Dr. Marcus argues that weak, stiff or damaged muscles are responsible for three out of four bad backs, regardless of age. Back pain is often “referred,” he says; that is, a muscle damaged in another part of the body triggers anguish felt in the back. Dr. Marcus believes that doctors who target OA of the spine as a significant contributor to this common problem are misguided. “We’re spending a huge amount of money on back pain,” says Dr. Marcus, “and our results are getting worse.” In fact, a study by researchers at The Dartmouth Institute in Lebanon, NH, found that spending on back and neck problems has doubled in the United States since the late 1990s, to $90 billion a year. And while the study didn’t find that outcomes are worsening, the outcomes don’t seem to be getting better: The number of annual office visits for spine-related woes is about the same today as a decade ago.  

Dr. Weiner feels that while there’s “definitely too much focus” on OA as a source of back pain, she says it can be part of the problem for some patients. “Back pain is usually multifactorial,” she says, noting that OA of the spine may conspire with other conditions to produce discomfort in the lumbar region. For instance, studies show that seven percent of women over 60 have fibromyalgia, a condition of unknown origin that can cause back pain. OA is also linked to scoliosis, or abnormal curvature of the spine. Depression and anxiety, or even having mismatched leg lengths can contribute, too, says Dr. Weiner.

Exercise is a Must
Given that back pain has many causes beyond OA, it’s no surprise that experts say that there’s no one-size-fits-all treatment. Some patients respond well to simple over-the-counter pain relievers such as ibuprofen (Advil) and other nonsteroidal anti-inflammatory drugs (NSAIDs). For severe inflammation, cortisone injections can provide relief, although it’s often temporary. When nothing else helps, surgery is a last resort. According to Dr. Marks, many patients with OA of the spine respond well to a procedure called a laminectomy, in which a surgeon removes a portion of bone from vertebrae to relieve pressure on the spinal cord and nerves.

Regardless what’s causing your back pain, all doctors agree that getting it under control requires exercise to increase the strength and flexibility of muscles that surround and support the spine. But for some, that means overcoming tension in the muscle between their ears.

“People often believe their pain is unsafe,” says Carol Hartigan, MD, a spine physician at New England Baptist Hospital in Boston. “They become fearful of moving, and start to anticipate pain and avoid activities. That makes your muscles weak and tight, which makes you more sensitive to pain.” Once Dr. Hartigan and her colleagues rule out fractures, infections, tumors and other potentially serious causes of back pain, they start educating patients. “We tell them: You have discomfort and pain, but it’s not dangerous. It’s safe to move, even if you initially experience some pain,” says Dr. Hartigan. Exercising increases blood flow to the back, which nourishes joints and muscles with oxygen and nutrients, while clearing away destructive inflammatory waste products.

Just as importantly, a patient’s fear gradually clears away too. For many, realizing they can once again unload the dishwasher or take out the trash without wincing is a revelation. “They feel less afraid to move,” says Dr. Hartigan. “They say: Oh my gosh, I actually did that—and it was okay.”