Yes, stress is a normal part of life. But when it’s chronic and unrelenting it can really take on a toll on your emotional health as well as your physical well-being. If you’re under a lot of stress and haven’t found good ways to manage it, you may find yourself coping with wide-ranging issues: getting sick more often, dealing with an upset stomach, having more frequent headaches, or learning that your blood pressure is elevated. Stress can also lead to muscle tightness and tension, including in the neck, shoulders, and back.

Back pain from stress isn’t at all unusual. In fact, research has shown that people who are under a lot of stress are more likely to have chronic low back pain. Sometimes stress may directly cause the pain, and other times it exacerbates aches caused by a physical strain (more on that below). 

Regardless, if you're dealing with back pain that’s related to stress, you have a lot of options for getting both your back pain and stress under control. Studies have found that a combination of psychological interventions and physical therapy can help a lot. And some of the most effective tools — such as movement — help ease both stress and back pain at the same time. “I think my pain has a lot to do with stress,” one Hinge Health member recently shared. “But I've been trying to improve how I deal with my stress, and I believe it is helping.”

Here, learn more about the connection between stress and back pain, and find out how to feel better with tips from our Hinge Health physical therapists.

What’s the Connection Between Stress and Back Pain?

Stress doesn’t always cause pain, but it can certainly contribute to an increase in pain in some cases, says Justin Melson, PT, DPT, a physical therapist at Hinge Health. If you’re under stress for a long period of time, you may also notice that you: 

• Get less sleep (or less quality sleep) 

• Skip meals or make poorer food choices 

• Exercise and move less 

• Skip social events 

• Eliminate activities that relax you 

• Tense your muscles more frequently (especially the muscles in your back)  

All of these things can make your pain system more protective, so a twinge that normally bothers you just a little might become more irritating.

Other Pain Contributors

There are many physical and lifestyle factors that can contribute to pain. These things often come and go depending on what’s going on in your life. But being under higher levels of stress makes some pain contributors more likely to be present, including: 

• Over-tensing your core and other back muscles. Stress makes a lot of people tense their muscles. And while you may have heard that having a strong core protects your back, people with back pain actually show higher levels of trunk muscle engagement compared to people without back pain. This means that tensing your muscles too much and too often can put pressure on sensitive structures in your back and contribute to pain.

• Poor sleep. Many people with back pain get caught in what experts call the pain-sleep cycle. This is when stress interferes with sleep, which exacerbates back pain. And that makes it even harder to sleep.

• Low activity levels. Movement is one of the most important factors for preventing and reducing back pain. But when you’re under higher-than-normal stress levels, exercise may be the first thing to get deprioritized, making back pain flares more likely. 

• Being sedentary. Stress — say from a tight deadline at work — may cause you to spend more time sitting than you normally would. Sitting in one position for too long without taking movement breaks, or sitting in a position your body isn’t used to, may lead to stiffness and loss of flexibility and back strength. 

• Fatigued muscles. Stress tends to make muscles more fatigued. This can make you more likely to feel pain, or more likely to injure your back with activities like lifting.

Stress and Your ‘Pain Backpack’

Pain is incredibly complex and multifactorial, meaning a lot of different things contribute to pain. Stress is one of those factors that many people carry in their ‘pain backpack.’ The pain backpack is an analogy Hinge Health physical therapists use a lot. 

Imagine every factor that contributes to your pain (e.g., a previous injury, poor sleep, stress) goes in a backpack. Everyone carries unique factors in their backpacks, some of which may contribute to your pain more so than others. But when your backpack becomes so full that you can’t zip it shut, your body sends a warning in the form of pain. 

So while a past injury or arthritis alone may not be the sole cause of your pain, adding something like stress into the mix can certainly make you more likely to experience back pain.  

Fortunately, there’s always something you can do about this. You can address the pain contributors that are within your control — thereby reducing your chances of experiencing back aches — with approaches that include movement, education, social support, and other lifestyle modifications.

How Physical Therapy Helps

Treating back pain that’s related in some way to stress may require a multi-pronged approach, but physical therapy and exercise therapy should play a starring role, says Dr. Melson. A physical therapist can design a customized movement plan for you. They’ll also help you feel more confident about being active.

Additionally, a physical therapist — though not a mental health professional — can provide some support to help you with stress management. “Yes, back pain can be improved with movement and exercise, but addressing your stress can also help alleviate back pain,” says Dr. Melson. 

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

These exercises recommended by Hinge Health physical therapists can help alleviate back pain and also help reduce stress levels. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Strategies to Treat or Prevent Stress-Related Back Pain

Whether you need help right now or are hoping to prevent future problems, curtailing both physical and mental stress is essential in protecting your back. Consider exploring the following strategies:

1. Move more often. “I know that people have to work and everyone is busy, but little movement breaks can make a big difference. Try setting a timer to go off every 30 minutes,” Dr. Melson suggests. “Even standing up for five to 10 seconds will help — all you need is a quick change in position.” This is great for relieving mental stress (especially if you combine it with deep breathing) and physical strain on your body.

2. Try box breathing. When you get stressed, your breathing and heart rate speed up. Focusing on your breathing helps slow both back down. One helpful technique that Dr. Melson likes is called box breathing: Breathe in for a count of four, hold for a count of four, breathe out slowly for a count of four, and hold for another four. Repeat as needed throughout your day. 

3. Cut back on inflammatory foods. Sugar, salt, caffeine, and alcohol can all lead to more inflammation in your body. If you’re already stressed and achy, replacing these types of foods with whole food options — like fruits and veggies — can make a huge difference.

4. Get support to quit smoking. Research shows back pain is more common among people who smoke than those who don’t. The chemicals in cigarettes can affect your circulation and cause damage to the tissues in your back. “Smoking also slows down your body’s ability to heal,” says Dr. Melson. 

5. Try mindfulness exercises. Mindfulness is all about being present in the moment and noticing your emotions (like feeling stressed) and physical sensations (like having some back pain) without judging them. Research has shown that people with chronic pain who practice mindfulness experience decreased activation in the parts of the brain that process pain. Consider downloading an app, buying a book, or taking a class to get started.

6. Focus on what’s working. When you have chronic pain and high levels of stress, it’s easy to think you’ll hurt or feel anxious all the time. But is that actually the case? Journaling or even just taking a minute to appreciate when you feel good may help. “If you look at your day, hour by hour, there are going to be moments when you’re not feeling pain,” says Dr. Melson. “Remembering that there are times when you don’t feel pain and showing yourself that you won’t always be in pain can be very helpful.” 

PT Tip: Monitor Your Movement

Many people with chronic back pain are afraid to increase their activity levels, which is a mistake, says Dr. Melson. “It’s okay — even normal — to have a little soreness after activity or a moderate increase in symptoms that goes away within 48 hours,” he explains. That said, it can be helpful to modify or temporarily avoid movements that lead to unacceptable levels of pain for you, or lead to other things that worsen pain, like poor sleep. 

Instead, focus on doing movements and activities you really enjoy. Start slow and gradually increase the intensity and frequency of those activities. This will help you nudge into your pain (which is safe to do) while finding your movement sweet spot and avoiding pain flares. 

How Hinge Health Can Help You 

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.  

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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