Wait, Stress Can Cause Back Pain?

Learn about the connection between stress and backache, what you can do to treat it, and smart ways to safeguard your back from future pain.

The connection between stress and back pain

One of the physical symptoms of stress? Yep, it's back pain.

“When we get stressed, a lot of things happen,” says Kavita Trivedi, DO, associate professor in the Department of Physical Medicine and Rehabilitation at UT Southwestern Medical Center in Dallas.

First up, your body experiences a chemical reaction in response to stress when the adrenal glands dump hormones epinephrine (adrenaline), norepinephrine, and cortisol into your body. These chemicals are part of your body's fight-or-flight response and can upregulate pain receptors, Dr. Trivedi says.

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One note: During extreme stress—say you’ve been hit by a car while biking—your body inhibits your pain response in order to give you the ability to get out of a life-or-death situation, Dr. Trivedi says. You may not feel the pain in the moment, but you'll experience it later, she says. But this differs from opening up your inbox in the morning and seeing an email from your boss instructing you to prioritize a project that throws your entire schedule into chaos. It’s not life-or-death, but your body still triggers that danger-ahead stress response.

Next, a change in body mechanics. When you notice you’re stressed, think about how your body is responding. The muscles in your shoulders and neck likely tense up. Maybe your jaw tightens, too. “When stressed, the body’s natural inclination is to try to protect itself, and we do that by contracting and tightening,” Dr. Trivedi explains.

So, not only are you primed to feel more discomfort, but that tightness can directly translate into pain. And that’s where back pain comes in. Muscle tension from stress that affects your upper body (neck, shoulders) is connected—the same group of muscles that line your entire spine, top to bottom, says Dr. Trivedi. “If the upper part of your back is tight, eventually it can travel down the chain to tighten up your lower back, as well,” she explains.

Stress is one of the psychological factors in back pain. People who report severe stress are nearly three times more likely to experience low back pain compared to those with no stress, according to a July 2021 study in Scientific Reports. Among the many reasons for this: Researchers point out that cortisol is inflammatory, which can, over time, cause cellular aging and tissue damage that promotes the development of chronic (or long-lasting) pain.

Other research in Frontiers in Public Health in August 2020 on health care workers with low back pain found that those with high work-related stress were twice as likely to report back pain compared to those with low stress. One thing these authors add that really resonates in a palm-to-forehead moment: Low back pain becomes another stressor for the person experiencing it. There’s no doubt that there’s a real mind-body connection in back pain.

"When stressed, the body’s natural inclination is to try to protect itself, and we do that by contracting and tightening.” —Kavita Trivedi, DO, spine and musculoskeletal specialist

How to know if you’re dealing with stress-related back pain

Causes of back pain are numerous, and include the following, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS):

• Arthritis of the spine, such as ankylosing spondylitis
• Vertebrae slips out of place
• Degenerative disc disease (caused by the aging process)
• Endometriosis
• Fibromyalgia
• Kidney stones or infections
• Herniated disc
• Osteoporosis
• Pregnancy
• Scoliosis
• Spinal infection
• Sprain and strain
• Tumors in the spine

That’s a wide-ranging list, to be sure. So, it’s important to take a step back and evaluate your situation. Ask yourself “what’s changed that’s now causing me to have this back pain?” says Dr. Trivedi. That doesn’t mean taking out your doctor’s pad and diagnosing yourself, but it can help give you some clues as to where to start. Is the back pain new or has it been lingering for a while? Did you have a change in lifestyle—such as a new job that requires you to sit at a desk all day—that may contribute? A new baby that you’re carrying all day? Or did you bend down to lift a couch as you were moving into your apartment and you tweaked something?

In addition, think about the stressors in your life, especially if you’ve gone through a big change recently. Was there a breakup or divorce? Did a loved one pass? Is work really putting you through the wringer? When it comes to emotional stress and backache, “many times, stress is subconscious, so it’s really having to be self-aware that this has changed in my life and probably is contributing because of a situational or emotional change,” Dr. Trivedi says.

Also keep in mind that both physical and mental stressors can be present that contribute to your back pain.

How to relieve the pain

Most important is identifying the root cause, which will clue you and your doctor into what the appropriate treatment is.

In the meantime, the reality is that you’re still strapped with the symptoms of back pain. To ease discomfort in the short-term, Dr. Trivedi says you can:

• Use a heating pad on the aching area to relax muscles.
• Apply a pain-relief topical or patch, such as BioFreeeze or Salonpas. These contain ingredients like menthol, a topical NSAID, or lidocaine to relieve discomfort.
• Take an over-the-counter anti inflammatory, such as ibuprofen (Advil) or naproxen (Aleve) or acetaminophen (Tylenol) to diminish discomfort. (Despite being readily available, these medications have risks, particularly if you take a lot of them, use them over a long period of time, or take another medication that interacts with them. Always read the warnings on the label, per the National Library of Medicine.)

If your back pain is stress-related, there are a couple things you can do. One is some self-checking to identify what stressor is the top culprit. Is there anything you can do to change your situation? In addition, incorporating stress management for back pain means relying on some go-to stress-busting skills, such as deep breathing, stretching, yoga, spending time with loved ones, or doing things that you find joyful, all of which can help buffer you against the effects of daily stress.

And while this may feel like a physical problem that you see a medical doctor for, a psychologist or therapist may be able to help. In a 2022 meta-analysis of nearly 100 randomized controlled trials on over 13,000 people with back pain in BMJ, combining psychological care, such as behavioral or cognitive behavioral therapy (CBT) or pain education, with structured exercise helped improve pain intensity and physical function. (One example of how CBT is used might be using relaxation or imagery.)

Speaking of exercise, it’s not only been found to help reduce back pain compared to no treatment or placebo conditions, per the Cochrane Database of Systematic Reviews in September 2021, but it’s also a known mood-booster. “Exercise is beneficial physically, but also mentally. If you do have stress, staying active can help,” says Dr. Trivedi.

How to prevent stress-induced back pain

Set the foundation for a back that’s more resistant to pain. “One thing that’s important for back pain is core strength. Core includes the abdominal and back muscles, which stabilize your spine,” says Dr. Trivedi.

In addition, stay active–a habit that’s important for improving resilience against stress and is physically good for your back. That includes structured exercise, but also finding small amounts of time to get moving throughout the day. “Our backs do not like to be in one position for long periods of time,” says Dr. Trevedi. These mini breaks can also help mitigate stress by giving you time to walk away and regroup. She recommends setting an alarm on your phone for every 60 to 90 minutes as a reminder to get up, go to the bathroom, refill your water bottle, or shift your body position. If you do sit down all day, you’ll also want to practice sitting exercises to release your ‘stress’ muscles.

Lastly, think about your relationship with your devices. Social media is often a go-to when you want to zone out. And sometimes it is helpful. But it may not be the best coping tool. It’s also been found to cause stress, according to a study in Current Opinion in Psychology in June 2022. But there’s also something to remember as you’re staring down at your phone–it hunches your neck and shoulders in a terrible position, says Dr. Trivedi. If possible, hold your phone at eye level. “Even the little things we do can help prevent and manage back pain,” she says. Oh, and check-in with yourself to ask if TikTok is helping or hurting your stress levels right now.

When to see a doctor or therapist

Back pain can happen to the best of us. If you have four to six weeks of back pain (without the red flags, below), tried over-the-counter medication, heating pads, and topical pain patches to no avail, Dr. Trivedi recommends seeing your doctor. “Most injuries caused by strained muscles go away after a few days, but they should definitely be resolved after a few weeks,” she says.

That said, if your back pain is accompanied by numbness, leg weakness, severe enough discomfort to wake you up at night, or is affecting your urinary or bowel function, call your doctor asap to schedule an appointment. These are all concerning symptoms that indicate something more than stress or run-of-the-mill muscle strain or sprain is behind your pain.

Stress-induced back pain requires a lot of self-awareness, says Dr. Trivedi. “Stress can involve a lot of denial where you feel as if it’s something that’s okay or that you can overcome. For many people, it can be difficult to come to terms with and say that it’s really bothering them and now affecting them physically,” she explains.

If you come to a point where your stress is difficult to manage, your stress-management techniques are not enough, and you’re suffering from stress physically, you can feel free to reach out to a therapist whenever–you don’t have to wait a specific timeframe. The sooner you work through these underlying feelings or come up with a plan to change your circumstances–all things a licensed therapist can help with–the sooner you’ll feel better, in body and mind.

—reviewed by Jennifer Gilbert, MD, MPH