Therapist Q&A: Back Pain

Back pain is one of the most common issues that bring people to physical therapy. Read on to learn the answers to some of the most common patient questions about back pain!

I’ve been having more back pain as I age. Is this an unavoidable part of aging, or can it be resolved?

Back pain can certainly become more common as you get older, in fact, the World Health Organization reports low back pain occurs most frequently in people between the ages of 35 and 55. The onset of degenerative conditions in the back, such as arthritic changes or disc degeneration, can also contribute to the risk for back pain as well. I think it is important to note, however, that the presence of these changes does not necessarily “doom” someone to a life of back pain. I have had many patients where they had mild to no back pain and had significant arthritis in the low back when x-rays were taken; on the flip side, I have also had patients with severe back pain and no significant findings were noticed on advanced imaging. A lot of times, back pain can be provoked by our daily activities, so sometimes changing the way we do things and improving our abilities can make a big difference in resolving pain. At that point, learning from these adjustments and continuing to make them in the future can be a great way to keep back pain at bay.

Where is the most common back pain?

Back pain can be complex and may be caused by many different factors. Most commonly, I see patients with pain across the low back, just above the pelvis. I’ll also see patients with pain along the pelvis or with radiating pain down a leg. Sometimes, patients will come in with a mixture of these symptoms and I must figure out why!

What everyday activities should I avoid that may be making my back pain worse?

In general, bending and twisting motions tend to be most bothersome to the back, especially if these activities are done while carrying a heavy object. Prolonged activity also tends to be problematic; for example, I had a patient who had to bend forward for about 30 minutes to wash his dog and his back pain was flared up after this activity. Because of this, I often try to have my patients adjust their postures regularly to avoid staying in one position for too long.

What are the best stretches for back pain?

Because back pain can be caused by many different factors, the best stretches for one individual may not be as effective for someone else. Generally, hip stretches can be helpful for many people, as stiffness within the hips can increase strain on the low back during activity. Stretches to the chest muscles can also be helpful, especially if pain begins to be present higher up in the back.

One thing I discuss frequently with patients is ensuring that they avoid stretching through pain as we treat their backs. Understandably, stretching is not always comfortable. But if stretches are provoking significant discomfort, tingling, or your symptoms are worse afterwards, you are either stretching too hard or doing the wrong kinds of stretches for your problem. Seeing a physical therapist for guidance can be helpful in this situation.

Is my posture really contributing to back pain? How can I correct it while working at my desk?

I work on posture a lot with patients because it absolutely can contribute to pain! As I mentioned previously, prolonged positions can be bothersome to the back. Our muscles and connective tissue work to keep our body in position and if we stay in positions that are inefficient for a long time, muscle strains can occur and lead to pain. A lot of times, we aren’t aware we are even doing this; there have been many occasions when I have been sitting and working for a few hours and then stand up with an ache in the back or neck due to the way I was sitting!

Because we are not always aware of how we are positioned, correcting posture can be difficult; it requires a lot of vigilance to check in on your positioning through the day. One of the best ways to work on posture is to try to take movement breaks regularly through the day. Poor posture tends to be most bothersome when it is held for a long time, so getting up and changing position regularly can make a big difference. Sometimes I have patients set a timer on their phones when they work to remind them to get up and change position.

Adjusting desk setup can also be helpful if work tends to bother your back. ACCESS PT has some good resources explaining general principles of ergonomics, but you want to get your desk, computer, and chair all lined up well so your body can work efficiently and comfortably. A physical therapist can also provide suggestions if workspaces are more complex or if you are having trouble figuring something out.