Back Pain

Why back pain matters for longevity

Back pain is the leading cause of disability worldwide and one of the most common reasons people limit physical activity as they age. About 80% of adults experience at least one episode during their lifetime, and roughly 23% develop chronic low back pain ^[1]. Left unaddressed, it doesn't just hurt — it erodes the movement capacity you need to stay independent and physically capable for decades.

From a longevity perspective, the real danger isn't the pain itself. It's the cascade that follows: reduced activity, muscle loss, weight gain, poor sleep, and eventually a sedentary lifestyle that accelerates biological aging. A 2021 meta-analysis found that severe back pain in older adults was associated with increased mortality risk, particularly in women ^[2]. The goal isn't simply to "fix" back pain — it's to build a resilient spine that supports active living well into old age.

What causes back pain as you age

Most back pain is "non-specific," meaning imaging can't identify a single structural cause. That's actually good news — it means the problem is usually functional, not permanent. The most common contributors include weak or deconditioned spinal muscles, poor movement patterns, prolonged sitting, and chronic low-grade inflammation (inflammaging) that accelerates disc degeneration ^[3].

Age-related changes are real but often overstated. By age 40, about 40% of people show disc degeneration on MRI. By 80, that number reaches 80% ^[4]. Yet many of these people have zero pain. The presence of degeneration doesn't predict who will hurt. What predicts pain more reliably is a combination of physical deconditioning, central sensitization, and psychosocial factors like fear of movement and catastrophizing.

Exercise is the strongest medicine

The evidence is clear: exercise outperforms rest, passive treatments, and most surgical interventions for non-specific back pain. A Cochrane review of 249 trials confirmed that exercise therapy produces meaningful improvements in both pain and function compared to no treatment or usual care ^[5]. The most effective types include core stability training, Pilates, yoga, and progressive resistance training.

Stuart McGill's research at the University of Waterloo has shown that core stability — specifically training the transverse abdominis, multifidus, and obliques for endurance rather than raw strength — reduces pain and improves function better than general exercise alone ^[6]. His "Big Three" protocol (curl-up, side plank, bird dog) remains one of the most evidence-backed starting points for people with active back pain.

For those past the acute phase, progressive loading matters. Deadlift training, when properly prescribed, has been shown to reduce pain and improve function in people with mechanical low back pain ^[7]. The key is progressive overload with good form, not avoiding load altogether.

Walking as prevention

A landmark 2024 randomized controlled trial published in The Lancet (the WalkBack trial) found that a simple walking program nearly doubled the time before back pain recurrence — 208 days versus 112 days in the control group. It also reduced the risk of recurrence requiring medical care by 43% ^[8]. Walking is free, accessible, and one of the most effective long-term strategies for keeping back pain from returning.

Beyond exercise: sleep, inflammation, and the mind

Sleep quality directly affects pain perception. A medium-firm mattress that maintains neutral spinal alignment has the strongest evidence for reducing back pain during sleep ^[9]. Side sleeping with a pillow between the knees helps maintain pelvic alignment.

Chronic systemic inflammation — what researchers call inflammaging — accelerates disc degeneration and sensitizes pain pathways. Anti-inflammatory nutrition (rich in omega-3s, polyphenols, and vegetables), maintaining a healthy body composition, and regular movement all help reduce this background inflammation.

Psychosocial factors are equally important. Fear-avoidance behavior and pain catastrophizing are among the strongest predictors of chronic pain development. Cognitive behavioral approaches, combined with graded exposure to movement, break these cycles effectively.