.png?format=original){kind=spacer}
If you spend enough time sitting at your desk or slouching on the couch, your back will inevitably pay the price, regardless of your age or fitness level. But for some people prolonged rest can seriously put their spine through the wringer, causing a painful stiffness that only movement can soothe.
If you can relate, you’re far from alone. Back pain is one of the most common medical problems in the US and the leading cause of disability worldwide. And although rest may seem like the best remedy, in some cases staying still for too long can make you feel a whole lot worse.
Here’s what it might mean if your back pain tends to improve with activity and worsen with rest.
Which types of back pain may improve with activity?
Generally, when you injure your back—like, say, after lifting a heavy box—the first treatment suggestion is always to rest because “more pain is not more gain,” says Salvador Portugal, DO, a sports medicine and rehabilitation physician at the NYU Langone Orthopedic Center. This recommendation applies to a range of back injuries, such as herniated discs and muscle strains. Though physical therapy can help strengthen your back post-injury, moving around while you’re still in pain will likely only make you feel worse, Dr. Portugal says.
But you could also find yourself in the polar opposite situation, where instead wiggling around feels like the only way you can get through a painful flare-up. If that’s your experience, experts say it’s possible your condition is more chronic and inflammatory in nature.
Take axial spondyloarthritis, for example, an umbrella term for a group of autoimmune diseases that affects about 3.2 million people in the US. With these conditions, which are considered forms of arthritis, your immune system attacks your spine, causing chronic inflammation in the sacroiliac joints that connect your lower back and pelvis. When the disease causes damage to your bones and joints that’s visible on X-rays, the condition is called ankylosing spondylitis; when these differences aren’t apparent in imaging, it’s referred to as non-radiographic axial spondyloarthritis.
The constant swelling these conditions cause can break down the cartilage between your vertebrae (the bones that make up your spine) until there’s “bone-on-bone rubbing,” says Joseph Cheng, MD, a spinal specialist and chair of the Department of Neurosurgery at the University of Cincinnati College of Medicine. The result is a painful stiffness that often worsens with rest yet eases with activity, he says. That’s because when you move, your muscles take some of the weight off your injured joints, according to Dr. Cheng. “It’s kind of like when you’re skiing and you bend your knees to absorb all the shock into your muscles,” he explains. Alternatively, he says, “If you lock your knees, all the shock goes into your joints.” (Exercise can help alleviate back pain in other ways, too, but more on this later.)
However, if you have severe ankylosing spondylitis, which can cause your spine to start fusing together, movement may hurt more than help, Dr. Cheng says. Once your vertebrae have locked into a fixed position, your muscles “will still fire and try to contract, but nothing moves,” he says. So it’s likely better to rest during a flare-up rather than attempting to move your way through it.
Other inflammatory conditions can also cause back pain that worsens with rest and improves with activity, Dr. Portugal says. Up to 30% of people with the skin condition psoriasis, for instance, will develop psoriatic arthritis, which can cause pain and swelling in the fingers, wrists, knees, and ankles and about 20% of those folks will experience spine-related issues (psoriatic spondylitis), according to the Spondylitis Association of America. Meanwhile, about one in five people with inflammatory bowel disease like Crohn’s disease or ulcerative colitis will develop enteropathic arthritis, another type of chronic arthritis that can impact the spine, the association says.
Why can activity help alleviate some types of back pain?
For better or worse the entire body is connected, Dr. Cheng says. This means it’s possible for an injury in one place, like your knee, to give way to a separate injury in another, like your hip. On the flip side, strengthening one part of your body can help bolster another, which is especially true for your back, Dr. Cheng says. That’s because your spine quite literally holds everything together, keeping you from buckling into a pile of bones.
And this, experts say, is why movement truly is the best medicine for many types of back pain. In fact, the Spondylitis Association of America notes that one expert referred to exercise as the “granddaddy” of therapy options for ankylosing spondylitis. And even for the 90% of people whose chronic low back pain has no clear cause, physical activity is often still the treatment of choice among doctors and patients alike, thanks to its effectiveness, low cost, and basically nonexistent side effects.
Exercise programs that emphasize core strength, for example, have been shown to reduce chronic low back pain by approximately 77%, according to a 2016 review of more than a dozen studies. Your core includes the muscles that surround your spine, from your abdominals to your lower back. So the stronger your core is, the more stable your spine and “the less load you put on your back,” Dr. Cheng says. As a bonus, working on your core also helps with balance and flexibility.
Research also shows that moderate aerobic exercise, such as walking and cycling, increases blood flow to the back, which encourages tissue repair and reduces inflammation and stiffness. Additionally, some research also suggests that aerobic exercise spurs the production of endorphins and other chemicals associated with reduced feelings of pain and can help people feel more confident with movement, improving their functionality.
Even a simple stretch can work wonders for back pain. For example, consider your hip flexors. Tight hamstrings can pull on them, reducing their range of motion and adding stress to your lower back. Stretching your hammies, as well as other muscles in your legs, butt, and back, can improve your overall flexibility, which will, in turn, help boost joint mobility and reduce back pain and stiffness.
That said, there’s no one-size-fits-all approach, experts say. The type, duration, and intensity of physical activity that will ultimately help you depends on your pain’s root cause and severity level, along with other factors like your age and overall health status.
When in doubt seek a professional’s help, Dr. Portugal says, explaining that doing too much or too little physical activity (or simply doing it incorrectly) can increase your risk of additional injury.
Get more of SELF’s great service journalism delivered right to your inbox.
Related:
