Back pain due to osteoarthritis can cause a frustrating ripple effect on many parts of your life. The pain can affect your sleep and also your mood if it becomes difficult to do the things you need and like to do. However, there are a number of evidence-based approaches you can use to find relief. “The main takeaway is that there is help,” notes Laura Hey, an Arthritis Society physiotherapist in London, Ontario.
“Often our clients have been told, ‘Well, you have arthritis in your spine and there’s nothing you can do about it; your X-rays look terrible and just figure it out.’ But we know that there is not a good correlation between X-ray findings and function.” In other words, it makes sense to work with a trusted healthcare provider to customize a toolkit of approaches to help you manage osteoarthritis back pain.
What does osteoarthritis back pain feel like?
Osteoarthritis of the spine affects the ligaments and the cartilage between the facet joints that make up the spine. It is a degenerative condition and worsens with age. As you get older, the cartilage that coats the facet joints can wear away. Also, the discs in your back, which are composed mainly of water, can lose that water as you age, causing the discs to narrow and put pressure on the facet joints.
“People complain of stiffness or an aching or stabbing pain and often, if there is nerve involvement, then the pain may be described as a burning pain,” says Hey. Pain often starts in the lower back but can then move down into the buttocks, or even down to the foot if the nerve is involved, she says. “It can be quite uncomfortable. Clients complain of difficulty moving around and difficulty with their functional activities.”
Dr. Aksa Ahmed, a Toronto chiropractor at Mount Sinai Hospital, agrees. She explains,
Patients [with osteoarthritis back pain] often have limited tolerance to prolonged sitting, standing and/or walking. These limitations can have significant negative effects on their overall quality of life. The symptoms depend on the location of the degeneration in the spine and whether there is nerve involvement. Patients typically report worsening of their pain, stiffness and range of motion when in static positions for prolonged periods of time and report significant improvement in their symptoms with proper exercise prescription. Inflammatory types of arthritis, such as rheumatoid arthritis or ankylosing spondylitis, can also cause back pain but it’s usually also associated with pain and swelling in other joints. The symptoms of inflammatory arthritis differ from those of degenerative arthritis.
While your doctor or nurse practitioner can recommend or prescribe pain medication, that’s only part of the puzzle. Here are some self-care options to consider:
When it hurts to move, we might avoid any exercise for fear of causing more back pain, but this can actually make back pain worse. Being sedentary can ultimately lead to tight or weak muscles, weight gain, as well as poor sleep and mood, all of which can worsen back pain. The key is to find exercise that helps your back. “Appropriate exercise is about trying to improve the mechanics of the spine so that there is more strength in the core, and more flexibility, particularly in the hamstring muscles and the lower back muscles,” says Hey.
Swimming and exercising in water are good options, because you still get a workout while the buoyancy of the water reduces strain. Walking is beneficial too. “Walking poles are a great option, because they support posture, and you are able to walk farther and a little bit faster with less discomfort. It's a good workout and you feel more confident,” she says. Given the varied causes of back pain, it is important to see a healthcare provider for an accurate diagnosis prior to starting exercise.
2. Stretching and strengthening
A physiotherapist can also suggest specific strengthening and stretching exercises to do under their guidance as well as on your own at home. “These exercises will help to improve the mechanics in the back by balancing the structures in the back,” explains Hey. “Strengthening the core is really important to provide stability during movement. And improving flexibility improves the length of the muscles, which reduces the pressure on the spine.” She adds that the goal is to avoid having joints that are overloaded by very tight muscles; instead, we want joints supported by strong muscles.
A chiropractor can also assist individuals suffering from back pain related to osteoarthritis. Evidence-based chiropractic treatment for osteoarthritis of the spine consists of a combination of manual therapy, exercise prescription, self-management strategies and patient education, says Dr. Ahmed. “Osteoarthritis is a degenerative condition. Once diagnosed, it is a lifelong condition, so it’s important to know how to self-manage the symptoms with regular exercise,” she says.
3. Weight management
If you’re carrying extra weight, your healthcare provider will likely talk to you about weight loss strategies for a gradual and sustained loss of 1 to 2 lbs a week. “Weight loss is very important because our spines are weight-bearing structures and additional weight can put a lot of pressure on those joints,” says Hey. More pressure means more strain and likely an increase in symptoms.
4. Shoes and posture
Properly fitting shoes provide support, help absorb the impact of walking or standing on hard surfaces, and help you achieve a healthy, balanced posture, all of which reduce pressure on your joints. Visit our resources to learn more about choosing the right shoes and the correct posture for sitting, standing and lifting to protect your joints.
5. Heat and cold
If you’re experiencing a painful flare-up, a cold pack is better in the initial stages to help reduce inflammation, says Hey. After that, most people prefer heat in the form of a heating pad, warm bath or microwavable pack to help relax muscles and soothe pain.
It’s important to pace your activities so that the spine has a chance to rest, and it is also important to rest in the appropriate position, says Hey. You may think of sitting down as resting, but prolonged sitting is usually not a good idea because it puts pressure on the spine. Instead, lie down (practicing good posture again, with pillows or other supports to keep your head or hips from causing your spine to curve too much).
Though not as effective as lying down, reclining in a reclining chair (for reading or watching TV, for example) is another way to reduce pressure on your joints. Remember, staying in the same position for too long can make osteoarthritis symptoms worse. Try to change positions regularly and break up periods of prolonged sitting with periods of standing or stretching, says Dr. Ahmed.
7. Moves to avoid
While you’re experiencing an arthritis flare, try not to carry heavy loads. Twisting can also be a problem. “Twisting creates a lot of torsion in the joints. It’s a complex movement, and it tends to create forces in the joints that can cause problems. There are a lot of tissues in there that can be compressed, and twisting tends to increase that compression,” says Hey.
There is currently no cure for osteoarthritis of the spine, though luckily you don’t have to suffer with increasing pain and an inability to carry out your day-to-day activities, says Dr. Ahmed. “Research shows that when individuals incorporate regular exercise and self-management strategies into their daily routine, they are able to decrease their pain and improve their overall function. It’s important to understand your pain and know what activities to avoid and what to do when experiencing a flare-up.”