Pain in the back or neck is much like gray hair and forgetting where you put the keys—it seems to happen as we grow older. But the question is one of degree. How much back pain is abnormal? Is that sharp stabbing feeling just the “creakiness” that comes with aging—or the symptom of a bigger problem?

Alexis Tingan, MD, CAQSM, physician at Penn Medicine, says this is a normal question many people have. Dr. Tingan discusses some of the signs of an aging spine—and some symptoms that might indicate disease or injury.

Penn Medicine offers an online assessment test to help you learn when it is time to see a doctor for your back or neck pain.

Online Back and Neck Health Assessment Test

Normal or not?

It’s normal to feel back or neck pain as you age. “Aches and pains in the spine are just facts of life,” Dr. Tingan says. “They are incredibly common—some estimates say that upwards of 85% of people will experience some sort of back or neck pain.

According to Dr. Tingan, most people start noticing back pain between the ages of 40 and 60. However, there isn’t necessarily cause for concern if it starts younger—some people begin to feel the effects of an aging spine as young as 30.

While a little bit of spine pain is perfectly normal, there are several signs that back or neck pain is due to something more sinister, like a tumor or infection.

Back or neck pain that’s so severe that it’s debilitating needs to be checked out by a physician,” says Dr. Tingan. “If you have significant pain when you do things you normally do, like exercise or work, make sure you see a physician."

You should also see a physician if you have these symptoms in addition to back or neck pain:

• Fevers
• Unexplained weight loss
• Increased pain at night
• Bladder or bowel incontinence
• Pain that shoots down the legs
• Numbness or tingling
• Weakness
• Severe pain that doesn’t improve after you’ve rested
• Pain that occurs after you’ve taken a fall or injured yourself

Even if you don’t experience these symptoms, there’s no harm in seeing a physician for your back or neck pain.

Back or neck pain may be inevitable, but you don’t have to succumb to it,” Dr. Tingan says. “If you don’t treat it, you risk not being able to function the way that you used to. You may have trouble doing your job or enjoying your favorite activities.

To relieve pain, your physician might prescribe:

• Medications
• Injections
• Physical therapy
• Surgery

What causes back or neck pain?

Discs

Many times, back or neck pain comes down to discs—the gel-like cushions that rest between the vertebrae (bones in the spine). They help maintain the natural curvature of your spine, and allow your back to flex or bend. And most importantly, discs absorb shock as you walk or run.

When a disc ruptures, leaking its jelly-like center and irritating nearby nerves, it’s called a herniated disc. Dr. Tingan says that while herniated discs are probably the most common cause of back pain in younger people, they are still a common cause of pain in older patients.

As you get older, the discs dry out, and become less spongy and pliable,” he says. “They become rigid, increasing your risk of having a herniated disc.

Arthritis

Osteoarthritis—a “wear-and-tear” type of arthritis—is another common cause of back or neck pain.

The joints that connect the vertebrae are lined with cartilage, a flexible, elastic tissue. When you age, the cartilage fades away. At the same time, the discs lose water and become narrow, adding more pressure to the joints. This pressure causes inflammation and can lead to back pain.

When spine pain is primarily in the neck, it could be due to cervical spondylosis (arthritis of the neck). Cervical spondylosis develops when there is abnormal wear on the bones and cartilage in the neck.

Spinal stenosis

Dr. Tingan often sees patients who have pain due to spinal stenosis.

Spinal stenosis occurs when one or more areas of the spine narrow. The narrowing puts pressure on the spinal cord or nerves, causing pain, numbness, or cramping.

Aging is one of the biggest risk factors for spinal stenosis, but this condition can also be caused by:

• Arthritis
• Bone disease
• Herniated discs
• Tumors
• Spinal cord injuries

Can you keep your spine young?

Even though some back pain is to be expected with age, there is one way to lower your risk of severe pain. “I always say—weight, weight, weight,” says Dr. Tingan.

“Every pound on your body puts pressure on your musculoskeletal system,” Dr. Tingan says. ‘In general, each pound puts about 4 pounds of pressure on the system when you’re walking, and 8 pounds when you’re running. The less pressure you can put on your back, the better, so it’s incredibly important to maintain a healthy weight.”

In addition to eating a healthy diet, Dr. Tingan recommends regular aerobic activity, like walking, jogging, or biking. “Exercise helps you lose weight and strengthen your back,” he says.

Just be careful—if activity is causing more pain, talk to your physician. “Anything that causes pain is bad,” Dr. Tingan says. “Pain is the body’s natural, built-in mechanism to tell us that the body doesn’t like what we’re doing. You should never do something that’s putting you in pain.”