Back Pain: Causes, Prevention, Treatment, and Best Exercises

Your back has a very important job. From putting your shoes on or playing catch with your kids to sitting in front of your computer, your back is involved in most everyday activities. Many people assume that’s why back pain is so common. What many people don’t realize is that although back pain is common, it’s not inevitable. Even if you’re prone to back pain, there’s a lot you can do to manage it and start feeling better.

Here, learn more about what causes back pain, and how to prevent and treat it — especially with exercises from our Hinge Health physical therapists.

What Is Back Pain? 

Your back is a complex structure that’s made up of three sections: the cervical spine (neck), thoracic spine (mid-section of the spine), and lumbar spine (low back). The sacrum and coccyx bones sit at the bottom of the spine. Back pain is a general term for pain that occurs anywhere in the thoracic or lumbar spine — between the base of your neck and tailbone. 

The muscles, bones (called vertebrae), discs, tendons, ligaments, nerves, and other structures in your back all work together to provide the strength and flexibility needed to protect your spinal cord, support your body, and allow you to move. The structures of the back are incredibly strong and resilient, but certain injuries and problems with the back can lead to back pain.    

Back Pain Symptoms

Back pain can range from a dull ache to shooting, burning, or stabbing pain. Other symptoms include: 

• Persistent stiffness anywhere from the base of the neck to the tailbone

• Sharp, localized pain anywhere in the back 

• Pain that gets worse with bending, twisting, lifting, standing, or walking

• Backache after staying in one position for a long time 

• Muscle spasms with standing

Back pain may come on suddenly (after lifting something heavy, for instance) or it can develop gradually. It can be characterized as acute (lasting less than 12 weeks) or chronic (lasting longer than 12 weeks). 

Back Pain: A Hinge Health Perspective 

Back pain can feel frustrating, upsetting, or even a little hopeless, especially when it persists or interferes with your daily activities. No matter how bad your back pain is, or how long it’s been going on, you can always do something to help improve it. And that usually starts with moving more. Although moving through back pain can be scary and uncomfortable, small changes to your habits can yield huge benefits. And no matter what might be causing your back pain (which we’ll discuss below), you're in the right place to get support for dealing with it.

Causes of Back Pain

Anyone can develop back pain, but certain risk factors may increase your chances, including:

• Advancing age (lower back pain becomes more common after age 45) 

• Fitness status, especially lack of muscle mass (strong back and abdominal muscles support the spine)

• Excess weight, which puts extra stress on your back

• Smoking 

• Occupations and hobbies that require frequent or heavy lifting, pushing, pulling, or twisting 

• Sedentary lifestyle or job 

• Pregnancy, due to hormone, posture, and weight changes 

Here are other common reasons you may experience back pain.

Sprains and strains. An injury to the soft tissues in your back can cause temporary pain. Sprains (ligament injury) and strains (muscle or tendon injury) may result from lifting heavy objects, lifting from an awkward position, or repeated lifting that your body isn’t prepared for. 

Herniated disc (also called a ruptured or slipped disc). Discs act as cushions between the bones (vertebrae) in your spine. If a disc bulges from its place, it can put pressure on a nerve and cause back pain. It’s worth noting that discs are designed to bulge so we can move. A herniated disc is only a problem if it catches a nerve root and causes symptoms. 

Degenerative disc disease. It’s common for intervertebral discs to change as you get older. In some cases, this can contribute to pain, but most of the time these changes are harmless — much like gray hair. In fact, a study from the American Journal of Neuroradiology found that 96% of people over age 80 with no back pain showed signs of disc degeneration on MRI. In another study of young adults without any back pain symptoms, 77% showed structural abnormalities on an MRI. 

Sciatica. The sciatic nerve runs from the low back down the legs. If it gets pinched (often from a herniated disc), it can cause shooting pain that travels down the buttocks and into one or both legs. 

Spinal stenosis. This condition occurs when the spinal column narrows and puts pressure on the spinal cord and nerves. It’s often characterized by pain that gets worse when walking and improves upon sitting down.

Spondylolisthesis. This is characterized by a vertebra in the spine moving out of its normal place. If there is excessive motion of the vertebra or if the vertebra puts pressure on a nerve, it may contribute to symptoms.  

Arthritis. Osteoarthritis is one of the most common types of arthritis, characterized by changes in the shock-absorbing cartilage between bones. Sometimes, these changes don’t cause any symptoms, but they can contribute to symptoms such as pain and stiffness that tend to worsen after activity for others. Other types of arthritis affect the back, too, such as spondyloarthropathies— chronic inflammatory diseases that can affect the spine and pelvis.  

Osteoporosis. Loss of bone mass in the vertebrae can result in painful fractures in the back.

Scoliosis and other congenital changes in the spine are characterized by abnormal curvature.  

Other medical problems such as kidney stones, cauda equina syndrome (nerve dysfunction near the low back and tailbone), cancer, infection, endometriosis, and sleep disorders can all contribute to back pain.  

When to See a Doctor 

Back pain usually doesn’t indicate a serious problem, though it’s normal to be concerned about it. Many people wonder, “How do I know if my back pain is serious? Shouldn’t I see my doctor, just to be safe?” 

“Unfortunately, many people will experience lower back pain at some point in their lives,” says spine surgeon Raymond Hwang, MD, senior medical director at Hinge Health. “While the pain can be very uncomfortable, the good news is that most cases of back pain improve with time and non-surgical treatments such as rest, NSAIDs, physical therapy, and spinal injections. Most episodes of lower back pain are not dangerous, but there are some situations when you should seek medical attention for additional care and possibly surgery.” 

See a doctor if your back pain: 

• Persists for several weeks without improvement 

• Extends down one or both legs, especially if it reaches past the knees

• Causes weakness, numbness, or tingling in the legs

• Occurs with numbness near the groin 

• Begins after a fall, accident, or blow to the head  

• Is accompanied by unexplained weight loss, fever, or bladder or bowel problems

Prevention Tips

If you’re prone to back pain, there are many things you can do to manage and prevent it. 

• Get regular exercise. Combine aerobic activities and strength training for better muscle endurance and function to support your spine and prevent back pain and injury. Strengthening your core muscles may be especially important. “Research that shows increased core strength improves back pain,” says Hannah Hargis, PT, DPT, a physical therapist at Hinge Health. “While we can’t say that lack of core strength is the sole cause of back pain — remember, back pain is very complex — there’s good evidence that combining core-strengthening exercises with total body and endurance exercises can help prevent back pain from occurring or worsening.”  

• Maintain a healthy weight for you as excess weight can put extra strain on back muscles. 

• Quit smoking. Risk of developing back pain increases with more smoking. 

• Wear the right shoes. Flat shoes with good support put less strain on the back than high heels or flat shoes that lack support (such as flip-flops). 

• Check your bed. If your pain is consistently worse in the morning, your mattress may be a factor. The Sleep Foundation recommends assessing your mattress every six to eight years. Many people with lower back pain benefit from a medium-firm mattress, but this is a personal preference. The most important thing is that your mattress supports you well enough to maintain the same curvature of your spine as when you stand.

• Change your sleep position. Try to sleep on your back or side — stomach sleeping can put extra strain on your back. When sleeping on your side, try placing a pillow between your knees. If you prefer to sleep on your back, place a pillow under your knees or the small of your back to reduce pressure on your back muscles. 

• Keep moving. As Hinge Health physical therapists say, your next position is your best position. If you have to stay in one position for long periods of time, such as working at a desk, make a point of moving around and changing positions frequently to avoid pain and stiffness. 

• Do exercise therapy. Targeted gentle movements, exercises, and stretches increase the strength and flexibility of the structures in your back. This reduces stress on the spine and helps reduce risk of low back pain. (More information on this below).  

Posture and Back Pain

Hinge Health physical therapists love to educate members on this surprising fact: There is no such thing as perfect posture and “bad posture” doesn’t cause back pain. 

“One of the biggest misconceptions I hear from patients is that their back pain is solely due to ‘bad posture,’” says Hinge Health physical therapist Dylan Peterson, PT, DPT, a physical therapist at Hinge Health. “How you hold yourself is not what’s important. What matters is how long you stay in one particular position. Ballerinas and soldiers stand with ‘perfect’ upright posture and they are still prone to aches and pains. Holding one position for too long, whether it is with ‘good’ or ‘bad’ posture, can be irritating to your back and it is an important consideration as you sit, stand, or set up your desk.”

If you’re prone to back pain, changing how you sit, stand, and lift may help prevent future flare-ups. 

• Sitting: When possible, choose a seat with good lumbar (low back) support. You can also place a pillow or rolled-up towel against the small of your back to help maintain its natural curvature when sitting. Adjust the height of the chair so that your feet touch the floor, or use a footrest so that your knees and hips sit at the same level. 

• Standing: Try not to hunch over or lean to one side. Rather, stand up straight, maintain a neutral pelvic position, and distribute your weight evenly across both feet to reduce load on your low back. 

• Lifting: A common myth is that lifting is inherently bad for your back. Recent evidence has challenged the idea that you should avoid lifting to protect your back. Even if you experience pain or flare-ups, lifting is almost always safe and can be an important motion to help get your back pain under control. As you lift, remember to:

  • Be intentional about your body position. We are naturally stronger in certain positions. Take a moment to find a firm stance and squat down (instead of bending over).  

  • Engage your core muscles. 

  • Keep the object being lifted close to your body. 

  • Keep your neck in a neutral position (not looking up or down). 

  • Above all, lift in a way that feels comfortable for you.

Treatment for Back Pain

The right course of treatment for back pain depends on the nature and cause of your pain. The following tips from our Hinge Health physical therapists and medical doctors can provide relief for mild to moderate back pain.

• Over-the-counter (OTC) medication. Pain relievers, such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol), can be helpful for back pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Ice and heat. Alternate using an ice pack and heating pad for 20 minutes at a time as needed to reduce inflammation (ice) and increase blood flow to combat stiffness (heat).  

• Topical pain relievers. These products come in creams, salves, ointments, and patches. They deliver pain-relieving substances (usually ibuprofen, menthol, or lidocaine) through your skin. 

You can talk to your medical provider about the following if you need more back pain relief: 

• Steroid injections. If over-the-counter medication does not offer sufficient pain relief, your doctor may suggest cortisone steroid injections. These shots contain an anti-inflammatory steroid that’s injected into the epidural space of the back, or around small joints in the back known as facet joints. They can offer back and leg pain relief by decreasing inflammation near the nerve roots, and can also provide diagnostic clarity as to the sources of the pain. 

• Radiofrequency neurotomy. This is a procedure in which a small needle is inserted near the location of your pain. Radio waves are passed through the needle to damage the nearby nerves, which interferes with the delivery of pain signals. If back pain is thought to be coming primarily from the facet joints in your back, this can be a good option.

• Traction. Traction uses weights, pulleys, or an inflatable device to gently stretch your back, which can help relieve pain in some people. 

• Electrical stimulation. There are a few forms of electrical stimulation that can help pain: 

  • Implanted nerve stimulators are devices that get surgically implanted to deliver electrical impulses to specific nerves with the intent of blocking pain signals. 

  • A transcutaneous electrical nerve stimulation (TENS) unit is a device that delivers tiny electrical impulses through electrodes placed on your skin near the site of your pain. The electric current disrupts pain signals from nerves in the body. 

• Complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for back pain relief, such as massage, acupuncture, or chiropractic care.

While all of the above steps can help back pain, one of the most effective is exercise therapy.

Movement is the not-so-secret sauce to back pain relief. Many people worry that movement or activity will make their pain worse. Remember that your back is incredibly strong and resilient. The human body is designed to move, and too much rest and not enough movement can actually make back pain worse.

The given gentle stretches and exercises recommended by Hinge Health physical therapists improve the strength, flexibility, and range of motion of the muscles and tendons in your back and surrounding areas. 

New exercises can make your back feel a little sore at first but that doesn’t mean movement is harmful. The National Institute of Arthritis and Musculoskeletal and Skin Diseases recommends starting slowly and gradually increasing the amount of exercise you do for steady improvement.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Surgery for Back Pain 

Surgery is rarely needed to address back pain. Most cases can be managed with exercise therapy and conservative measures. Surgery is usually most appropriate for people with: 

• A structural problem that causes severe, constant pain

• Nerve compression that causes muscle weakness

• Spinal cord compression that limits daily activities

Common surgical procedures for the back include: 

• Lumbar decompression: This type of surgery is intended to reduce pain caused by compressed nerves in the low back. Two of the most common types are laminectomy and discectomy. The term -ectomy refers to removal of a body part. A surgeon removes one or more lamina (bony structures shaped like small arches that form a “roof” over the spinal canal) or discs to create more space for spinal nerves. 

• Lumbar fusion: A surgeon inserts implants (usually screws, rods, and cages) and bone graft across two or more vertebrae so they fuse together. This helps stabilize vertebrae, improve spinal alignment and curvature, and in many cases, increases space for spinal nerves. 

• Disc replacement: An artificial disc replaces an existing intervertebral disc in the back to restore disc function and create more space for the nerves.

Talk to your doctor about whether you’re a good candidate for surgery. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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