MOVEMENT SNACKING FOR MECHANICAL LOW BACK PAIN: EVIDENCE, BEHAVIOURAL RATIONALE AND A TRAFFIC LIGHT MICRO-DOSING FRAMEWORK

Background: Mechanical low back pain (LBP) is a common musculoskeletal problem associated with pain, stiffness, activity limitation and reduced participation. Prolonged sedentary behaviour and uninterrupted sitting may be relevant for some individuals, particularly when combined with low physical activity, reduced movement variability, fear of movement and difficulty maintaining structured rehabilitation programmes. Movement snacking—brief, repeated bouts of purposeful movement distributed across the day—has emerged as a potentially practical strategy for interrupting prolonged sedentary behaviour. However, the evidence remains heterogeneous and does not establish a standardized clinical dose. Objective: To synthesize available evidence concerning movement or exercise snacks, active breaks, prolonged sitting and behavioural adherence in relation to mechanical LBP, and to develop a clinically reasoned Traffic Light Micro-Dosing Framework (TLMS) for future evaluation. Methods: An integrative narrative review was developed from the two source manuscripts supplied for this study. The literature considered acute/mechanical LBP, therapeutic exercise, active breaks, sedentary behaviour, self-management, exercise adherence, movement snacking and fear of movement. The source manuscripts report searches of PubMed, Cochrane Library, Web of Science and SCI/Scopus-indexed literature and incorporation of relevant clinical guidelines and reviews. The evidence was synthesized narratively rather than through meta-analysis. Because the source material does not provide a fully reproducible search string, duplicate-removal process, complete screening counts or formal risk-of-bias assessment by the present authors, this manuscript is presented as a narrative/integrative review rather than a systematic review. Evidence Synthesis: The most directly relevant evidence summarized in the source material is a 2026 systematic review of six randomized controlled trials involving 210 participants investigating exercise snacks for musculoskeletal discomfort associated with prolonged sitting. Four trials reported beneficial findings and two reported null between-group findings; five of six trials were judged to have high risk of bias. Workplace evidence also suggests that active breaks and postural shifts can influence discomfort and, in some high-risk office-worker populations, the incidence of new low-back pain. These findings provide a rationale for further investigation but do not establish movement snacking as a proven treatment for established mechanical LBP. Framework The proposed TLMS organizes brief movement opportunities according to behavioural triggers and current symptom status. Red represents higher symptom sensitivity and emphasizes low-threat symptom- settling activity; Yellow represents manageable pain or stiffness and emphasizes gentle mobility and postural movement; Green represents relatively favourable symptoms and emphasizes functional movement, balance and capacity building. The framework is intended to complement, not replace, individualized physiotherapy. Conclusion: Movement snacking is a promising adjunctive behavioural strategy, but the TLMS remains conceptual and experimentally developing. Feasibility studies and adequately powered randomized controlled trials are required before the framework can be considered a validated clinical intervention. Keywords: low back pain; mechanical low back pain; movement snacking; exercise snacks; sedentary behaviour; active breaks; micro-dosing; kinesiophobia; behavioural adherence; physiotherapy; rehabilitation