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Back Pain & Back Problems

About 8 in 10 people have back pain at some point. Most low back pain is not serious and gets better within a few weeks. Staying active, heat, and hands-on and mind-body care are first-line options — and a few warning signs need emergency care.

What is back pain?

Back pain can be anything from a dull, constant ache to a sudden, sharp pain (MedlinePlus), and leg pain sometimes comes with it (OrthoInfo). Lower back pain is especially common (NHS). Pain often gets worse with bending and lifting, sitting, or standing and walking, and it can make everyday activities hard to do (OrthoInfo).

How common is it?

Very. Back pain affects 8 out of 10 people at some point in their lives and is one of the most common medical problems (MedlinePlus). Low back pain is also the most common cause of job-related disability (NCCIH).

Acute, subacute and chronic

The good news: most back pain gets better

Most back pain goes away on its own, though it may take a while (MedlinePlus); in most cases it eases within a few weeks (OrthoInfo). The American College of Physicians notes that most people with acute or subacute low back pain improve over time regardless of treatment (ACP guideline, 2017). Back pain can sometimes last longer or keep coming back, though (NHS), and treatment for chronic pain sometimes helps a great deal and sometimes doesn’t (NCCIH).

What causes it?

Back pain can have many causes, and it’s not always obvious what causes it (NHS). Common causes include:

What raises the risk: getting older, which brings wear-and-tear changes in the spine; overdoing activities your body isn’t used to; and extra weight, which puts added stress on the lower back (OrthoInfo). Movements that jolt or strain the back — repeated pushing, pulling or twisting, or vibration of the spine — are worth avoiding, and smoking reduces blood flow to the lower spine (NINDS). Sleep problems, depression and anxiety commonly go along with chronic pain (NINDS).

Inflammatory back pain: in ankylosing spondylitis, back pain and stiffness are usually the main symptoms; the pain tends to get better with exercise but not with rest, and is often worse in the morning and at night (NHS). If your back pain fits that pattern, ask your doctor about it — and see our ankylosing spondylitis guide and our arthritis guide.

Back pain with any of these needs emergency care — call 911 or go to the emergency department now:

  • Loss of bladder or bowel control, trouble peeing, or numbness or loss of feeling around your genitals, anus or buttocks (the “saddle” area) (NHS, AANS). These can be signs of cauda equina syndrome, pressure on the bundle of nerves at the bottom of the spine — most often from a very large herniated disc. Left untreated, it can cause permanent paralysis and incontinence, and treatment within 48 hours of symptoms starting gives a significant advantage for recovery (AANS).
  • Pain, weakness, numbness or tingling in both legs (NHS).
  • Back pain after a serious accident, such as a car accident (NHS).

Contact your provider right away, or go to urgent care, for back pain with:

Also see your provider soon if you have back pain and have lost weight without trying, or have a lump or swelling in your back or a change in its shape (NHS, OrthoInfo).

Don’t drive yourself to the emergency department — ask someone to drive you or call for an ambulance (NHS). Don’t wait for a chiropractic, acupuncture or massage appointment for any of these signs.

Do I need an X-ray or MRI?

Usually not at first. The American College of Physicians advises imaging for low back pain only for people with severe or worsening nerve problems, or signs or symptoms that suggest a serious or specific underlying condition; for everyone else, routine imaging brings no meaningful benefit and can lead to harms (ACP, 2011). A review of six randomized trials (1,804 people) found that X-rays, MRI or CT scans done right away did not improve pain or function compared with usual care without immediate imaging, for people with no sign of a serious cause (review, Lancet, 2009). When a doctor does order tests, X-rays show bones, while MRI shows soft tissues such as nerves and discs (OrthoInfo).

Sciatica, neck pain and upper back pain

  • Sciatica is pain, weakness, numbness or tingling caused by a problem with the sciatic nerve. It can start in the lower back and run down the leg, usually on one side. It is a symptom of another problem, such as a ruptured (herniated) disc or spinal stenosis (MedlinePlus). It usually gets better in a few weeks to a few months, but it can come back (NHS). A separate MBHA sciatica guide is on the way.
  • Neck pain is very common and is often caused by muscle strain or tension — from sitting at a computer too long, sleeping in an awkward position or overdoing it during exercise (MedlinePlus). Get medical care right away for a stiff neck with a sudden high fever and severe headache, which can be signs of meningitis (MedlinePlus), or for neck, jaw, arm or back pain with chest discomfort, shortness of breath or heavy sweating, which can be signs of a heart attack (NHLBI). See a provider if neck pain or stiffness doesn’t go away after a few weeks, painkillers haven’t worked, or you have other symptoms such as pins and needles or a cold arm (NHS).
  • Upper or mid-back pain — pain coming from between your shoulder blades rather than your lower back — is worth getting checked by a doctor (NHS).

When to see a doctor: if your back pain is severe or hasn’t started to improve after three days, or follows an injury (MedlinePlus); if it doesn’t get better within a few weeks, or comes with fever, chills, unexpected weight loss or weakness in your legs (OrthoInfo); or if it is stopping you from doing everyday things, you’re struggling to cope, or it is worse when you cough or sneeze (NHS).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Following the 2017 ACP guideline: stay active and use heat, massage, acupuncture or spinal manipulation for new pain; exercise, rehabilitation, yoga, tai chi, mindfulness or CBT for chronic pain; NSAIDs if medicine is wanted; opioids only as a last resort. Physical therapy, and injections or surgery for specific problems. National cash listings put a physical therapy treatment visit at about $42–$179 per session, and an initial evaluation at about $95–$308 (The Pricer, August 2026). Medicare Part B covers medically necessary PT (20% coinsurance after the deductible). Most new low back pain improves within weeks. Imaging is rarely needed early. Medicines give modest, short-term relief; surgery helps only a small group with specific problems.
Chiropractic Spinal manipulation and mobilization, often with soft-tissue work and exercise advice, usually over several weeks. About $55–$100 a follow-up visit without insurance; first appointments $90–$200. Medicare Part B covers spinal adjustment for subluxation (20% coinsurance). Modest benefit for acute and chronic low back pain, similar to other recommended treatments such as exercise. Mild soreness is common; serious problems are rare. Neck manipulation carries a small, debated stroke risk.
Acupuncture A course of needle treatments, mainly for chronic low back pain, alongside staying active and other care. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers up to 12 visits in 90 days for chronic low back pain (up to 20 a year) from qualified providers. Modest benefit for acute and moderate benefit for chronic low back pain in reviews; part of the effect is also seen with sham needling. Few complications with sterile, single-use needles.
Herbal medicine Capsicum (cayenne) cream or plaster on the skin; devil’s claw or white willow bark by mouth; comfrey ointment. Cost estimate being researched. Small trials suggest short-term pain relief, strongest for capsicum on the skin. Willow bark can have aspirin-like side effects and shouldn’t be combined with blood thinners or NSAIDs; devil’s claw has been linked to ulcers and stomach bleeding. Never take comfrey by mouth.
Massage therapy Hands-on soft-tissue work for acute or subacute low back pain, or as a comfort measure for chronic pain and neck pain. At one national chain, about $125–$160 for 60 minutes for non-members (memberships about $70–$90 a month). Medicare doesn’t cover massage ordered by a chiropractor. Short-term pain relief in low-quality studies; benefits fade over months. The ACP lists massage for acute pain but not chronic. Low risk with gentle pressure.
MBHA Wellness Coach Staying active instead of resting in bed, a gradual walking and exercise plan, safe lifting and desk setup, sleep, weight, quitting smoking, stress and pain coping skills, and pacing. Cost estimate being researched. Supports — never replaces — medical care. Staying active is one of the best-supported steps for new low back pain, and coping skills help with chronic pain.

Approach 1 of 6

Conventional medicine (AMA)

In the U.S., the main guide for treating low back pain without surgery is the 2017 guideline from the American College of Physicians (ACP), based on a review of randomized trials (ACP guideline, 2017). Its message: start with non-drug treatments, and use medicines carefully. Treatment depends on what kind of pain you have and what is causing it (MedlinePlus).

1. New (acute or subacute) low back pain

  • Because most people get better over time regardless of treatment, the ACP strongly recommends starting with non-drug options: superficial heat (moderate-quality evidence), or massage, acupuncture or spinal manipulation (low-quality evidence) (ACP guideline, 2017).
  • Stay as active as you can and try to carry on with your daily activities; do not stay in bed for long periods (NHS). Staying in bed for more than 1 or 2 days can make back pain worse (MedlinePlus).
  • Ice and heat: the NHS suggests a wrapped ice pack to reduce pain and swelling, and a wrapped heat pack to relieve stiffness or muscle spasms (NHS).

2. Chronic low back pain (longer than 12 weeks)

The ACP strongly recommends non-drug treatment first: exercise, multidisciplinary rehabilitation, acupuncture and mindfulness-based stress reduction (moderate-quality evidence), or tai chi, yoga, motor control exercise, progressive relaxation, EMG biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy (CBT) or spinal manipulation (low-quality evidence) (ACP guideline, 2017). A Cochrane review of 41 trials (6,858 people) found moderate-quality evidence that multidisciplinary rehabilitation — care that combines a physical component with psychological or work-focused support, from professionals of at least two backgrounds — eased pain and disability a little more than usual care (Cochrane review, BMJ, 2015). CBT is a form of talk therapy that builds skills for coping with pain, such as scheduling daily activities, building sleep routines, working with thoughts and emotions that can increase pain, and relaxation and mindfulness (NINDS).

3. Physical therapy

Physical therapy can include heat, ice, massage and electrical stimulation, along with active therapy such as stretching, strength training and cardiovascular exercise; exercising to restore motion and strength to the lower back can be very helpful in relieving pain (OrthoInfo). For chronic low back pain, a Cochrane review of 249 trials found moderate-certainty evidence that exercise probably eases pain compared with no treatment, usual care or placebo, though the gain in everyday function was small (Cochrane review, 2021).

4. Medicines

We don’t list doses; ask your doctor or pharmacist which medicine, if any, is safe for you.

5. Injections and procedures

For severe sciatica that other treatments haven’t helped, a specialist may offer a painkilling injection such as an epidural (NHS). Doctors may also suggest steroid injections, nerve blocks or radiofrequency ablation, which heats a small area of nerve tissue to stop pain signals, and electrical stimulation such as spinal cord stimulation helps some people (NINDS). For long-term lower back pain, the NHS lists a procedure to seal off some of the nerves in the back as an option (NHS). A Cochrane review of 18 trials found no strong evidence for or against any type of injection for subacute or chronic low back pain, though some groups of patients may respond to a specific type (Cochrane review, 2008).

6. Surgery

Surgery for low back pain should be considered only after non-surgical treatments have been tried and haven’t worked — ideally for 6 months to a year — and only if your doctor can pinpoint the source of the pain and believes surgery can improve it. Some people are not candidates even when their pain is significant, and some types of chronic low back pain simply can’t be treated with surgery (OrthoInfo). Operations include removing part of a herniated disc, relieving pressure on the nerves in spinal stenosis, and spinal fusion for problems such as an unstable spine (OrthoInfo). Cauda equina syndrome is the exception: urgent surgery is usually the treatment of choice (AANS).

Who treats back pain

Long-lasting pain is best managed by a team that may include pain management specialists, doctors for any other conditions you have, nurses, mental health providers, physical or occupational therapists, complementary or integrative health providers and social workers (NINDS).

What it costs

  • Physical therapy: cash-price estimate being researched. Medicare Part B covers medically necessary outpatient PT when your provider certifies you need it; you pay 20% of the approved amount after the deductible (Medicare.gov).
  • Acupuncture under Medicare: since January 21, 2020, Medicare has covered acupuncture for chronic low back pain (CMS) — see the acupuncture section below for the rules.
  • Prescription medicines, injections and surgery: MBHA cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractors perform adjustments (manipulations) of the spine or other parts of the body, and may also use heat and ice, electrical stimulation, relaxation techniques, exercise, and advice on diet, weight and other lifestyle factors. Many people see chiropractors for low back pain, neck pain and headaches (MedlinePlus). Most spinal manipulations are done by chiropractors, though osteopathic physicians and physical therapists use it too (NCCIH).

Before you start

Tell the chiropractor about your health history, medical conditions, medicines and supplements; ask whether they have training or experience with your condition; and ask how many sessions you’ll need, what you can expect to pay and what your insurance covers (NCCIH).

What the research says

  • Acute low back pain: a 2017 analysis of 15 studies (1,699 people) found moderate-quality evidence that spinal manipulation brings a modest improvement in pain — similar to the benefit from NSAIDs — and in back function (NCCIH). An earlier Cochrane review was less positive, finding low- to very-low-quality evidence of no difference compared with sham or inactive treatments (Cochrane review, 2012).
  • Chronic low back pain: a 2019 review of 47 trials (9,211 people) found that manipulation or mobilization relieved pain about as well as other recommended treatments, such as exercise, and improved function slightly more (NCCIH, review, BMJ, 2019). A 2011 Cochrane review similarly found no meaningful difference between manipulation and other treatments (Cochrane review, 2011).
  • Guideline: the ACP lists spinal manipulation as an option for both acute and chronic low back pain, based on low-quality evidence (ACP guideline, 2017).
  • Neck pain: spinal manipulation can help acute neck pain, and manipulation or mobilization may reduce chronic neck pain and improve function, though the studies were small and mixed (NCCIH).

In plain terms: spinal manipulation is a reasonable option that helps about as much as other recommended treatments — not a cure, and not clearly better than exercise.

Safety

  • Mild, short-lived side effects are common — more pain or discomfort, stiffness or headache, usually gone within 24 hours. Serious problems, such as spinal or nerve injury or stroke, have been reported but are very rare. The risk may be higher if you have other health problems, so share your full health history and medicines with the practitioner (NCCIH).
  • Neck manipulation and stroke: neck manipulation has been linked to small tears in the arteries of the neck (cervical artery dissection), which are rare but can cause a stroke. Experts disagree about whether manipulation actually causes these tears, but patients need to be told about the possible risk (NCCIH). The American Heart Association says the risk is probably low and that patients should be informed of the association before neck manipulation (AHA/ASA statement, 2014).
  • When manipulation may not be safe: if you take blood-thinning medicine or are at higher risk of bleeding or stroke, have bones or joints that are very weak or seriously damaged, or have a condition affecting your nerves, such as peripheral neuropathy (NHS). For people with ankylosing spondylitis who have spinal fusion or advanced spinal osteoporosis, rheumatology guidelines strongly recommend against spinal manipulation (ACR/SAA/SPARTAN, 2019) — see our ankylosing spondylitis guide.

As a precaution, MBHA suggests seeing a medical provider first if you have any of the red-flag signs above, and talking through the risks and alternatives with your chiropractor before any neck manipulation.

Medicare coverage

Medicare Part B covers only adjustments of the spine by a chiropractor to correct a subluxation (when spinal joints don’t move properly), done by hand or with an “activator” device. It doesn’t cover other services or tests a chiropractor orders, such as X-rays, massage or acupuncture. You pay 20% of the Medicare-approved amount after the deductible (Medicare.gov).

What it costs

  • Without insurance: about $55–$100 for a follow-up visit and $90–$200 for a first appointment; several weeks of care can add up to $500–$1,000 (The Pricer).
  • With insurance: coverage can lower the cost, but deductibles, copays, coinsurance, visit limits and services that aren’t covered can still leave a sizable bill (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

In the United States, acupuncture is most often used for pain such as back, joint or neck pain (NCCIH).

What the research says

  • A 2017 evaluation of 49 studies with more than 7,900 people found a modest benefit for acute low back pain and a moderate benefit for chronic low back pain (NCCIH).
  • For back or neck pain, a 2018 review found acupuncture worked better than no treatment (12 studies, 8,003 people) and better than sham (simulated) acupuncture (10 studies, 1,963 people). The gap over sham was smaller than the gap over no treatment, and the pain relief was comparable to that of NSAIDs (NCCIH).
  • In an analysis of 20 studies (6,376 people) with back pain and other painful conditions, the benefits lasted a year after treatment ended for every condition studied except neck pain (NCCIH).
  • Guideline: the ACP includes acupuncture as a first-line option for chronic low back pain (moderate-quality evidence) and as an option for acute low back pain (low-quality evidence) (ACP guideline, 2017, NCCIH).

In short: acupuncture may add some relief, especially for chronic low back pain, used alongside — not instead of — staying active and exercising.

Safety

Relatively few complications have been reported. Problems have come from non-sterile needles and poor technique; the FDA requires acupuncture needles to be sterile and single-use, and most states license acupuncturists (NCCIH). MBHA suggests telling your acupuncturist if you take a blood thinner or are pregnant.

Medicare coverage for chronic low back pain

  • Since January 21, 2020, Medicare covers acupuncture — including dry needling — for chronic low back pain only (CMS, Medicare.gov).
  • “Chronic low back pain” here means pain that has lasted 12 weeks or longer, has no known body-wide cause (such as cancer that has spread, or an inflammatory or infectious disease), and isn’t linked to surgery or pregnancy (Medicare.gov).
  • Medicare covers up to 12 treatments in 90 days. If you improve, it covers 8 more, for a maximum of 20 in 12 months. If you aren’t improving, further treatments aren’t covered and you’d pay the full cost (Medicare.gov).
  • Medicare can’t pay licensed acupuncturists directly. You must get acupuncture from a doctor or another provider (such as a nurse practitioner or physician assistant) who has a master’s or doctoral degree in acupuncture or Oriental Medicine from an accredited school and a current, full state license to practice acupuncture (Medicare.gov). Other staff who meet the same degree and license rules may provide it under supervision (CMS).
  • After the Part B deductible, you pay 20% of the Medicare-approved amount (Medicare.gov).

What it costs

Published cash prices run about $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer). A course of several sessions adds up, so ask about package prices and check your insurance.

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

A few plant remedies have been tested for low back pain. The evidence is limited, the studies are small and the products tested were specific standardized extracts, so results may not apply to what you buy in a store. Herbal products can also have side effects and interact with medicines (NCCIH).

What the research says

A 2014 Cochrane review looked at 14 randomized trials (2,050 people) of herbal medicine for non-specific low back pain (Cochrane review, 2014):

  • Capsicum (cayenne) cream or plaster, applied to the skin, probably eases chronic low back pain more than a placebo (3 trials, 755 people, moderate-quality evidence). It’s unclear whether it helps acute pain.
  • Devil’s claw, taken by mouth, may ease pain in the short term better than a placebo (2 trials, 315 people, low-quality evidence).
  • White willow bark, taken by mouth, probably eases pain in the short term better than a placebo (2 trials, 261 people, moderate-quality evidence).
  • Comfrey ointment, Brazilian arnica gel and lavender oil applied with acupressure each had a single small trial with low- or very-low-quality evidence.
  • No significant side effects were reported in the trials, but reporting was generally poor, and the authors called for larger, well-designed trials against standard treatments.

The NIH agrees that cayenne used on the skin may help, and that devil’s claw, white willow bark, comfrey, Brazilian arnica and lavender oil might be beneficial (NCCIH).

Safety of the most-used herbs

  • White willow bark contains salicin, the compound aspirin was developed from, and may cause aspirin-like side effects, including effects on blood clotting. Don’t take it if you take warfarin or another blood thinner (higher bleeding risk), take NSAIDs (higher risk of stomach damage and bleeding), are sensitive to aspirin, or have asthma or other breathing problems. Never give it to children, because of the risk of Reye syndrome, and stop it before surgery (Memorial Sloan Kettering).
  • Devil’s claw has caused indigestion, and ulcers and stomach bleeding have been reported. One case of raised blood pressure has been reported, and it may interact with many medicines processed by the liver, although the evidence on that is conflicting (Memorial Sloan Kettering).
  • Comfrey contains compounds that are toxic to the liver, and liver damage has been reported when it is taken by mouth; in 2001 the FDA advised dietary supplement makers to remove comfrey products from the market (Memorial Sloan Kettering). Never take it by mouth.

Before you take any herb or supplement, show it to your doctor or pharmacist — especially if you take a blood thinner, an NSAID or other pain reliever, or several prescription medicines, or if you are pregnant or breastfeeding, or planning surgery. “Natural” doesn’t always mean safe, supplements may interact with medicines or raise bleeding risk around surgery, and some products have been found to contain hidden prescription drugs (NCCIH). We don’t list doses here, and no herb should delay care for the red-flag signs above.

Approach 5 of 6

Massage therapy

Massage is one of the most popular ways people try to ease a sore back. It can feel good and may bring short-term relief; the research behind it is limited.

What the research says

  • Cochrane review: 25 trials (3,096 people) found that massage improved pain only in the short term, for acute, subacute and chronic low back pain. Compared with no treatment or sham treatment, it also helped function in the short term for subacute and chronic pain. The evidence was low or very-low quality, and the authors said they had “very little confidence” that massage is an effective treatment (Cochrane review, 2015).
  • Longer term: a 2018 government review found slightly greater effects on pain and function 1 to 6 months after treatment compared with sham massage or usual care, but no evidence of an effect at 6 to 12 months (NCCIH).
  • Guideline: the ACP includes massage as an option for acute or subacute low back pain but not for chronic low back pain (NCCIH, ACP guideline, 2017).
  • Neck and shoulder pain: massage may help, but the benefits may last only a short time (NCCIH).

Safety

No serious side effects were reported in the Cochrane trials; a temporary increase in pain was the most common problem (Cochrane review, 2015). Rare serious problems — a blood clot, nerve injury or broken bone — have been reported, sometimes with vigorous deep-tissue massage or in older adults (NCCIH). MBHA suggests telling your therapist about osteoporosis, blood thinners, recent injury or surgery, and asking for gentle pressure. Don’t use massage to put off seeing a provider about red-flag signs.

What it costs

  • Prices vary by location. At one national chain, franchise price lists show about $125–$160 for a 60-minute massage for non-members and about $65–$90 for members, whose memberships run about $70–$90 a month (The Pricer).
  • Medicare doesn’t cover massage therapy ordered by a chiropractor (Medicare.gov).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Much of what helps back pain happens between appointments. An MBHA Wellness Coach can help you build these habits — alongside, never instead of, your medical care.

Keep moving — don’t rest in bed

  • Stay active, try to continue with your daily activities, and don’t stay in bed for long periods (NHS); staying in bed for more than 1 or 2 days can make back pain worse (MedlinePlus).
  • A Cochrane review found that people with acute low back pain who were advised to stay active had slightly less pain and better function than those advised to rest in bed (Cochrane review, 2010).
  • A gradual plan: get moving with gentle activity — walking, swimming, yoga and pilates may all help ease back pain — and try exercises and stretches for back pain, stopping and seeing a doctor if your pain gets worse (NHS).

Exercise for the long run

Regular exercise can help prevent low back pain and reduce how much it gets in the way of daily life (NINDS). Combine aerobic exercise, such as walking or swimming, with specific exercises that keep the muscles of your back and stomach strong and flexible (OrthoInfo). Ask a physician for low-impact exercises that strengthen your lower back and stomach muscles (NINDS).

Lifting, sitting and everyday habits

  • Lift safely: lift with your legs, not your back; bend at your knees rather than bending over, keep your back straight, and hold the object close to your body (OrthoInfo, NINDS).
  • Sit smarter: use ergonomically designed furniture at home and work, switch sitting positions often, get up to walk around and gently stretch, and rest your feet on a low stool if your chair lacks good back support (NINDS).
  • Mind the load: avoid overloading children’s backpacks (NINDS). For neck pain, sit upright and don’t keep your neck in the same position for a long time, such as at a desk (NHS).

Sleep

Sleep problems commonly go along with chronic pain (NINDS). Sleeping on your side with your knees drawn up can relieve pressure on the spine (NINDS), and a coach can help you build a regular sleep routine.

Weight, bones and smoking

Stress, fear and the pain cycle

Pain is affected by the body, the mind and life circumstances together (NINDS). Being afraid of hurting your back again is understandable, but avoiding movement for too long can weaken muscles, slow recovery and play a part in pain becoming chronic; getting support for worry, low mood and unhelpful thoughts about pain has been shown to improve chronic pain (NINDS). Mindfulness-based stress reduction and cognitive behavioral therapy are recommended options for chronic low back pain (ACP guideline, 2017), and coping strategies such as deep breathing, social support and activities that bring joy can help build resilience (NINDS).

Pacing

Coping skills for pain include scheduling daily activities and building sleep routines (NINDS). A coach can help you set realistic goals, build up in small steps and plan a week that balances activity and rest, so you avoid both overdoing it and doing too little.

Another approach

Yoga & tai chi

Gentle mind-and-body exercise is one of the non-drug options the American College of Physicians recommends trying first for chronic low back pain (ACP guideline, 2017).

Yoga

  • A 2022 Cochrane review of 21 trials (2,223 people) found yoga slightly better than no exercise for back-related function and pain at three months, though the difference may be too small to matter much to patients. Yoga worked about as well as other back exercise for function (Cochrane review, 2022, NCCIH).
  • A 2020 government report of 10 studies (1,520 people) found yoga improved pain and function for up to 12 months, with effects similar to exercise and massage (NCCIH).
  • Safety: yoga is generally safe for healthy people when done properly with a qualified instructor, but injuries can happen, and older adults need extra care (NCCIH). In trials, people doing yoga were more likely than people not exercising to report side effects — mainly more back pain — but about as likely as people doing other exercise (Cochrane review, 2022).

Tai chi

  • A 2019 review of 10 studies (959 people) cautiously concluded that tai chi, alone or added to physical therapy, may reduce pain and improve everyday function such as carrying groceries or climbing stairs (NCCIH).
  • Tai chi appears to be safe; side effects in studies were no more common than with other activity or no activity (NCCIH).

Whichever you choose, start slowly with a qualified teacher, tell them about your back, and pick the one you enjoy enough to keep doing.

What it costs

Cost estimate being researched.

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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