HEALTH
If you do too, you’re a member of a very large, not very fun club. You don’t even get a T-shirt when you join! But you do get this advice on how to manage the pain that affects most of us at some point in our lives.
BY AMY MACLIN
IT IS A TRUTH universally acknowledged (by most spine specialists, anyway) that if you’re an adult, you either have had back trouble, will have back trouble, or are having back trouble right this minute. According to a study in the journal Archives of Internal Medicine, an estimated 80 percent of people in the United States will experience lower back pain at least once—but Brett A. Freedman, MD, an orthopedic spine surgeon at the Mayo Clinic in Rochester, Minnesota, believes the figure is actually closer to 100 percent. “Part of understanding back pain is understanding that it’s part of being human,” Freedman says. In fact, a Mayo Clinic study found that it’s one of the top three reasons people go to the doctor (after skin issues and joint pain).
Why do most of us have painful, er, backstories? For one thing, it’s the price we pay for walking upright. “Our spine looks straight when we’re born,” Freedman says. “When we start to walk, our body naturally adjusts our alignment to provide more flexibility and support, which is how we wind up with the classic S shape.”
Though humans’ signature standing posture has come in handy for throwing spears, carrying babies, and pushing carts around Target, it puts stress on our spines, especially in the lower back, or lumbar region. Plus, we did our backs no favors by inventing the chair: Sitting tightens our hip flexors and lower back, weakens our legs and glutes, and compresses the spinal disks, the cushioning shock absorbers between our vertebrae.
There’s a lower-back-pain gender gap: Women are more likely to suffer than men, especially after menopause.
Everyday living causes wear and tear too. We awkwardly lift heavy boxes, or slip down a few stairs carrying the laundry, or just bend over one time too many. Your body is like a pair of jeans, says D.J. Kennedy, MD, professor and chair of the department of physical medicine and rehabilitation at Vanderbilt University Medical Center. “When you’ve lived in it long enough, you can do something you’ve done a thousand times, like pick up the newspaper, and rip—there it goes.”
There’s also a lower-back-pain gender gap: Women are more likely to suffer than men, especially after menopause. This could partly be due to estrogen loss, which can make disks degrade faster, and decreasing bone density, which can raise the risk of fractures.
But most noninjury-related back pain can’t be chalked up to a single cause, says Lillie Rosenthal, DO, a New York City–based physiatrist (translation: a specialist in physical medicine and rehabilitation). “It’s usually a matter of lifestyle things we do or don’t do.” When we neglect our well-being, one negative tends to feed into another. “Say you have a big meeting and you’re stressed, so you don’t get any sleep, which is when the body repairs itself,” Rosenthal says. “And if you’re tired, you may not have enough energy to exercise, which is essential for healthy joints and circulation. Instead of moving, you sit, which leaves the muscles tighter. Plus, being inactive may increase your tension and stress, and so on. It’s a vicious cycle.”
Help, I Hurt My Back!
Here’s the good news: Your body generally knows how to heal itself. “Most back pain resolves on its own,” Freedman says. “It may take a day or two. Or if the pain was triggered by a particularly strenuous activity or an event like a fall, it could be four to six weeks.”
The first line of defense is to treat it with cold and/or hot compresses. “The traditional advice is to apply cold early to help bring down inflammation, but use whichever one feels better to you,” Freedman says. Also take hot showers or baths with Epsom salts. If you need more relief, try an anti-inflammatory med, like ibuprofen or naproxen.
In most cases, remaining active is key, even though it may be the least appealing idea to you in the moment. As back doctors like to say, motion is lotion. “Moving encourages circulation, carrying inflammatory chemicals away from the muscles and joints and replacing them with healing nutrients,” Kennedy says. Being sedentary can also weaken our core muscles, which are essential for spinal stability.
And while it’s difficult, especially when you’re nursing tender lumbar muscles, try to move normally. “A lot of people with back pain don’t move, because they’re scared,” Rosenthal says. “Then when they do move, they’re in a bracing, protective stance, which makes the muscles very tight, and they spasm, which only leads to more tension and pain.” In general, experts advise trying to go about your life as usual—unless that causes agony, which brings us to the next point.
In certain situations, you don’t want to wait to see if the problem goes away on its own. Seek prompt medical attention if you’re experiencing any of the following.
The pain radiates down your leg, or you have numbness or tingling in your legs. You may have irritated or damaged the sciatic nerve, which runs from the lower back through the butt and legs, Rosenthal says. You might need physical therapy or other treatments.
Your lower back pain came on abruptly, and you’re experiencing incontinence, an inability to urinate, or other changes to your bladder or bowel function. This could mean spinal cord issues. “Make an immediate appointment with your doctor or go to urgent care,” Kennedy says. “Since other issues can also cause these symptoms, it takes an exam and a look at your medical history to determine the next steps.”
The pain wakes you up at night. “We’re not talking about muscular pain or pain that makes it hard to roll over,” Rosenthal says. “But if it’s so bad that it’s regularly waking you, it could indicate a fracture or a tumor on your spine. See your general practitioner, who can refer you to a specialist if needed.”
It’s been six weeks and you’re just not getting better. If the pain is interfering with your life—it prevents you from doing basic activities, or it happens so often you’re constantly reaching for compresses—then it’s probably time to see your general practitioner, who may refer you to a physical therapist or a physiatrist, like Kennedy and Rosenthal. “We try to treat the whole patient,” Rosenthal says. “If somebody comes in with back pain, I’m asking, ‘What’s your computer situation like? What are you eating? What’s your stress level?’” You might need physical therapy, an inflammation-fighting diet, pain relief treatments, or mind-body techniques, like meditation. The key, Rosenthal says, is to “find somebody who is curious and can figure it out with you.”
Though humans seem destined for back pain, we can help ward off the misery by—you guessed it—staying active, especially with weight-bearing exercises (moves that make your body work against gravity, like planks) to build strong bones, and strength-training exercises to build supportive muscles. “Life is a strength-training event,” Kennedy says. “If I advise a patient to pick up a 15-pound kettlebell, they’ll look at me funny. But that’s how you build up to carrying around a 15-pound kid.”
Simple lifestyle changes can also help tremendously. “Get up every 30 minutes to move,” Rosenthal says, even if you just walk to the water cooler. She also recommends remaining hydrated (“When we’re dehydrated, nothing in our bodies works as well”), getting plenty of sleep, and if you smoke, giving it up, as it inhibits circulation and oxygenation, essential for healing. “Back pain is miserable,” Rosenthal says. Thankfully, she adds, “the body really wants to heal and be healthy, and there’s so much we can do to support it.”
JILLIAN MICHAELS has doled out health and wellness advice on TV, launched a wildly popular fitness app, and pulled off countless pistol squats (for the uninitiated, those are one-legged squats with the other leg extended in front of you). But she’s no stranger to back pain. In 2021 she suffered a severe injury, and it didn’t happen on a black diamond ski slope. She slipped on a wet bathroom floor, smacking her lower back into the bathtub. “I saw stars,” she says, “but I didn’t think I’d done any real damage.”
In the weeks that followed, Michaels kept pushing through her regular travel and workout schedule, all while noticing that her lower back was increasingly tight and her back muscles sometimes felt like they were spasming. “I assumed it was stress and was stretching a lot and doing things like deep tissue massage,” she says. Nothing helped. Four months after her fall, the pain had gotten so bad she couldn’t stand up, and her wife rushed her to the emergency room. Eventually Michaels was diagnosed with three herniated disks and a fractured vertebra. (Yes, it’s possible to walk around with a broken back.)
She had several epidurals to treat the pain and practiced rehab techniques from her spine specialist, Stuart McGill, PhD. (She’s a fan of his book, Back Mechanic.) For three months, she spent time lying on her stomach (doctor’s orders!), then began relearning ways to move—walking, opening doors— that wouldn’t put extra pressure on her spine. She also discovered the DB Method, a workout that uses a squat machine to stabilize the back while strengthening the glutes and core (she’s now a spokesperson).
These days, she’s feeling herself again, but she’s more cautious, and she has regretfully given up the pistol squats. The trainer known for her tough-love approach wishes she’d gone easier on herself. “They say when your back hurts, you have to walk, and there’s truth to that,” Michaels says. “But if you’re in acute pain, don’t take matters into your own hands.”
Illustrations by Ana Ayala