Back pain is one of the most common orthopedic complaints. Pain in the back is complex in that many things can cause it. In short, it is typically caused by stiffness or injury to the muscles and joints that make up the spine. In addition, back pain is not picky in that it can impact all areas of your spine: the lower back, mid-back, or upper back.
When it comes to the mid-back, hunching over your desk, repetitive work with your arms or prolonged standing can cause pain specific to this area. In addition to these activities, osteoporosis can also cause middle back pain. Vertebrae affected by osteoporosis become weak and can compress together, causing pain and difficulty with movement.
Your Spine and Osteoporosis
When you understand how osteoporosis can affect the spine, it is no surprise that it can lead to back pain.
Your spinal column is composed of small bones (vertebrae) stacked on top of each other with cartilage (discs) in between. Because the spine is made up of so many joints, it can move in many different directions, allowing you to move freely throughout life. However, when the vertebra become weak or osteoporotic, they can compress on one another. This can lead to inflammation at the site and stiffness, which in turn will affect movement capabilities.
Severe incidences of vertebral compression due to osteoporosis can lead to compression fractures. Vertebral compression fractures from osteoporosis are almost twice as common as fractures in other body parts, such as the hips, shoulders, and wrists (American Academy of Orthopedic Surgeons, 2021). Many times these fractures go undiagnosed, because they don’t cause pain or aren’t caught without imaging. However, according to a recent study, those with compression fractures, even when undiagnosed, had higher complaints of back pain than those without (Sawicki et al., 2021).
The back can be categorized into three different areas. Each part of the back can be impacted by osteoporosis and can cause pain in its respective area.
- Lower Back: This part of the back is referred to as the lumbar spine. Because of its close proximity to your hips, it takes on a lot of the load of your body with walking, standing and bending. A defect here can lead to lower back pain and occasional pain radiating down one leg. Low back pain due to osteoporosis in the lumbar spine can be helped with core stabilization exercises, postural training, and proper lifting techniques.
- Mid-Back: This part of the back is made up of the lower thoracic spine and the junction where the thoracic spine meets the lumbar spine. The thoracic vertebrae are attached to your ribs, so this part of your spine does not move a whole lot. Mid-back pain due to osteoporosis in the thoracic spine can be helped with core stabilization exercises, postural training, and stretching, which will be discussed below.
- Upper Back: The upper back consists of the upper thoracic and cervical spine (the neck). Any problems in this part of the back can cause neck pain or pain around the back of the shoulders. Poor posture or a forward head position can contribute to pain here. Management of pain in this area can be helped with postural exercises and stretching.
How Stretching Can Help
As you age, the forces of gravity can take a toll on the body. Most daily movements consist of things that are in front of you: eating, cooking, driving, caring for your children or pets, writing, working on a computer, etc.. Because of this, it is no surprise that older adults tend to assume a rounded forward position.
This, coupled with the detriments of osteoporosis, which can further compress the spine forward, can lead to significant postural imbalances. As a result, muscles in the front of the body (the chest and abdomen) can tighten up, whereas muscles in the back (back muscles and shoulder muscles) get weak.
There are certain stretches and exercises that loosen up the tight muscles and strengthen the back muscles to improve the imbalances. It is important to work on these imbalances before they progress, resulting in compression fractures or permanent spine deformities. Movement can also help lubricate the joints, allowing improved movement and decreased discomfort.
How to Stretch Your Middle Back
The back stretches discussed below can help improve posture, decrease back pain and address tight muscles associated with a forward posture.
This is a gentle stretch that involves unloaded flexion and extension of the spine. If you have osteoporosis, you should avoid flexion (or the "cat" portion of this exercise) and simply move between neutral spine and "cow" stretch.
- Start on your hands and knees on a yoga mat or a soft surface.
- Start in a neutral position, meaning that your spine is parallel to the mat.
- Without bending your elbows or shifting your weight forward or back, tuck your chin to your chest and round your spine up towards the ceiling. This is cat pose.
- Next, slowly look forward and up while dropping your belly towards the mat. This is cow pose.
- Alternate between cat and cow for 5-10 rounds.
- Try to link your breath with the movements, exhaling with cat and inhaling with cow.
Important: If you have low bone mineral density, you should be cautious with this stretch. Avoid the "cat" stretch and go from neutral spine to "cow" stretch only. Any extreme flexion or extension could be painful or harmful to your spine. If you are unsure if this stretch is for you, speak with your healthcare provider or your physical therapist before doing it.
2. Child's Pose
This restorative yoga pose helps stretch the muscles in the mid back and open up your hips.
- The starting position is on your hands and knees on a yoga mat or a soft surface.
- Without moving your hands, sit your hips back onto your heels.
- You can bring your knees wider to accommodate your trunk if needed or to make this comfortable.
- Hold for 30-60 seconds and breathe steadily.
This stretch is intended to round your spine a bit. There is no need to force your back straight. This is a gentle flexion of your back, intended to stretch your mid-back muscles.
3. Cobra Pose
Another popular yoga pose which can help reverse the forward rounding mentioned above.
- Start by laying on your stomach with your hands placed on the mat or floor, just under your shoulders.
- Gently push your upper body and rib cage up off of the mat.
- Hold for 2-3 seconds before returning back to the mat.
- Perform this 5-10 times.
Through this exercise, you may feel a stretch in the front of the body and/or back pain relief. If you feel pain during this stretch, press up within a smaller range of motion, or hold off on this exercise altogether. If you feel pain shooting down your leg with this exercise, seek medical advice from your doctor or physical therapist on an alternative stretch.
4. Passive Backbend
Back-bending is often deemed unsafe and scary for those with osteoporosis. However, don't worry! This movement is very small and gentle. It is also intended to safely and slowly reverse that forward rounded position.
- Start by standing with your hands on your hips.
- Gently push your hips forward, aiming your upper body and rib cage up towards the ceiling.
- Hold for 2-3 seconds before returning back to an upright position.
- Perform this 5-10 times.
This stretch may provide back pain relief. Only bend as far back as you feel comfortable. You should be able to breathe steadily throughout this stretch.
5. Latissimus Dorsi Stretch
The latissimus dorsi (or “lat” for short) is a very large muscle that starts in your low back and ends in your upper arms. Stretching these muscles can help alleviate back pain and improve posture.
- Start by standing in front of a chair or a countertop.
- Place your right hand on the top of the chair back or the countertop.
- Slowly lean your chest forward until your trunk is parallel to the floor. Keep your right arm straight. You should feel a stretch in your right shoulder or just under your right armpit.
- Hold for 15-30 seconds.
- Repeat this with the left arm.
- Perform 2-3 sets on each side.
If you perform this stretch and feel a stretch in the back of your thighs, slightly bend your knees so the focus is on your lat. This exercise can also be done seated, or while kneeling.
Tips for Managing Back Pain
Because back pain is so complex, managing pain is a multimodal process. There are several other things you can do to help with your pain.
- Practice good posture. The more you fight the inevitable forward posture and practice an upright posture the sooner it will become second nature. An upright spine is safe, strong, and ready to handle activities of daily life, such as standing, walking, carrying, bending, and lifting. Start practicing good posture with easy activities such as brushing your teeth. This can make it routine. Also be sure to keep a straight spine with activities such as bending and lifting.
- Consider alternative therapies. Non-medical services such as acupuncture, chiropractic care, and massage can help loosen muscles and ease pain. These work great in conjunction with physical therapy to make the lasting changes your body needs to stay healthy.
- Focus on movement. Exercise, no matter which form you enjoy doing, loosens muscles and joints, which can decrease pain due to tightness and stiffness. Exercise also helps improve general wellness and physical preparedness, which can decrease your chances of injury or pain down the road.