“I could 100% see myself getting hurt if I did it wrong”: a qualitative exploration of exercise perceptions in people with chronic low back pain

Traditionally, a specific “core” exercise focus has been favoured for chronic low back pain (CLBP) which contrasts holistic exercise approaches. This study aims to explore the perceptions of exercise in people with CLBP and whether exercise itself can convey implicit messages regarding its use in CLBP management in the absence of a clinical narrative. Participants were asked about their CLBP history, views of exercise for CLBP, and current exercise behaviours through online semi-structured interviews. Then, participants watched the interviewer perform the deadlift, Jefferson curl, and bird dog and were asked if they thought each individual exercise was beneficial for CLBP, and why. Data were analysed using reflexive thematic analysis through a critical realism and social constructivism lens. All participants (n = 16) viewed all exercises as beneficial for health and pain relief, but perceived efficacy varied. “Core” exercises were deemed crucial for CLBP relief, while spinal flexion and external load were often perceived as potentially injurious. Distrust towards healthcare practitioners also influenced exercise perceptions. People with CLBP perceive different exercises to either relieve pain or improve health. Healthcare practitioners can influence these perceptions, highlighting the need for consideration of exercise perceptions in clinical contexts. Exercise itself can convey implicit messages to people with chronic low back pain irrespective of an accompanying clinical narrative.‘Core’ exercises are perceived as beneficial whereas exercises involving spinal flexion or loading may be perceived as dangerous.Exercise for reducing pain is perceived as distinctly different from gym related exercises or other exercises for improving health.Healthcare practitioners must consider their client’s exercise perceptions when using exercise as an intervention for chronic low back pain. Exercise itself can convey implicit messages to people with chronic low back pain irrespective of an accompanying clinical narrative. ‘Core’ exercises are perceived as beneficial whereas exercises involving spinal flexion or loading may be perceived as dangerous. Exercise for reducing pain is perceived as distinctly different from gym related exercises or other exercises for improving health. Healthcare practitioners must consider their client’s exercise perceptions when using exercise as an intervention for chronic low back pain.