Back Pain: Finding solutions for your aching back

Treatment of back pain has undergone a recent sea change. Experts now appreciate the central role of exercise to build muscles that support the back. This Special Health Report, Back Pain: Finding solutions for your aching back, helps you understand why back pain occurs and which treatments are most likely to help. This report describes the different types of back problems and the tailored treatments that are more likely to help specific conditions.

Back Pain: Finding solutions for your aching back Cover

Pain Relief: Natural and alternative remedies without drugs or surgery

Pain relief takes many forms. This Special Health Report, Pain Relief: Natural and alternative remedies without drugs or surgery, looks beyond the standard approaches of drugs and surgery and explores alternate pain-relief strategies, from acupuncture and mind-body therapies to chiropractic medicine, physical and occupational therapies, herbal remedies, mindfulness meditation, and music therapy among others. The report also provides…

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Back pain has many causes and, as a result, many treatments. This Special Health Report, Back Pain: FInding solutions for your aching back, helps you understand why back pain occurs and which treatments are most likely to help. Treatment of low back pain has undergone a recent sea change. Experts now appreciate the central role of exercise to build muscles that support the back. They also better understand which conditions surgery will help and which patients are good surgical candidates. This report describes the different types of back problems and the tailored treatments that are more likely to help specific conditions. A special section is dedicated to the self-care steps you can take to mend your back, and features information on different types of exercise and complementary therapies such as chiropractic care, acupuncture, and massage, as well as healthy back habits and tips on choosing a mattress.

This report was prepared by the editors of Harvard Health Publishing in consultation with Jeffrey N. Katz, M.D., M.S., Professor of Medicine and Orthopedic Surgery, Harvard Medical School. 48 pages. (2014)

  • Who develops back problems?
    • Age
    • Gender
    • Family history
    • Work and play
    • Physical characteristics and posture
    • Psycholigical factors
    • Other factors
  • The anatomy of your back
    • Disks: Your back’s shock absorbers
    • A flexible, protective column
    • Ligaments and muscles
    • Nerves
  • Why does your back hurt?
    • Sprains and strains
    • Nerve-compression syndromes
    • “Red flag” situations
    • Other causes of back problems
  • Diagnosing back pain
    • Your medical history and exam
    • Imaging studies and other testing
  • Assessing your treatment options
    • Factors to consider
  • SPECIAL BONUS SECTION: Healing your back
  • Medications for back pain
    • Over-the-counter pain relievers
    • Prescription pain relievers
  • When surgery is an option
    • Surgery for disk disease
    • Surgery for spinal stenosis
    • Surgery for compression fractures
    • Surgeries for other back problems
  • Guidelines for recovery
    • Five rules for a safe comeback
  • Resources
  • Glossary

Who develops back problems?

If you’re like most adults, you’re likely to suffer from low back pain at some point in your life. Although anyone can develop backache regardless of their health or circumstances, research has found that some conditions or activities put you at greater risk for such problems. Key factors include the following.


People are most likely to suffer from low back pain in midlife. During the middle years, even in the absence of any injury, the bones and joints in your lower back (the lumbar spine) begin to change. Disks (the structures that serve as cushions between the bones in the spine) tend to wear out and sometimes become fragmented. These structural alterations sometimes cause pain. While back pain problems may be more common in people in their middle years, in older individuals back pain attacks are more severe and last longer.


Studies suggest that back pain plagues men and women equally. However, in Western industrialized societies, men are more apt to have disk problems, and they are more likely to be treated surgically. These differences most likely reflect the fact that a greater number of men than women work in jobs that involve heavy lifting, pushing, and pulling, and that men in such jobs often feel the need to return to work as soon as possible following an absence due to back pain.

On the other hand, osteoporosis (loss of bone density and strength) occurs in women much more often than men. This disorder can cause severe weakening of vertebrae and may eventually lead to vertebral fractures. Vertebral fractures can cause a loss of height and a rounding of the back. They can also be very painful. Women are also especially susceptible to degenerative arthritis of the lower spine (a condition that generally involves the vertebral joints). They are also more likely to develop spondylolisthesis (an abnormal forward displacement of a vertebra relative to the one below it).

Family history

Heredity appears to play a role in certain types of back pain. Defects of the disks seem more common in some families; a hereditary difference in the chemical makeup of disks may render them more prone to fragmentation or herniation, conditions that can trigger back pain. Ankylosing spondylitis and spondylolisthesis likewise seem to run in families.

Work and play

Certain jobs and activities put a greater strain on your back. Riding in motor vehicles is notoriously hard on your back, for instance, because it involves prolonged periods of sitting and exposure to vibration. The sitting positions necessary for office work — from typing to computer programming — can also eventually take a toll on your back regardless of your age.

Several other job-related activities increase the likelihood of future back problems:

  • lifting or forceful movements such as pulling and pushing
  • frequent bending or twisting of the back
  • heavy physical exertion
  • maintaining the same position for long periods
  • repetitive motion patterns
  • prolonged exposure to vibration.


Physical characteristics and posture

Your build, weight, and height seem to have little to do with your likelihood of developing back pain, although being overweight puts you at increased risk of having your symptoms return. Even a moderate difference in leg length (up to three-quarters of an inch) has no proven adverse effect on the lower back.

And despite your mother’s admonition to “sit up straight,” experts now agree that, in most cases, posture alone — whether bad or good — will neither predispose you to back pain nor shield you from it. Slumping and slouching don’t seem to have much effect on the basic health of your spine. But before you sit in your chair, note that poor posture can exacerbate existing back pain. Improving your body mechanics can help relieve your symptoms and prevent recurrences.

Psychological factors

A growing body of evidence shows that our emotions and psychological well-being have a significant influence on our physical health. It is not surprising, therefore, to learn that these factors also affect the back. Although study populations and methods vary, in general, research has shown that psychological factors such as stress, anxiety, and negative mood and emotions all increase the likelihood of developing acute (sudden) or chronic (longer-lasting) back pain. Such psychological factors seem to be especially important in determining whether an acute bout of back pain will become a chronic problem. One review of studies that examined this question, for example, found that people who were distressed or depressed were more likely to develop chronic back pain than other people. The reasons for this are not completely understood. Symptoms of chronic pain and depression share some of the same biochemical roots. The neurotransmitters serotonin and norepinephrine, for example, not only are involved in mood disorders such as depression but also are important in producing the sensation of pain.

Fortunately, this dynamic can also be reversed: by changing the behaviors and thinking patterns that may aggravate and worsen the situation, it is often possible to alleviate low back pain and prevent it from becoming a long-term problem.

Other factors

How you live can make you more susceptible to back pain. Research shows that smokers are at greater risk. And being physically out of condition is an important reason people have a recurrence of the “sprain and strain” type of back pain.

A person’s education level and job situation appear to have an association with back pain, according to many studies. People who are unhappy at work because a job is unfulfilling or the pay is low tend to develop more back problems than the general population. The exact reasons for this are unclear, but these findings underscore the importance of psychological and social factors.

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