Why Your Back Hurts, and What You Can Do About It
Saying “my back hurts” is a bit like saying “my car is making a noise.” It may be serious, or it may be nothing, and only a professional will know for sure. But if you have back pain, especially in your lower back, you’re not alone: By some estimates, 75% of us will have an achy lower back at some point in our lives, often without any obvious cause.
I cannot diagnose your back pain over the internet. That said, I can tell you about common reasons for back pain, and provide general strategies that can help you feel less achy.
Back pain doesn’t always mean you’re injured
We tend to assume that pain is a sign that some part of our body is damaged and needs fixing. But that’s not always true. When it comes to back pain, around 90% of the time there is no detectable injury. That doesn’t mean that the pain is imaginary—there can be physical causes that don’t show up on x-rays or MRIs, and other factors also contribute to us feeling a sensation of pain.
Doctors and scientists used to think of pain as a simple signal sent from damaged body parts to the brain. It’s now considered more accurate to say that pain is a perception created in the brain in response to a variety of things we experience. Tissue damage can be one of them, but our experience of pain is also shaped by our expectations, our fears, and other things going on in our brain and body.
You might feel pain more acutely if you’re stressed or worried about it. This increases your stress, and things snowball from there. Or maybe you’ve been to the doctor about something that was worrying you, only to find out that the issue is actually very minor, and you’ll be fine. It’s not unusual to experience less pain from that point onward, even though nothing has physically changed.
Obviously, there are back problems that are physical and fixable, so it’s definitely worth getting checked out to rule out serious issues. But if you just have an achy back sometimes and your doctor says nothing is seriously wrong, what can you do?
A strong back tends to be a healthier back
Exercise tends to help people with low back pain feel better, according to a 2021 meta-analysis of trials that included everything from strength training to Zumba.
If you’re dealing with pain on a daily basis, the first step doesn’t have to be finding the “best” exercises to deal with it. Instead, focus your efforts on finding something you can do without experiencing pain, or at least without increasing your pain. A physical therapist can help guide you through this process, especially one who specializes in sports medicine or who has experience working with active people. (Some physical therapists prescribe exercises that are too easy to be effective, especially to older adults; this is a recognized problem in the industry.)
There is still disagreement on exactly what kind of exercise is best to prevent or treat back pain. Some PTs focus on core work, believing that it’s crucial for your deep core muscles, such as the transverse abdominis, to be strong to protect your back. Using this approach, you may find yourself doing a lot of dead bugs and bird dogs, and get a lot of practice drawing your belly button in toward your spine.
Another school of thought holds that core muscles are only a small part of the picture, and that strengthening your back muscles themselves should be the focus of training. This approach is more likely to favor work with free weights, like deadlifts, dumbbell rows, and lunges. Done correctly, these moves also work your core; you need to brace your core to stabilize your spine for a deadlift or squat, and that’s as legitimate a type of core work as anything you do on a yoga mat.
Sore muscles are okay, actually
It’s normal to be concerned about protecting your back. After all, if you’ve heard a million times not to “lift with your back,” you might worry that any soreness after lifting or bending means you injured something.
But there are muscles in your back, and they can get fatigued or sore when you use them a lot—just like the muscles in your arms or legs. You wouldn’t be surprised or worried if you had sore thighs after a heavy squat day or after running a race. The muscles in your lower back can feel sore after your deadlift day at the gym, or even after a long day of standing and walking more than you’re used to.
Sometimes people confuse this normal soreness with injury, and worry that those deadlifts did something terrible to their back. But before you panic, consider treating your back the same way you would any other sore muscle: Use gentle heat, walk around a bit, and consider foam rolling or massage. The pain from sore muscles tends to feel a bit better with activity, and will usually fade within a few days.
Stretches and exercises that are good for people with back pain
What exercises can you do to potentially prevent back pain and possibly manage back pain you already have? Again, it’s best to check with a professional to be sure of what makes the most sense for you, but here are some strengthening and stretching exercises that are often recommended:
Core exercises
Back-strengthening exercises (with barbells, dumbbells, or kettlebells)
Deadlifts or Romanian deadlifts
Rack pulls or block pulls
Split squats or your favorite regular squat