Deborah Douglas likes to walk to work, but she usually stops halfway to rest her back. A lecturer at Northwestern University, the 56-year-old is often on her feet, which has become more difficult since she was diagnosed last year with arthritis in her back, a condition known as spondylosis.
“I’m in pain all the time,” she says. The pain radiates down her legs, making her whole body miserable. Sometimes, it just hurts when she has to move. “I find myself mentally anticipating all the pain I’m going to feel when I have to move. It’s just not a normal way to live.”
Douglas’ condition is fairly typical. About eight out of ten people will experience back pain at some point in their lives, and these symptoms tend to become more common after about age 45.
Why does my back hurt?
Back pain can be caused by simple muscle tension or by an underlying condition such as kidney stones, endometriosis or cancer. Chronic back pain, especially in middle age, can develop for a number of reasons, including degenerative disc disease, nerve root irritation, arthritis or a displaced vertebra, says Nicholas Beatty, a physiatrist specializing in sports medicine and spine at the Hospital for Special Surgery in New York City.
Pain appears to occur slightly more often in women than in men, which may be due to anatomy, biology, or a combination of factors, including a person’s environment or job. Bending, twisting, lifting, walking, or even standing can make it worse. Many middle-aged adults are also “weekend warriors” who are relatively inactive Monday through Friday and then very active on the weekends. This increases the risk of sprains, strains, and disc injuries.
There’s also ergonomics. A mattress that’s too soft, poor posture, an unsupportive chair, hunching over a laptop or phone, and a sedentary lifestyle can all contribute to persistent pain. Psychological distress (chronic stress, anxiety, or depression) can worsen mechanical back pain and be a source of back pain itself, Beatty says.
“Personal beliefs about back pain and anxiety-related fear of moving when in pain can increase the intensity of the pain and make it last longer,” he explains.
You are also at higher risk of suffering from chronic back pain if you
- Don’t exercise
- You have an existing medical condition such as arthritis or cancer
- Are overweight
- Lift using your back instead of your legs
- Smoking or using other tobacco products
Other types of chronic oxidative stress, such as a diet high in processed foods, prediabetes, diabetes, metabolic syndrome or poor cardiorespiratory fitness, can create inflammation inside the disc, leading to more rapid disc degeneration beyond normal aging, Beatty says.
How to Treat Back Pain at Home
You can initially treat most chronic back pain at home, with low-impact exercises like swimming, gentle stretching, or walking, combined with ice or heat, and over-the-counter medications like ibuprofen. These techniques usually help relieve pain, loosen knotted back muscles, and make daily activities easier.
While the evidence varies on alternative approaches like acupuncture and structural integration, Beatty says there’s little risk in trying them as long as you vet the practitioner first.
What to Do When Home Treatments Don’t Work
If the pain persists, it’s time to see a doctor. If you experience severe pain, notice bowel or bladder changes, weakness, fever, chills, or unexpected weight loss, see a doctor immediately. Additionally, “people with cardiovascular or kidney disease need to make sure their back pain is simply mechanical and not medical. It’s important to have their pain evaluated and determined by a doctor,” Beatty says.
Sibyl Wilmont, a 54-year-old nurse researcher in Chapel Hill, North Carolina, has suffered from back pain for much of her life. She even quit her job as an emergency room nurse to take a less physically demanding position: “My body was betraying me. I had such terrible back spasms that I couldn’t get up off the floor.”
After being diagnosed with multiple herniated discs, she tried numerous treatments, including cortisone injections and physical therapy, with little success. Other options—disc surgery, spinal fusion, regular epidural injections or learning to live with chronic pain—proved equally unappealing.
Wilmont’s physical therapist suggested she get evaluated for sacroiliac, or SI, joint dysfunction, an extremely painful condition that can be difficult to diagnose and is often mistaken for a herniated disc or sciatica. A sacroiliac specialist quickly confirmed that it was the root cause of her pain.
Although this condition is most commonly seen in pregnant women, it can also occur for other reasons. In Wilmont’s case, horseback riding falls as a child likely destabilized the joint. At age 43, she opted for open joint fusion surgery, and once healed, she was pain-free in her sacroiliac joint for about a decade.
“It gave me life again,” she says. The pain from her herniated discs is manageable with ibuprofen and rest.
Be proactive about your back health
A healthy, multifaceted approach at home can help prevent back pain; optimizing overall health and well-being is essential:
- Get up and walk around every hour, especially if you have a sedentary job.
- Do some gentle stretches every day.
- Take a few leisurely walks around the block to keep your muscles limber.
- Replace your mattress if it is more than 10 years old.
- Develop a daily practice of exercises or postural cues to improve body positioning over time. Most posture issues are modifiable and can be optimized.
- If you have a physically demanding job or need better office ergonomics, work with your human resources department. Many human resources departments partner with occupational therapists to conduct an office assessment. If a new injury is a concern, discuss your job description and physical demands with your doctor and human resources manager.
- If you experience pain, avoid aggressive manipulation, strenuous exercise, or high-speed movements until you receive a diagnosis.
- Limit taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen to no more than two weeks; prolonged use has been associated with gastrointestinal problems and you may become dependent on these medications.
Consider several options for pain management. Neuropathic medications can help target specific nerve pain. Physical therapy and exercise can help strengthen core muscles to better support the spine. Spinal manipulation can improve both pain and function. Surgery may be appropriate for certain conditions (e.g., disc problems and stenosis) and increase spinal stability. If you are unsure about whether surgery is necessary, seek a second opinion.
“Get the best diagnosis, then use the evidence to treat it, instead of just calling it back pain,” Beatty says.