Maybe it started as a twinge or a dull ache. Days, then weeks, spent hunched over a laptop at the dining room table made it worse. Transitioning to the couch for evening Netflix binges didn’t help. That occasional twinge evolved into persistent low back pain.

Our bodies, and our backs in particular, need to move. A lot can go wrong when they don’t. But since the coronavirus pandemic upended society in March 2020, physical activity has plummeted, time spent sitting has skyrocketed, and isolating at home to avoid the virus has fueled a different kind of epidemic: low back pain.

Even before COVID-19, more than 8 in 10 American adults were expected to have a significant episode of low back pain in their lifetimes, says Diane Dalton, a clinical associate professor and physical therapist at the BU Physical Therapy Center in the Ryan Center. The pandemic created a perfect recipe for the acceleration of those episodes. “Chronic back pain was at epidemic levels as it was,” Dalton says. “Now it’s going to be worse.”

Perfect Storm

“The way we use our bodies has changed over time,” says James Camarinos, clinic director of the BU Physical Therapy Center. “In the last 12 months, probably more so than ever.”

Pandemic-related lockdowns and quarantines forced abrupt changes to daily routines. For anyone who started working from home, commutes were eliminated, walks between meetings or to the office coffee machine wiped out, and gyms closed. A study in the Annals of Internal Medicine, using data from digital activity trackers, showed step counts decreased by 27.3 percent worldwide in the first month of the pandemic. The British Journal of Sports Medicine reported that sitting time rose 30 percent.

Our bodies, and our backs in particular, need to move. A lot can go wrong when they don’t. But since the coronavirus pandemic upended society in March 2020, physical activity has plummeted.

If you spend the day stationary, even a perfectly ergonomic workspace won’t prevent back pain. Regular movement keeps the back engaged and healthy. “It’s activating the muscles that support the back, moving the joints, getting your heart rate up so there’s more blood flow into all of the body’s tissues,” Dalton says.

The pandemic also fueled a rise in several other risk factors for back pain, according to the American Psychological Association’s “Stress in America” poll. That report, published one year into the pandemic, revealed that 42 percent of Americans gained more weight than intended (an average of 29 pounds); 67 percent reported changes in sleep patterns; and 23 percent drank more alcohol to cope with stress.

And for people already living with back pain, the pandemic disrupted the routines they used to manage their discomfort, like periodic physical therapy treatment and regular exercise. “I think people just lost their strategies,” Camarinos says. “People’s sense of normalcy was upended and the things that helped them stay physically healthy suddenly, poof—gone.”

A Complicated Matter

The pandemic may explain why back pain is on the rise, but pinpointing the exact cause of the pain—that’s complicated.

Your back is an intricate structure. Five vertebrae (L1–L5) make up the lower, or lumbar, region. Discs pad those vertebrae, ligaments hold them in place, and tendons bind them to surrounding muscles. Thirty-one sets of nerves control motion and carry messages to and from the brain.

“There’s a lot we don’t understand about back pain—85 percent of the time, we can’t put our finger on the cause,” Dalton says.

Instead of diagnosing the precise problem, she says, a physical therapist will often look for common symptoms that are known to respond to specific interventions. She compares it to an ankle sprain where the damage could be to ligaments, muscles, or both—and the combination might be irrelevant to a successful treatment.

Dalton cautions against putting too much faith in diagnostic images, like MRIs and X-rays, which can provide misleading information. A scan might reveal degeneration of the spine, which can be a normal product of aging and may not be the source of the pain. That can lead to a vicious cycle of managing discomfort by avoiding activity, thus weakening the back further.

Early Intervention

One of the best predictors of future back pain, Dalton says, is previous back pain. And early intervention is critical. If ignored, periodic pain can become chronic. That, in turn, could lead to invasive surgeries and medications, including opioids.

While the pandemic brought in-person physical therapy appointments to an abrupt halt, the healthcare industry adapted quickly by embracing telehealth—technology that can allow patients to get help more quickly.

“Telehealth was sort of at a tipping point at the beginning of 2020. People were coming around to the idea, but to the general healthcare market as a whole, telehealth was still a niche offering,” says Bob Knox (CGS’08, Sargent’10, SPH’12), who was a product manager at AmWell, a telemedicine company, until January 2021. “That flipped overnight.”

The BU Physical Therapy Center has gradually returned to in-person treatments—by spring 2021, about 85 percent of patients had returned to the Ryan Center—but that doesn’t mean telehealth will be phased out. Virtual visits are often quicker to get, which eliminates one barrier to progress. They also help physical therapists understand—and potentially adjust—their patients’ daily environments, like how they sit at the computer. And they could help people avoid problems before they begin by enabling them to check in with physical therapists for periodic injury screenings, rather than wait until they’ve aggravated an injury.
For now, Dalton has simple advice for people emerging from the pandemic with new or more severe back pain: get moving again and rebuild your capacity.

“It boils down to a gradual increase in activity—and maintaining that over time,” says Dalton. “As healthcare providers, we need to figure out how to support people with behavior change.”

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