Guidelines for treating low back pain in older adults take into consideration the increased potential for complications. Recommendations primarily center on pain management and controlled, progressive, and consistent exercise. Adequate activity also helps prevent unexpected outcomes, such as pressure sores from excessive bed rest or psychological distress related to limited daily activities and a reduction in endorphin production. On days that pain is severe and exercise seems impossible, just gently stretching is far superior to bed rest.
Use Ice Therapy
Most episodes of severe low back pain tend to be related to a spike in inflammation. Application of cold therapy, such as a commercial ice pack or even a frozen bag of vegetables, will bring inflammation down. It is typically advisable to immediately apply ice therapy (cryotherapy) for 20 minutes at a time, every 2 hours as needed, to sooth inflammation following activity or exercise.
Ice therapy may not be recommended for older adults with diabetes or other nerve conditions, because the skin may be at risk for further damage.
Use Heat Therapy
Low back pain is commonly related to muscle spasms or stiffness from osteoarthritis. Application of a heat pack will relax muscles and increase the range of motion of the lower back, quickly addressing both spasms and stiffness. It is recommended to apply heat packs for about 20 minutes at a time, well before performing any strenuous physical activity or exercise.
Heat therapy may not be recommended for people with certain skin conditions, such as dermatitis, heart conditions, or diabetes.
Engage in Controlled, Progressive Exercise
A physical therapy program that includes regular, controlled, and progressive exercise is a central component of almost any lower back pain care plan. Back pain at advanced ages is rarely remedied, rather it is reduced or brought to a more tolerable level that allows for increased function and ease with daily activities.
A general recommendation for older adults is about 1 to 2 hours of aerobic activity, such as brisk walking, and 2 days of strengthening exercises per week.1 Commitment to regular activity is important, as these exercise programs are most effective when performed for at least 6 weeks. Time to recovery is usually longer in advanced age than in youth.
Activities that are practical, easy, and effective for older adults include:
- Aquatic exercise. Exercises done in a warm swimming pool are as effective as other supervised exercises performed at home, at physical therapy, or at a gym.2 The buoyancy provided by the aquatic environment is a safer alternative for older adults. The initial pain and stiffness tend to be less intense with water exercises. Aquatic therapy has the further benefits of improving balance, flexibility, and function, while also reducing depression and anxiety.3
- Lumbar stabilization exercise. Older adults who perform dynamic stability exercises have stronger muscles and are better able to avoid injury from falls or recover balance after a fall.4 This form of exercise can decrease pain and disability by about 30%.5
- Core strengthening exercise. Activities that stabilize and strengthen the trunk muscles are considered to be effective in reducing low back pain,6 particularly when done as part of a comprehensive physical therapy program.7 Strengthening the core muscles helps improve overall stability, posture, and steadiness while walking.
Specific exercises may be more or less appropriate depending on the underlying diagnosis. The following examples of exercises may not be suitable for all patients.
- Yoga poses that involve hip rotation or fully bending forward or backward are contraindicated for someone with osteoporosis.8
- Exercises that include bending backward may be painful for someone with lumbar spinal stenosis or degenerative spondylolisthesis.
- Exercises that include bending forward at the waist may not be recommended for someone with a disc problem in the lower back.
Some types of exercises that emphasize flexibility can place excessive strain on the spine and increase back pain.9,10 As a general guideline, it is best to start any new stretching or exercise program under the guidance of a qualified health professional.
Gentle, low-intensity exercises and activities that are easier to perform have a higher likelihood of being adhered to over time. For older adults with little to no physical activity, starting a new exercise program will most likely require the help of an appropriately qualified professional, such as a physical trainer, physical therapist, or physiatrist.
Individuals over 65 years of age are at high risk for falls, and this risk increases further when taking multiple medications or sedatives.11 Once a fall occurs, there is a substantial risk of further complications, such an osteoporotic fracture. Older adults who sustain a bone fracture from a fall may not achieve complete recovery.
It is critical to prevent falls by taking precautions and proactive steps, such as:
- Exercise for at least 3 hours per week. A comprehensive routine of aerobic exercises and strengthening exercises is best performed for 1 to 2 hours a day, for 2 to 3 days a week. An exercise program that enhances balance can lower the risk of falling by 39%. , Specifically, tai chi has been shown to effectively protect against falls, with more frequent sessions associated with greater fall prevention.14,15
- Walk for at least 1 hour per week. One hour of brisk walking can be included in the minimum 3 hours of exercise. Walking is free, easy to do, and can be readily incorporated into one’s daily routine. For those who are new to physical activity or in pain, walking can be done in shorter intervals throughout the day. A habitually brisk walking speed, at or above 3 miles per hour, is more protective against a fall than a generally slow walking pace. Individuals living within walking distance from nearby parks or grocery stores have lower rates of back pain as well as knee pain.16
- Wear nonslip shoes. Slipping is a common cause of falls. Nonslip shoes or slip-resistant shoes are the most suitable option when the fall risk is high. A shoe with an outsole that offers the best floor grip and traction are typically made of soft rubber. Some nonslip shoes are designed with treads or grooves to disperse liquid that may otherwise trap the shoe. Nonslip shoes are often made and sold by various brands and are labeled “work shoes,” because they are required to be worn in professional settings, such as at a restaurant, construction site, or hospital. While doctors recommend rocker bottom shoes for patients who have diabetes or painful joints, rocker bottoms actually increase the chance of slipping or tripping17 and are best avoided if the fall risk is high.
- Install handrails on the stairs and in the shower. Handrails are important to aid in balance while walking up or down the stairs or in the shower. Falls on stairs are more common during the descent.18 Showers and bathtubs tend to be slippery, making handle bars a necessity in the shower as well.
- Remove tripping hazards. Preventative measures include removal or safe fixture of common tripping hazards, such as throw rugs and lamp cords.
Precautions against falling are especially important when taking psychotropic drugs. Drugs such as antidepressants, antipsychotics, benzodiazepines, narcotics, and sleep medications are related to a greater risk of falls.19
Older adults may find more focused care at specialized clinics, such as spine clinics, which have better outcomes in pain relief and are less likely to lead to a dependence on muscle relaxants than standard clinical care.20 All comprehensive spine clinics take an algorithm-based approach, screening for depression, anxiety, insomnia, fibromyalgia, and symptoms of lumbar spinal stenosis. The screening is followed by a structured physical examination, a discussion of the identified contributors to back pain, and a collaborative effort between the doctor and the patient to devise a treatment plan.
Read more about Specialists Who Treat Back Pain
It is important to explore treatment options with healthcare professionals and develop a plan that works best with the specific cause of low back pain and other ongoing health conditions.