If you’ve been stressed out lately and noticing pain flares, you may be wondering, Can anxiety cause back pain? The answer is yes. 

Research suggests a strong association between the two: One study found that people with chronic back or neck pain were almost twice as likely to have anxiety as those who didn’t have any discomfort. “There’s definitely a clear relationship between back pain and anxiety,” says Nikki Bond, PT, DPT, a physical therapist at Hinge Health. “Sometimes anxiety can cause pain, and sometimes living with chronic pain can trigger anxiety.”

The good news: If you’re dealing with back pain that’s related to anxiety, there are many ways to get both better under control. Some of the most effective tools — like movement and mindfulness-based therapies — help treat back pain and anxiety at the same time.

Read on to learn how anxiety can play a role in back pain and what you can do to feel better, including tips recommended by Hinge Health physical therapists.

Can Anxiety Cause Back Pain?

Back pain is complex, and is often multifactorial, which means that it can have many causes. In general, anxiety itself doesn’t literally cause back pain, but causes behaviors that can contribute to back pain, including:

• Muscle tension. Think about when you’re anxious. You’re more likely to tense your muscles and not even realize it. “We often elevate or hunch our shoulders when stressed, and when you hold a posture like that for a prolonged period of time, it will naturally create muscle soreness,” says Dr. Bond. You may also breathe differently too. “It’s common to develop a shallow breath pattern when you’re anxious, and this breathing style can put strain on back muscles,” she adds.

• Inactivity. When you’re anxious, you may become less active. This is especially true if one of the things you’re anxious about is your lower back pain. Fearing more pain, you may start to think it’s best to avoid movement as much as possible, but that actually has the opposite effect. Inactivity stiffens muscles and causes more pain. In fact, research suggests a bidirectional pattern between physical activity and symptoms of anxiety: People who are inactive are more likely to feel anxious, and people who have anxiety are less likely to work out. 

• Sleep issues. “Back pain, anxiety, and sleep all intersect,” explains Dr. Bond. “We know that when you’re anxious, you have trouble falling asleep, which in turn can worsen back pain, which can then worsen your anxiety. It’s a vicious cycle.”

• Heightened nervous system. “When you’re stressed and anxious, your body can get stuck in fight-or-flight mode, where your body increases the release of stress hormones such as cortisol or adrenaline,” says Dr. Bond. “This essentially turns up the volume on your entire nervous system, sending you into a much higher state of awareness. As a result, you’re more likely to notice back pain than if you were in a relaxed state.”

While this brain-pain connection can be frustrating, there’s a lot you can do to break the cycle — starting with moving more. One of the most important benefits of exercise is that it improves mental well-being by improving sleep, increasing resilience to stress, improving confidence, and reducing fear of movement.

Anxiety Back Pain Symptoms

If you suffer from periodic back spasms, you may not automatically be able to tell that anxiety is one of the causes. But if you pay attention, you’ll notice that there are some clues that anxiety is worsening your back pain, including:

• Back pain that doesn’t seem to stem from an activity. “When anxiety is triggering back pain it will seem to come on without cause, like an actual muscle strain or a specific incident that could trigger it,” explains Dr. Bond.

• Back pain that intensifies when you feel anxious.

• Pain around your upper back muscles from tensing up your shoulders.

• Back pain that worsens after a poor night of sleep.

How to Relieve Back Pain from Anxiety

Whether you need help right now, or anticipate an anxious time in your future, it’s a good idea to have many tools in your toolbox that will address both back pain and anxiety. “When you talk about the two, they are best treated by a holistic approach that combines movement therapy and mindfulness practices,” says Dr. Bond. Here’s how to relieve back pain from anxiety:

• Physical therapy. A physical therapist (PT) can offer a range of solutions to help manage back pain and anxiety through exercise and manual therapy such as massage, says Dr. Bond. “There are some physical therapists who do vagus nerve mobilization, which activates your parasympathetic nervous system,” she says. They can even work on sleep hygiene techniques with you, too, to help ensure you’re getting a good night’s rest. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Exercise. “Movement is helpful for both anxiety and back pain,” points out Dr. Bond. It improves blood flow and oxygenation to your back, and releases endorphins to boost your mood. “It does a great job of reversing some of the physiological effects of anxiety, such as hunched shoulders or a tensed back,” she says. “It will bring you out of these positions to give your muscles relief and improve your back pain.” It can be challenging to start an exercise program when you’re dealing with anxiety. Dr. Bond recommends starting small — even with just brief “movement snacks” — to get going and help you gradually build from there. 

• Diaphragmatic breathing. This breathing technique can help to relieve lower back pain, according to a review of 11 studies published in the journal Complementary Therapies in Medicine. “Diaphragmatic breathing is an incredible way to tackle back pain related to anxiety, because your breath can help reduce tension in your diaphragm, abdominals, and lower back muscles to relieve lower back pain,” says Dr. Bond. “It activates your parasympathetic system — the calming portion of your nervous system — to decrease your anxiety.” 

• Yoga. “Yoga encourages you to focus on your breathing, which calms your nervous system while also increasing your flexibility,” says Dr. Bond. A 2022 review inthe journal Pain found that yoga significantly improved pain and quality of life in people with chronic lower back pain. “Even if you can’t get out to a yoga class, doing moves at home like a seated cat cow or a seated side stretch will relax both your mind and your back,” says Dr. Bond.

• Consider therapy. If you have both chronic anxiety and chronic lower back pain, a short course of either talk therapy or an online mindfulness-based stress reduction program may help. People who participated in either reported significant decreases in lower back pain and improved overall functioning, according to a 2016 study in the journal JAMA. 

How long does anxiety-induced back pain last? There’s no clear-cut answer, says Dr. Bond. “What we do know is that when patients tackle their symptoms of anxiety along with their back pain, they often report feeling better, both physically and emotionally,” she says.