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.

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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.

See How to Use Ice Massage Therapy for Back Pain


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.

See Benefits of Heat Therapy for Lower Back Pain

Effective Exercises for Alleviating Low Back Pain in Older Adults

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, allowing 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 two days of strengthening exercises per week. 1 Lee PG, Jackson EA, Richardson CR. Exercise Prescriptions in Older Adults. Am Fam Physician. 2017;95(7):425-432. Commitment to regular activity is important, as these exercise programs are most effective when performed for at least six 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 Kim Y, Vakula MN, Waller B, Bressel E. A systematic review and meta-analysis comparing the effect of aquatic and land exercise on dynamic balance in older adults. BMC Geriatr. 2020;20(1):302. Published 2020 Aug 25. doi:10.1186/s12877-020-01702-9 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 reducing depression and anxiety. 3 Silva LAD, Tortelli L, Motta J, et al. Effects of aquatic exercise on mental health, functional autonomy and oxidative stress in depressed elderly individuals: A randomized clinical trial. Clinics (Sao Paulo). 2019;74:e322. doi:10.6061/clinics/2019/e322

See Water Therapy Exercise Program

Lumbar stabilization exercise

Older adults who perform dynamic stability exercises have stronger muscles and can better avoid injury from falls or recover balance after a fall. 4 Hamed A, Bohm S, Mersmann F, Arampatzis A. Exercises of dynamic stability under unstable conditions increase muscle strength and balance ability in the elderly. Scand J Med Sci Sports. 2018;28(3):961-971. doi:10.1111/sms.13019 This form of exercise can decrease pain and disability by about 30%. 5 Nava-Bringas TI, Hernández-López M, Ramírez-Mora I, et al. Effects of a stabilization exercise program in functionality and pain in patients with degenerative spondylolisthesis. J Back Musculoskelet Rehabil. 2014;27(1):41-46. doi:10.3233/BMR-130417

See Lower Back Stabilization Exercises for Back Pain

Core strengthening exercise

Activities that stabilize and strengthen the trunk muscles are considered effective in reducing low back pain, particularly as part of a comprehensive physical therapy program. 7 Cruz-Díaz D, Martínez-Amat A, Osuna-Pérez MC, De la Torre-Cruz MJ, Hita-Contreras F. Short- and long-term effects of a six-week clinical Pilates program in addition to physical therapy on postmenopausal women with chronic low back pain: a randomized controlled trial. Disabil Rehabil. 2016;38(13):1300-1308. doi:10.3109/09638288.2015.1090485 Strengthening the core muscles helps improve overall stability, posture, and steadiness while walking.

See Back Exercises and Abdominal Exercise Recommendations

Exercises that May Not be Suitable for Older Adults

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 McArthur C, Laprade J, Giangregorio LM. Suggestions for Adapting Yoga to the Needs of Older Adults with Osteoporosis. J Altern Complement Med. 2016;22(3):223-226. doi:10.1089/acm.2014.0397
  • 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 Sinaki M. Exercise for patients with osteoporosis: management of vertebral compression fractures and trunk strengthening for fall prevention. PM R. 2012;4(11):882-888. doi:10.1016/j.pmrj.2012.10.008 , 10 Sinaki M. Yoga spinal flexion positions and vertebral compression fracture in osteopenia or osteoporosis of spine: case series. Pain Pract. 2013;13(1):68-75. doi:10.1111/j.1533-2500.2012.00545.x 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.

See Easy Exercise Program for Low Back Pain Relief

Prevent Falls

Individuals over 65 years of age are at high risk for falls, and this risk increases further when taking multiple medications or sedatives. 11 Muray M, Bélanger CH, Razmak J. Fall prevention strategy in an emergency department. Int J Health Care Qual Assur. 2018;31(1):2-9. doi:10.1108/IJHCQA-09-2016-0122 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 Lomas-Vega R, Obrero-Gaitán E, Molina-Ortega FJ, Del-Pino-Casado R. Tai Chi for Risk of Falls. A Meta-analysis. J Am Geriatr Soc. 2017;65(9):2037-2043. doi:10.1111/jgs.15008 , 15 Huang ZG, Feng YH, Li YH, Lv CS. Systematic review and meta-analysis: Tai Chi for preventing falls in older adults. BMJ Open. 2017;7(2):e013661. Published 2017 Feb 6. doi:10.1136/bmjopen-2016-013661

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 Okabe D, Tsuji T, Hanazato M, Miyaguni Y, Asada N, Kondo K. Neighborhood Walkability in Relation to Knee and Low Back Pain in Older People: A Multilevel Cross-Sectional Study from the JAGES. Int J Environ Res Public Health. 2019;16(23):4598. Published 2019 Nov 20. doi:10.3390/ijerph16234598

Wear nonslip shoes

Slipping is a common cause of falls. Nonslip or slip-resistant shoes are the most suitable option for high fall risk. A shoe with an outsole with the best floor grip and traction is 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 must be worn in professional settings, such as at a restaurant, construction site, or hospital. While doctors recommend rocker bottom shoes for patients with diabetes or painful joints, rocker bottoms increase the chance of slipping or tripping 17 Kimel-Scott DR, Gulledge EN, Bolena RE, Albright BC. Kinematic analysis of postural reactions to a posterior translation in rocker bottom shoes in younger and older adults. Gait Posture. 2014;39(1):86-90. doi:10.1016/j.gaitpost.2013.06.002 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 Wang K, Delbaere K, Brodie MAD, et al. Differences Between Gait on Stairs and Flat Surfaces in Relation to Fall Risk and Future Falls. IEEE J Biomed Health Inform. 2017;21(6):1479-1486. doi:10.1109/JBHI.2017.2677901 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 Seppala LJ, Wermelink AMAT, de Vries M, et al. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: II. Psychotropics. J Am Med Dir Assoc. 2018;19(4):371.e11-371.e17. doi:10.1016/j.jamda.2017.12.098


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 Weiner DK, Gentili A, Rossi M, et al. Aging Back Clinics-a Geriatric Syndrome Approach to Treating Chronic Low Back Pain in Older Adults: Results of a Preliminary Randomized Controlled Trial. Pain Med. 2020;21(2):274-290. doi:10.1093/pm/pnz179

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.

Dr. Rob Dickerman is a neurological and spine surgeon at the North Texas Brain and Spine Institute. He has more than 15 years of clinical experience and specializes in spine biomechanics, spinal cord injuries, and brain tumors.