Back Pain Beliefs that Keep You Frail

I felt a twinge in my back during a recent workout and had an "oh, what now?" moment.

I can't pinpoint the exercise that caused this pain, but I narrowed it down to a leg exercise. Squats, deadlifts, or the butt blaster machine were the most likely culprits.

And so it begins: heat, ice, and avoiding anything that makes it worse, along with complaining that I can't take Aleve because it raises my blood pressure. So I'm stuck with acetaminophen, which doesn't seem to do anything.

Turns out, my skepticism about the acetaminophen was warranted — and nearly everything else I was doing was making things worse.

In full disclosure, I began writing this intent on providing the best exercises for preventing back pain in people over 50. But once I dug into the research, I realized the exercises weren't the real story. The beliefs we hold about back pain and outdated advice on solutions matter even more.

Most of us have or will experience back pain at some point in our lives. I've had it on and off through my 67 years, usually from doing nothing more than simply living my life.

I'm far from alone. Lower back pain is one of the most disabling conditions in older adults and carries some of the highest healthcare costs of any condition.

Approximately 90% of back pain in all age groups — including those 60 and over — is non-specific. This means no specific structural cause can be identified through imaging or testing.

In the few times when I hurt my back severely enough to have tests done (as in a waterskiing accident in my 30s), nothing significant showed up. In every instance, I recovered slowly within a few weeks. In fact, less than 5% of back pain cases in older adults are due to fractures or serious disease or infections.

Post-menopausal women are also more likely to experience low-back pain at nearly twice that of age-matched men, which is believed to be related to declining estrogen.

Back pain solutions run the gamut — and many are outdated and even harmful. These myths cause real, measurable harm — leading to fear of movement, deconditioning, unnecessary procedures, and worse outcomes over time.

Rest isn't best

I don't hear this one as much as I once did, but many people still believe that complete rest is the best way to allow your back to heal.

Not only is this false, but studies show the consequences are worse for those 60 and over. Joint stiffness, muscle wasting, bone mineral density loss, and blood clot risk all increase with even short periods of bed rest. In effect, bed rest delays recovery and can trigger frailty.

The goal isn't a pain-free workout — it's about resuming normal activities even if some pain is still present. Pain during movement is often your nervous system being overprotective. Start with what you can do and work your way back.

MRIs can be misleading

If you opt for an MRI, know that it may not reveal anything — and can often make you unnecessarily fearful. In pain-free adults, 84% showed degenerative lumbar changes on an MRI. MRI findings do not correlate with the severity of pain — the same scan looks the same in someone with no pain.

Isolated routine imaging without red flags (neurological symptoms, fever, history of cancer) can lead to more testing, specialist referrals, psychological stress, and poorer outcomes.

Getting an MRI simply because your back hurts will almost certainly show "degeneration" that was present before the pain started. Hearing that you have degeneration can do real harm, however.

If your doctor suggests an MRI for your back pain, ask: "What are we looking for, and will the result change what we do?" If the answer is no, skip it.

A surprising driver of back pain

The biggest predictor of chronic back pain disability in older adults is an unexpected one: fear. Fear-avoidance beliefs, low mood, low self-efficacy, and catastrophizing showed increased disability, according to one study of over 250 patients with low back pain.

Like a vicious circle, studies show fear associated with activities can lead to hypervigilance about bodily sensations, which increases the risk of fear-related back disability, then withdrawal from daily life. Depression often follows, along with physical deterioration.

This is especially problematic for older adults. A 2026 study of older adults with back pain found that psychological response to pain was a stronger predictor of functional decline than pain intensity itself. Simply understanding the pain science, however, through a combination of education and physical activity changed outcomes.

If your movement has been organized around protecting the back (avoiding chairs, certain positions or activities), name it and treat it through pain neuroscience education, or cognitive behavioral approaches for chronic pain. Fear of movement is treatable and is the single most modifiable predictor of long-term disability.

Core strengthening is overrated

For years we've been told that a stronger core is the answer to back pain. The evidence says otherwise.

Pilates ranked #1 for both pain reduction and disability. Mind-body practices like yoga and tai chi rated second best, followed by core-based exercise, then strength training and aerobics. Rankings for reducing disability, as well, also gave Pilates first ranking, with strength training next and core-based exercise followed by aerobic exercise.

Interestingly, what did not work: stretching on its own, which was shown to be ineffective for reducing pain or disability.

While core-focused exercise didn't dominate this list as one may expect, Pilates includes core strengthening as part of the program.

The best three options for reducing back pain and disability include:

At least one to two sessions per week of Pilates or strength exercises
Sessions of less than 60 minutes of core-based, strength, or mind-body exercises
Training programs from 3 to 9 weeks of Pilates or core-based exercises.

Injections, surgeries, pain relievers… oh, my!

It's almost automatic to reach for a pain reliever when you hurt your back. As someone with a tendency towards high blood pressure, NSAIDs are out for me, but acetaminophen (Tylenol) is acceptable.

The problem? Neither works to alleviate back pain, research shows. NSAIDs resulted in small benefits, and acetaminophen didn't work any better than placebos.

Muscle relaxers might cause lightheadedness, which can be risky in adults with balance issues. Gabapentin was also no better than placebos and is associated with dizziness and fall risk in people 60+.

My mother had chronic back pain and underwent several surgeries over her later years, none of which seemed to do much good. They sometimes reduced her pain, but it always returned after a few months.

Studies back up her experience as par for the course. Epidural injections, joint injections, nerve blocks, and radiofrequency ablation were all shown as no better than sham procedures for non-specific low-back pain.

Surgery for back-dominant pain is not supported by evidence and may cause harm. Exceptions include surgery for disc herniations and stenosis with neurological compromise, not just for back pain alone. The same study showed an increased risk of adverse events in older adults receiving these procedures, including hyperglycemia and bone mineral loss with steroid injections, and temporary motor weakness with nerve blocks.

So what does work? Aside from Pilates and other exercises mentioned above, a heating pad or heat wrap helps for short-term relief, while cold therapy may help during the first several hours after an acute injury. Physical therapy is also shown to help.

(For specific precautions on how to use heat and cold after 50, check out my earlier story here.)

Live your best life

So much of how we perceive back pain affects the way we live our lives. Allowing fear to take over, catastrophizing, and avoiding activities we used to enjoy makes our world smaller and more isolated.

I saw myself starting to go down this road several times, but am making an effort to get back to myself. Aging doesn't have to mean limiting yourself — it's about making adjustments where you must but not becoming fearful of enjoying the simple things that make life worth living.

Disclaimer:_ This article is for informational purposes only and should not replace medical advice from your healthcare provider._

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