayaking, and rowing.
  • Dance and martial art styles that emphasize staying upright and maintaining a “frame” such as waltz, salsa, ballet, swing, and taiji.
  • Riding a bicycle in an upright position with (cruiser-style handlebars or a recumbant bike).

The above lists are for informational purposes only, and not intended to be complete nor to provide specific guidance for specific individuals and their conditions.

Remember that to get cardiovascular and weight-loss benefits from walking or cycling, one must move briskly enough to break a sweat and elevate breathing and pulse rate. The slower you move, the longer duration is required to acheive benefit.

What if your neck or back (or other body areas) feel more painful after exercise? In evaluating response to physical activity, it is important to be able to differentiate pathologic pain from injury vs. normal post-exercise delayed-onset muscle soreness (DOMS). Mistaking one for the other can lead us to forge ahead in a harmful activity, or more commonly, to hang back from, under-do, or quit an otherwise beneficial exercise. A licensed health care professional should be consulted promptly if there is suspicion that increased pain is due to an injury.

Motion is life, and too often I have seen patients unintentionally worsen their condition or their overall health with understandable but mis-directed self-prescribed immobilization (If a physician, physical therapist, acupuncturist, or other qualified health-care professional advises rest, then that’s another matter).

Tissue depends upon regular and appropriate usage to bring in oxygen- and nutrient-rich blood, and to carry away metabolic wastes, inflammatory substances, and injury debris. There are risks to remaining still and sedentary, including prolonged injury and recovery times, loss of muscle mass and bone density, increased body weight, decreased blood flow and cardiovascular fitness, depressed mood, poor sleep, increased pain sensitivity, the list goes on….in fact recent evidence suggests that sitting for more than 3 hours/day shorten’s one’s lifespan by an average of 2 years!


But with appropriate choices we can maintain cardiovascular fitness even with neck or back pain.

Need more information or advice about back pain, neck pain, and safe exercise options? Please Contact Us or use our Request Appointment form so we can help.