10 Tips for Managing Inflammatory Back Pain

Managing inflammatory back pain (IBP) usually requires some form of prescription medication — typically a nonsteroidal anti-inflammatory drug (NSAID).

The good news is, if you stick to the treatment recommended by your doctor, you should be able to manage the discomfort associated with IBP.

“Adherence to medical therapy is extremely important,” says Mohamad Bittar, MD, a rheumatologist and assistant professor of medicine at the University of Tennessee Health Science Center in Memphis.

“With currently available medications, it’s possible to halt progression, but nonadherence can lead to loss of efficacy and, eventually, progression. Progression can lead to serious complications, including spinal deformities and fractures.”

Plus, if your symptoms worsen, he adds, you may find you’re unable to work or engage in your normal day-to-day activities.

In addition to sticking with the treatment prescribed by your doctor, though, there are several steps you can take to keep your inflammatory back pain in check:

1. Stay Physically Active to Ease Inflammatory Back Pain

Unlike mechanical back pain, which can worsen with exercise, inflammatory back pain typically improves following physical activity — the right physical activity, that is. Your doctor should recommend that you see a physical therapist to learn exercises and stretches that can help relieve pain and strengthen the muscles around your back.

Certain stretches can also help.

“If you have inflammatory back pain, you should remain active and engage in muscle strengthening and stretching exercises to maintain a good spinal posture,” Dr. Bittar notes. “However, you should avoid high-impact exercises that could potentially be harmful to your spine.”

An example of a good stretch for IBP is the seated thoracic extension. To do this stretch, sit in a low-backed chair with your feet flat on the floor and your back straight against the back of the chair. Then place your hands behind your head with your elbows out (or cross your arms over your chest if that’s more comfortable). Keeping your head still, slowly lean backward, so the top of your spine extends over the back of the chair. Hold this position for 10 seconds, then return to the original position.

However, before beginning any stretching or exercise regimen, talk to your doctor to make sure you have a plan that will help reduce your IBP.

2. Do Deep Breathing Exercises to Maintain Lung Capacity

One type of exercise your doctor or physical therapist may recommend involves breathing. Simple breathing exercises usually involve repeated deep inhaling and exhaling to not only expand your lung capacity but also reduce any inflammation in your rib joints — the joints that connect the ribs to the spine.

If your IBP progresses to ankylosing spondylitis, which it can in many cases, it may affect your rib joints. This could limit the ability of your rib cage to rise and fall as you breathe, making it difficult for your lungs to work properly, particularly during strenuous activity.

3. Learn to Lift Heavy Items Properly

Staying active is great for inflammatory back pain, but heavy lifting isn’t. Your doctor and/or physical therapist will likely advise you to avoid moving bulky, high-weight objects. And, if you must lift something — a piece of furniture or bag of groceries, for example — you should use techniques recommended by your physical therapist, such as using your leg muscles more than those in your back.

4. Be Careful While Driving

The act of driving in and of itself won’t worsen your IBP. However, if you’re ever involved in an accident, your condition may increase your risk for serious injury, including spinal fractures.

“I always tell my patients to be very careful while driving and to avoid sudden movements of the neck or spine,” Bittar says. “Any impact, whether light or strong, can lead to serious problems.”

Of course, accidents happen, as the old saying goes, but if you have inflammatory back pain you can do things to help prevent them. For example, avoid driving for extended periods or long distances without breaks — sitting in the car for a long time can worsen aches and stiffness, too — and be sure to stop and rest if you’re starting to feel tired behind the wheel.

If you need to make a phone call or text or reset your GPS unit, pull off the road and stop the vehicle first.

5. Choose the Right Mattress

Sleeping on the right mattress won’t cure your IBP, but it may help you maintain good posture while you rest.

“I recommend sleeping on a firm mattress — not too hard and not too soft,” Bittar says.

He also suggests that people with inflammatory back pain try to sleep on their abdomen for approximately 30 minutes each night to help maintain good posture.

Getting enough sleep can also help you feel better overall. Poor sleep was linked with chronic low-back pain in a study published in July 2019 in the Scandinavian Journal of Pain.

6. Fall-Proof Your Home to Prevent Fractures

Bittar also emphasizes the importance of making your home safe to help prevent falls. Because inflammatory back pain increases your risk for spinal fractures, avoiding falls is crucial, he notes.

Keep your home free of “trip points,” such as rolled-up rug corners or cluttered rooms, and be careful on steps and getting in and out of the shower or bathtub. Nonslip rugs or floor mats in the bathroom and kitchen may also be helpful.

7. Consider a Raised Toilet Seat for Comfort

Speaking of the bathroom, a special raised toilet seat might also help relieve any discomfort when using the bathroom and reduce the risk for a fall. Bittar recommends raised toilet seats for his IBP patients with “severe stiffness and spinal deformity.”

8. Adapt Your Work Space for Good Posture

If you’re employed and have inflammatory back pain — and given that the condition typically strikes at around age 40, you probably are — look for ways to improve your posture at work. Consider using a standing desk, or ask your employer for an ergonomic chair – or both. You may find it more helpful to alternate between standing and sitting, rather than just doing one or the other.

Positioning your phone or computer screen and keyboard so that you’re not hunched over your desk as you work or forced to reach across your desk to retrieve items can also help reduce strain on your spine.

“I recommend that chairs have a good low-back support and to sit in a straight, upright position,” Bittar notes. “Also, if you sit at your desk a lot at work, you need to get up and move around frequently to stretch and stay loose. Avoid sitting for prolonged periods of time, preferably no more than 30 minutes at a given time.”