Back pain is one of the most common reasons older adults seek healthcare. Yet, despite its prevalence, many misconceptions persist - often leading to unnecessary worry, testing, or even harmful treatments.
Below, we’ll separate fact from fiction when it comes to back pain in later life.
Fact: While back pain is common as we age, it isn’t inevitable.
Research shows that the prevalence of non-specific back pain (pain not linked to a specific disease or injury) increases up to around age 60, then levels off or even decreases slightly. Working-age adults are actually most at risk for low back pain, not retirees.
However, specific causes of back pain - such as osteoarthritis, spinal stenosis, or osteoporosis - do become more common with age and can increase the likelihood of persistent pain or disability. Identifying and managing these specific conditions early can make a big difference.
Fact: Serious causes of back pain, like cancer, infection, or fractures, account for fewer than 5% of all cases in older adults.
The vast majority - around 90% - are classified as non-specific back pain, just like in younger age groups. Other serious causes, such as cauda equina syndrome or inflammatory back pain, tend to appear in much younger adults.
Fact: Imaging is not recommended unless there are red flags for serious disease.
Although age over 50 is sometimes listed as a red flag, it’s not one on its own. Unless there’s a history of cancer, trauma, infection, or other warning signs, imaging usually doesn’t help.
In fact, degenerative changes — such as disc bulges or joint wear — are extremely common in people without pain. Routine scans can create unnecessary anxiety, lead to more tests, and even result in worse outcomes.
Fact: Movement is medicine — even if it’s uncomfortable.
Avoiding activity often delays recovery and leads to stiffness, weakness, and fear of movement. Pain during activity doesn’t mean you’re causing damage.
For most older adults with mechanical or degenerative back pain, staying active and gradually returning to normal lifting and bending is beneficial. As the saying goes, “motion is lotion.” A strong, well-used spine is a resilient spine.
Fact: Bed rest can actually make things worse — especially for older adults.
Staying in bed will slow recovery and increase risks such as muscle wasting, joint stiffness, bone loss, and even blood clots.
Keeping active (within tolerance) supports circulation, muscle strength, and balance. Regular movement also helps maintain the body’s ability to respond to stress and injury as we age.
Fact: Non-drug treatments should come first.
Painkillers like paracetamol are no more effective than placebo for low back pain. NSAIDs offer only small benefits and can be risky for those with high blood pressure, stomach issues, or on blood thinners.
Other medications — including muscle relaxants, anticonvulsants (such as pregabalin), or certain antidepressants — have limited evidence of benefit and often cause side effects like dizziness, confusion, or balance problems.
For older adults, the safest and most effective approach usually includes movement, education, and lifestyle changes before medication is considered.
Fact: Surgery for primary (non-radiating) back pain is rarely effective.
Evidence does not support spinal surgery for back-dominant pain without leg symptoms, and risks increase significantly with age.
Surgery may be appropriate for leg-dominant pain caused by conditions such as spinal stenosis or disc herniation, but even then, back pain itself may not improve. Careful selection and conservative management first are key.
Fact: Almost all older adults show spinal “wear and tear” on imaging — but only a fraction experience ongoing pain.
Chronic non-specific back pain is often a biopsychosocial condition, influenced by physical, emotional, and social factors.
Fear of movement, low mood, or loss of confidence can all contribute to persistent pain. Addressing these factors — through exercise, reassurance, and behavioural support — is often more effective than focusing on structural findings.
Fact: Research shows these procedures often perform no better than placebo for chronic pain.
While they may offer short-term relief, injections and ablations don’t address the underlying factors driving ongoing pain.
They can also carry risks — such as bone loss, elevated blood sugar, and temporary muscle weakness — which may increase fall or fracture risk in older adults.
Fact: Disc herniations are most common between ages 30 and 50.
As we age, discs lose water and become stiffer, meaning they’re less likely to bulge or slip.
Herniations seen on MRI in older adults often represent old, inactive changes rather than the source of current symptoms. Clinical signs — such as nerve tension or weakness — are more reliable than scans for identifying true nerve irritation.
Back pain in older adults is common — but it’s rarely a sign of serious disease, and it doesn’t mean you have to stop being active.
The best evidence supports movement, reassurance, and targeted management rather than medication, bed rest, or unnecessary imaging.
If you’re experiencing persistent back pain, visiting a chiropractor will help by assessing the cause, rule out serious conditions, and guide you in safely staying active.
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