Back Pain: The Yale Medicine Guide to a Better Back

Healing movement

The right kind of exercise prevents back pain and can help with healing, too.

We draw upon the latest research and decades of practice to address some of our patients’ most common questions.

Quick facts about back pain
  • Eight out of 10 people will visit their doctor with a back pain complaint at some point in life.
  • The right kind of exercise prevents back pain, and helps with healing.
  • People with back pain should avoid exercise that involves repetitive lifting, twisting, bending and jumping.
  • Consider replacing work desk and chair with something more ergonomic and back-friendly.
  • Most spine procedures are successful and don’t require follow-up surgery.

If you do not suffer from back pain, consider yourself lucky. And be aware: While your good fortune may hold, the odds are against you. Eight out of 10 people will visit a doctor with back pain at some point in their lives. And, every year, according to estimates, half of all working adults in the United States will experience a back pain episode.

According to James J. Yue, MD, co-director of the Spine Surgery section at Yale Medicine’s Department of Orthopaedics & Rehabilitation, there are many misconceptions about back pain, its causes and its cures.

Beliefs about how to treat conditions such as disk degeneration, sciatica and herniated disks that were once commonly held are no longer valid, says Dr. Yue, who specializes in surgery for motion-sparing and endoscopic spine surgery. “We have many new treatments now,” he says.

To learn about back pain treatments at Yale Medicine,  click here.

What’s true and what’s not? Dr. Yue sheds light on some common fears, questions and misconceptions.

What is the latest thinking about exercise for people with back pain?

The right kind of exercise prevents back pain and can help with healing too. “Walking is good for your back,” Dr. Yue says. Stretching and using your muscles is beneficial, he says, and one of the major back-related benefits of exercise is that it improves circulation. “The spine is a relatively avascular region, without much blood flow,” Dr. Yue says. “Blood flow to the spine is really important. The more exercise you get, the greater the blood flow—and the less likely you are to have degenerative back conditions.”

What is the link between being overweight and having back pain?

“A lot of back pain is the result of people being inactive and overweight, which exceeds the limit of what your back can take,” Dr. Yue says. “Think of it like carrying a heavy bag of potatoes on your back for long periods of time—it overloads the structural capacity of what our bodies are made to do.” But, he says, if there are other underlying structural problems, such as disk degeneration, weight loss likely will not solve the problem. It may help to reduce the intensity and frequency of back pain episodes, but will not fix the underlying cause.

What sports are most likely to cause or aggravate back problems?

Some activities are more likely than others to cause back problems. “Once you are 50 or older, you need to be much more careful,” Dr. Yue says. “Anything that involves repetitive lifting, twisting, bending and jumping can be terrible for your back.”

Dr. Yue says sports such as basketball, volleyball and golf are particularly problematic. Also potentially troublesome to the back is running, especially on an uneven surface. If you are physically fit and enjoy those activities, go ahead and play–but moderation is key. “It’s not a good idea to go out and play four rounds of golf in one afternoon,” Dr. Yue says.

Is yoga good for the back or bad for the back?

There are pros and cons. "I don’t want to tell people they shouldn’t do yoga," Dr. Yue says. “I have seen people injure themselves by doing yoga, but I also think it can be really good for you, so it’s a plus-minus type of situation. If you want to do yoga, make sure you are working with an instructor who is well-trained and knowledgeable about the back."

What can people who work at desk jobs do to prevent or reduce back pain?

“There is more pressure on the back when you are sitting than when you are standing,” Dr. Yue says. He advises getting up regularly to stand, stretch and walk around, all of which go far toward preventing or ameliorating back pain.

Dr. Yue also suggests exploring ways you can can improve the ergonomics of your workstation. “I definitely think that standing desks can be good and helpful for the right patient with certain problems that are exacerbated by sitting, but you also might find relief from a different type of chair, like a ball chair,” he says.

What is the typical course of treatment for debilitating back pain?

Conservative, nonsurgical solutions are always the first line of treatment for back complaints. “There are many reasons people have back pain, including acute episodes and chronic,” Dr. Yue says. “Treatment has to be individualized for every patient. I don’t think that surgery is the right answer for everyone. I am actually very conservative when it comes to surgery.”

What is it like to have surgery for back pain?

“A lot of spine surgeries can now be done on an outpatient basis,” Dr. Yue says. For example, a new surgical treatment for herniated disk called minimally invasive endoscopic laser assisted spine surgery, done under local anesthesia, takes less than an hour. Unlike with traditional open back surgery, minimally invasive surgery is conducted through a small incision, allowing surgeons to access the damaged portion of the spine without disrupting muscles. A laser is directed through the endoscope to cut and shrink tissues.

Dr. Yue says minimally invasive surgery reduces post-operative pain and discomfort. “Patients go home the same day and are back to work within one or two days,” he says. 

Does back surgery offer a permanent solution to back pain?

Most spine procedures are successful and don’t require follow-up surgery.  “There’s a common belief that if you have a fusion, you’ll need another one in five years," Dr. Yue says. "This is one of the things that people are most afraid of when it comes to spine interventions.”

Techniques and technologies have improved and though it used to be much more common for people to need multiple procedures for their back pain, that’s no longer true, Dr. Yue says. 

Is it true that many back problems are caused by emotional issues?

“Back pain affects everything about a person, including their social, economic and psychological life,” Dr. Yue says. It makes sense to see a spine specialist about your back pain, even if you are facing emotional challenges that aggravate your condition. “Everything you do in life depends on your back, whether you standing or sitting or sleeping,” Dr. Yue says.

“If you can’t sleep, your pain level actually gets worse. Getting adequate sleep helps control your pain. Back pain is a life-encompassing issue. Fixing the physical source of back pain can change a patient’s life completely.”