Every autumn the same scene: the first cold days arrive and your back makes itself felt. It is such a common observation that it seems obvious, and the pain you feel is real. What the data do not confirm is the explanation we usually give for it.
Over the last ten years several research groups did something simple and decisive: they took thousands of people with a newly started episode of low back pain and compared the weather on the day the pain appeared with the weather for the same people one week and one month earlier. The result went almost always in the same direction, and it is not the one we expected.
⚠ Important: read this before continuing
The exercises and advice in this article are general guidance and may not suit your situation. Every person has a unique clinical history: what works for others could be counterproductive for you.
Want a professional's opinion? Start with the questionnaire: you register and see who will follow you, a physiotherapist registered with the Albo, chosen for your case, whom you write to in chat. If you would rather hear their voice, the first consultation is free and we look at your situation together.
What the weather studies really say
One of these studies followed 993 patients who came to the clinic with a sudden attack of back pain, cross-referencing the date of onset with the records of the weather office. Temperature, relative humidity, atmospheric pressure, wind direction and precipitation showed no association with the start of the pain. The only statistical signal concerned wind speed and gusts, with an increase in risk so small that the authors themselves judged it clinically irrelevant.
A later study of 981 patients replicated the design and concluded with a title that was not diplomatic: do not blame the weather. Rain, humidity, wind and pressure were not associated with the onset of low back pain. In one of the four analyses, a higher temperature slightly increased the chances of onset: the opposite of the belief about cold, and in any case an isolated signal that did not repeat in the other analyses.
One question remained: perhaps the weather does not make the pain start, but can make it worse day by day once the episode is already under way? An analysis of 1.604 patients with acute low back pain, who recorded their pain intensity every day for two weeks, found no relationship with precipitation, temperature, humidity and pressure, whether considering the same day, the day before, or the change between the two.
In 2024 a systematic review with meta-analysis pooled all studies of this type: 11 studies, 15.315 participants, 28.010 pain episodes. For low back pain, knee pain and rheumatoid arthritis, no association emerged with humidity, pressure, temperature or precipitation. There is one exception, and it is fair to mention it: in gout, high temperatures combined with low humidity were associated with more pain, redness and joint swelling. But gout is a different disease, with a different mechanism.
It is worth being precise about what all this means. "No association" does not mean you are imagining the pain, and it does not mean that no person in the world is sensitive to the climate. It means that, across tens of thousands of measured episodes, the weather does not help predict when your back will hurt. If it were an important cause, these numbers would have shown it.
So why does the back get worse in autumn?
The most solid hypothesis is not about the sky, but about what we do when the sky changes.
With short days and the cold, we go out less, walk less, and spend more hours sitting, between the desk and the sofa. A systematic review with meta-analysis found that time spent sitting is associated with low back pain: people who sit all day are more likely to report back pain, and the link is stronger for sitting at work. Be careful how this result is read: the data are largely cross-sectional, that is snapshots in time, and it cannot be ruled out that the relationship runs in the opposite direction (people in pain move less). The authors themselves say so. The most interesting part is another one: in intervention studies, reducing the hours spent sitting at work reduced lower and neck pain.
Then there is the mirror phenomenon in spring. After months of inactivity, everything resumes at once: running, gardening, cycling, the house move postponed for months, with a load the body is no longer used to managing. Here too the culprit is not the season: it is the sudden jump.
This change of perspective has an important practical consequence. You can do nothing about the weather. You can do a great deal about how many times you get up from your chair, how much you walk in November, and how gradually you pick things up again in March.
When the pain is not "just the back"
In the great majority of cases, back pain is non-specific: it is not possible to identify a single structure responsible, and this is the norm, not a failure of diagnosis. Only a small share of people have a well-defined cause such as a vertebral fracture, an infection or a tumour.
Small share does not mean none. See a doctor straight away, and not a set of exercises, if any of these pictures appears:
- Loss of bladder or bowel control, numbness in the "saddle" area between the thighs, weakness in both legs. This is the suspicion of cauda equina syndrome: it is an emergency, you go to the emergency department, you do not wait until Monday.
- Progressive neurological deficit: strength falling, foot giving way, tingling or numbness that spreads.
- Fever together with the pain, or pain that appeared after a recent infection or an invasive procedure.
- Significant trauma (a fall, an accident) or prolonged use of cortisone: these are among the few signs that truly shift the probability of a vertebral fracture, all the more so if they are present together. The same applies to even a mild trauma in a person with known osteoporosis.
- History of cancer: this is the sign with the greatest ability to point towards the suspicion of a lesion secondary to the spine.
- Unexplained weight loss, pain that does not ease with rest or that wakes you at night.
A useful clarification: many of the "red flags" that circulate in lists have, in fact, modest diagnostic value when taken on their own. What matters is the combination of signs and the clinical context, which is why they should be brought to a professional, not ticked off alone on a list.
And the move into summer? The same reasoning applies
The change of season that gets talked about is always the autumn one, but the same question comes up in June, with a different culprit: air conditioning.
It should be said straight away that no study has measured air conditioning: there is no case-crossover study on air conditioning, so anyone who takes it for granted is extrapolating. What has been measured is the ambient temperature, and as a variable it has not held up under testing.
What really changes between the two seasons is not the thermometer, it is what you spend time inside. In autumn it is the sofa. In summer it is the air-conditioned office: four or five hours in the same position, which we do not count because outside it is nice and we feel we move more, added to a load that changes suddenly: suitcases, hours of driving, the August move, the return to sport after months of inactivity.
The only precaution that really concerns cold is not to sit under a direct jet of air: a vent blowing on the lower back for hours, on sweaty skin, is a localised and prolonged chilling, which is a different thing from the temperature of the room. It remains a reasonable hypothesis, not a proven link, but turning the vent louvres costs nothing. The rest is in back pain and cold: what the studies really say.
What really works
Movement, and by a good margin. In a systematic review with meta-analysis of 21 randomised studies and over 30.000 participants, exercise combined with education reduces the risk of a new episode of low back pain by almost half (moderate-quality evidence); exercise alone shows a similar effect, but on lower-quality evidence. In the same work, education alone has no effect, and neither do lumbar belts and insoles: if you were considering a support belt for winter, that money goes further spent on an exercise programme.
Keep up your normal activities. The international guidelines agree: first the non-drug treatment, information, resuming movement and daily activities; medicines, imaging tests and surgery used sparingly. Prolonged rest is among the practices that the guidelines list as overused and to be reduced.
Heat, but with the right expectations. A Cochrane review found moderate-quality evidence that heat wraps give a small and short-lived reduction in pain and disability in acute and subacute low back pain, and that adding exercise improves the result further. A hot water bottle does not repair anything: it just makes moving more comfortable. Use it that way. On cold (ice), the available evidence is too limited to draw conclusions.
Gradual returns. In spring, increase load and duration bit by bit instead of trying to make up for the lost months in a single weekend.
There is, by contrast, no evidence that supplements or "anti-inflammatory" diets reduce low back pain, and they do not appear among the treatments recommended by the guidelines. If you suspect a vitamin D deficiency, that is a matter to assess with your doctor and a blood test, not a strategy against back pain.
If you want to work on the concrete points, these three articles are the natural next step: how to break up sedentary time, the exercises for the lower back and core stability.
How physiotherapy can help you remotely
A physiotherapist does two things that an article cannot: rule out that your case falls among the presentations to investigate further, and build a programme dosed to your history, your days and your starting level. Telerehabilitation lets you do this by video call, with sessions at 29,90 € each, and it is especially convenient in the months when leaving the house to go to a clinic is the perfect excuse to skip the appointment.
The point of this article, in one line: your back does not get worse because it is raining, it gets worse because when it rains we move less. The second thing, unlike the first, can be changed.
You might also be interested in:
Yoga and Physiotherapy: Benefits and How to Integrate Them Effectively Valgus Knee Exercises: 10 Corrective Movements for X-Legs Telerehabilitation: What It Is and What the Advantages Are
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Sources
- Steffens D, Maher CG, Li Q, et al. Effect of weather on back pain: results from a case-crossover study. Arthritis Care & Research, 2014. https://pubmed.ncbi.nlm.nih.gov/25044376/
- Duong V, Maher CG, Steffens D, et al. Does weather affect daily pain intensity levels in patients with acute low back pain? A prospective cohort study. Rheumatology International, 2016. https://pubmed.ncbi.nlm.nih.gov/26759130/
- Beilken K, Hancock MJ, Maher CG, et al. Acute Low Back Pain? Do Not Blame the Weather: A Case-Crossover Study. Pain Medicine, 2017. https://pubmed.ncbi.nlm.nih.gov/27980016/
- Ferreira ML, Hunter DJ, Fu A, et al. Come rain or shine: Is weather a risk factor for musculoskeletal pain? A systematic review with meta-analysis of case-crossover studies. Seminars in Arthritis and Rheumatism, 2024. https://pubmed.ncbi.nlm.nih.gov/38340613/
- Dzakpasu FQS, Carver A, Brakenridge CJ, et al. Musculoskeletal pain and sedentary behaviour in occupational and non-occupational settings: a systematic review with meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 2021. https://pubmed.ncbi.nlm.nih.gov/34895248/
- Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. The Lancet, 2018. https://pubmed.ncbi.nlm.nih.gov/29573870/
- Downie A, Williams CM, Henschke N, et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ, 2013. https://pubmed.ncbi.nlm.nih.gov/24335669/
- Steffens D, Maher CG, Pereira LSM, et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Internal Medicine, 2016. https://pubmed.ncbi.nlm.nih.gov/26752509/
- Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 2018. https://pubmed.ncbi.nlm.nih.gov/29573872/
- French SD, Cameron M, Walker BF, et al. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews, 2006. https://pubmed.ncbi.nlm.nih.gov/16437495/
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