Stress and back pain are deeply interconnected, forming a cycle in which each can intensify the other. Although people often view pain and or injury as purely physical and stress as purely an emotional state, research shows these two systems commonly and extensively overlap, and this is something we see regularly within the clinic.
In simple terms, the cycle often appears as. Injury presents > pain comes on > pain persists > limits your physical activity and social life > stress increases > pain increases and the cycle all starts again.
So, why does this happen?
When the body perceived stress, in whatever form this may be, work, social, home, physical danger, this activates a system in your body called the sympathetic nervous system, also known as the ‘fight or flight’ response. This response increases hormones within our bodies such as cortisol and adrenaline which are normal, commonly occurring hormones that help the body to act quickly. One normal response to this is muscle tension and tightening.
Often, muscles around the area of pain, but particularly in the neck shoulders and lower back are more sensitive to stress-related tension. Short bursts of this are normal and not harmful, but chronic stress can cause further fatigue stiffness, spasm and of course pain.
Cortisol itself, a commonly occurring hormone, is useful during brief stressful situations, but long-term elevation can contribute to back pain in several ways.
Cortisol can also have an effect on the natural healing process. But Cortisol also acts on the nervous system and its ability to process pain signals. Over time, stress can sensitize your nervous system, making it more reactive to small stimulus. Thus, the body can interpret sensations that are normally occurring in the body, as painful. These include low back pain during tasks such as sitting, bending, and light pressure.
Stress also has an impact on posture and behavioral patterns. They can indirectly cause worsening back pain. When people feel overwhelmed, anxious they often will:
- Sit for longer periods
- Sit with poor posture
- Partake in less exercise
- Have poorer sleep
These habits contribute to increased muscle tightness, low mood, poorer recovery, and increased stress.
Sleep disturbance is another major factor. Stress often reduces sleep quality or makes it difficult to fall asleep. Poor sleep is strongly associated with increased pain sensitivity and slower healing. When the body does not receive adequate rest, muscles remain tense and fatigued, creating conditions for ongoing back discomfort as well.
Beyond muscle tension, stress influences back pain through cognitive and emotional pathways. When people feel anxious or overwhelmed, their attention becomes more focused on bodily sensations, including pain. This heightened awareness can amplify the perception of discomfort and hence pain can worsen.
Additionally, fear and worry about pain such as the belief that movement will worsen injury can lead to avoidance behaviours. People may stop exercising, reduce physical activity, or move stiffly to protect themselves. Unfortunately, reduced movement weakens muscles and joints, making pain worse over time. This is why it is important to speak to a OHL Physiotherapist for guidance on the best and safest movement and exercise to do to try and improve your pain and reduce stress.
Accompanying this Conditions like anxiety and depression, which often coexist with chronic stress, further affect pain pathways. The brain’s emotional and sensory regions are tightly connected, and negative emotions can lower pain tolerance. This is why it is important to have a strong multidisciplinary team such as physiotherapist and a clinical psychologist working together to help you get the best outcomes with persistent and ongoing back pain and stress.
One of the strongest links between stress and back pain is how they reinforce each other. Back pain is not only uncomfortable, it can disrupt sleep, limit daily activities, reduce productivity, and increase feelings of frustration or helplessness. These emotional responses create more stress, which tightens muscles and worsens pain. This forms a self‑perpetuating cycle:
1. Stress increases muscle tension and pain sensitivity.
2. Pain creates worry, frustration, and reduced activity.
3. Emotional strain increases stress levels.
4. Stress feeds back into more muscle tension and pain.
Breaking this cycle often requires addressing both the physical and psychological aspects of stress and pain together.
So how do we do that? There are many ways to address this, but the research consistently shows that managing stress can significantly reduce back pain, even when the initial cause may have been physical. These strategies and plans should be made in a multidisciplinary team that includes a physiotherapist for your physical injury and our OHL Clinical Psychologist who can assist in reducing the stress associated with the pain.
If you or someone you know is struggling with ongoing pain, stress and or a lack of physical activity, please get in touch and our expert team will be happy to help. Appointments with our Clinical Psychologist and/or 30minute or 60minute bookings with our Physiotherapy team can all be made through 9431 5955 and/or via the Client Portal on the website.
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