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Stiff Back: What's Causing Your Stiff Back & How to Get Relief

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Stiff back can be caused by muscular causes such as muscle strain, muscle spasms, and poor posture. Arthritis of the lumbar spine and spinal cord pressure that compresses the sciatic nerve - the nerve that runs from the lower back to the legs - can also cause back pain and stiffness.

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Hallmark stiff back symptoms

Back stiffness is a common symptom that may start suddenly or develop slowly over time. Severe back stiffness can interfere with daily activities, such as movements required for work. Back stiffness can be particularly debilitating for elderly adults, but some conditions associated with back stiffness can occur at younger ages. The stiffness can occur due to problems with back muscles, joints in the spine, or the spinal cord itself.

Common characteristics of a stiff back

If you're experiencing a stiff back, it can likely be described by:

  • Pain
  • Pain and stiffness in other joints or muscles
  • Stiffness that is worse in the morning
  • Specific tender points in the back muscles
  • Intermittent muscle spasms

Common accompanying symptoms

It's also likely to experience the following symptoms with a stiff back.

6 stiff back causes

Arthritic causes

Arthritis may lead to a stiff back

  • Inflammatory arthritis: Some types of arthritis are characterized by inflammation within the joints. Inflammatory arthritis often leads to stiffness in the back, particularly in a condition called ankylosing spondylitis. This type of arthritis most commonly affects young men. Other parts of the body can be affected, particularly the eyes.
  • Osteoarthritis: Older people are often affected by osteoarthritis, resulting from accumulated damage to the joints due to wear-and-tear over a lifetime. Osteoarthritis in the spine can result in back pain and stiffness.

Muscular causes

Your back stiffness may be due to certain muscular conditions.

  • Muscle strain: Excessive force on the muscles in the back can cause stiffness and pain. Muscle strain can occur suddenly, such as from lifting a heavy object. It can also occur due to repetitive forces on the muscle over time during occupational or athletic activities.
  • Pain syndromes: Back muscles can be involved in musculoskeletal pain syndromes such as fibromyalgia. In this case, there will be chronic pain throughout the body, typically accompanied by stiffness. Back muscles are often involved and may be more stiff in the morning. Fibromyalgia is most common in young women.
  • Polymyalgia rheumatica: This inflammatory condition affects muscles close to the middle of the body, including the shoulders, hips, and back. Muscle pain is commonly accompanied by stiffness, particularly in the morning. This disorder is sometimes associated with inflammation of the temporal artery, which can lead to blindness if left untreated.

Traumatic causes

Injury to the spine or spinal cord can result in a stiff back.

  • Fracture: A fracture of part of a vertebra can lead to back pain and stiffness. Depending on the type of fracture, either young athletes or older adults are most commonly affected. Osteoporosis or bone thinning is a risk factor.
  • Spinal cord compression: Back pain and neurological abnormalities are the dominant symptoms of compression in the area of the spinal cord. Back stiffness can also occur, however. The spinal cord can be compressed by bony abnormalities or injury, infection, or a herniated disc. Immediate medical evaluation is recommended.

Vertebral osteomyelitis

Vertebral osteomyelitis, or spinal osteomyelitis, is an infection in the bones of the spine. It usually affects the lumbar, or lower, back, and may be either acute or chronic.

The infection is caused by bacteria, most commonly Staphylococcus aureus and Pseudomonas aeruginosa, and by some types of fungi. These agents can travel through the bloodstream from an infected wound elsewhere in the body and reach the bones of the spine.

Most susceptible are those with weakened immune systems; poor circulation; recent injury; or undergoing hemodialysis. Osteomyelitis of the spine is the most common form of osteomyelitis in adults, though children can also be affected.

Symptoms include swelling, redness, and pain at the site of the infection, along with fever, chills, and fatigue.

A medical provider should be seen for these symptoms, as vertebral osteomyelitis can progress to abscess and cause further complications if not treated.

Diagnosis is made through blood tests, imaging of the spine, and sometimes biopsy.

Treatment involves several weeks of intravenous antibiotic or antifungal medication, which can be given as an outpatient.

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Spine metastases

Metastasis is the term meaning the spread of cancer cells from tumors in other parts of the body. The spine is a common location for new tumors, or metastases, to form.

Some types of cancers, especially those of the breast, prostate, lung, thyroid, and kidney, are likely to spread to the spine. Exactly why this happens is not known.

Symptoms of spine metastases include back pain; bowel and urinary incontinence; arm or leg weakness; and hypercalcemia, or high levels of calcium in the blood.

Hypercalcemia can cause nausea and vomiting, constipation, and mental confusion.

These metastasized tumors can cause pain and fractures in the spine.

Diagnosis is made through various types of imaging, including x-ray, bone scintigraphy (bone scan,) CT scan, PET scan, and/or MRI.

Treatment is varied and is designed for each individual case. It may include IV osteoporosis medications to strengthen bones; chemotherapy to fight cancer cells; and steroids to reduce inflammation. All of these help to reduce pain, as well.

Radiation therapy and surgery may also be used.

Spinal stenosis

The spine, or backbone, protects the spinal cord and allows people to stand and bend. Spinal stenosis causes narrowing in the spine. The narrowing puts pressure on nerves and the spinal cord and can cause pain.

Next steps including visiting a primary care physician. For this condition, a physician might suggest further investigation including imaging of the spine. Treatments may include medications, physical therapy, or braces. For severe cases, surgery is sometimes recommended.

Rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory disorder that affects the lining of the joints, causing them to become thickened and painful. It can also affect other parts of the body such as the heart, lungs, eyes, and circulatory system.

Rheumatoid arthritis is an autoimmune disease, which means the body's immune system turns against itself for unknown reasons.

Most at risk are women from ages 30-60. Other risk factors are family history, smoking, and obesity.

Early symptom include warm, swollen, stiff, painful joints, especially the fingers and toes; fatigue; and fever. Usually, the same joints on both sides of the body are affected.

If untreated, irreversible joint damage and deformity can occur, with other complications. Early diagnosis can allow preventive treatment to begin as soon as possible.

Diagnosis is made through physical examination; blood tests; and x-ray, CT scan, or MRI.

There is no cure for rheumatoid arthritis, but the disease can be managed to improve quality of life. Treatment includes nonsteroidal anti-inflammatory drugs; steroids; anti-rheumatic drugs; physical therapy; and sometimes surgery to repair the joints.

Psoriatic arthritis

Psoriatic arthritis is a complication of psoriasis, which causes the skin to become thickened, red, and scaly. Arthritis may appear before or after the psoriasis appears.

Both conditions are autoimmune diseases, where the body attacks itself, and are thought to be caused by genetic and environmental factors.

Most susceptible are people from 30 to 50 years of age with a family history of the disease and who already have psoriasis.

Symptoms include the joints on one or both sides of the body becoming painful, swollen, and hot; swelling and deformity of the fingers and toes; pitted, flaking fingernails; foot pain in the heels and soles; and joint pain in the low back pain.

It is important to seek treatment, as psoriatic arthritis can permanently damage the joints, eyes, and heart.

Diagnosis is made through physical examination, x-rays, and MRI. Blood tests and joint fluid tests can confirm psoriatic arthritis.

Treatment includes over-the-counter, nonsteroidal anti-inflammatory drugs; anti-rheumatic medication; immunosuppressants; and steroid injections for the joints. Surgery to replace damaged joints may also be tried.

Polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is a chronic condition that involves inflammation, aching pain, and morning stiffness. It affects muscles close to the middle of the body, including the shoulders, hips, and back. Its cause is not known, but it is more common in people over 50 years old.

You should consider visiting a healthcare provider within the next day to discuss your symptoms. PMR can be evaluated with a review of your symptoms and medical history. Your provider may also perform a blood test. Once diagnosed, it can be treated with prescription steroid medication, which can improve symptoms within one week.

Paget disease of the bone

Paget disease of bone is also called PDB, osteitis deformans, or osteodystrophica deformans. It is normal for bone cells to renew themselves throughout life, but in PDB the renewal becomes disordered. New bone cells are produced too quickly, causing the bones to become weakened and overgrown.

The cause of PDB is not known. It may be due to an inherited trait combined with certain viral infections.

Symptoms include enlargement, bowing, and abnormal curving of the bones, with pain and tenderness. The skull, pelvis, spine, and upper arms and thighs are most often affected. However, many patients have no symptoms and the condition is discovered while assessing something else.

If not treated, Paget disease of bone can lead to bone deformity; fractures; osteoarthritis; and hearing loss due to changes in the small bones within the ear.

Diagnosis is made through blood tests and an x-ray or CT scan.

There is no cure, but symptoms can be managed with medication, pain relievers, physical therapy, and sometimes surgery.

Mechanical low back pain without sciatica

About 80 percent of people will experience mechanical back pain. Mechanical means that the pain comes from the spine or its supporting structures. Sometimes, people experience sciatica with their low back pain. Sciatica is a general term to describe pain that travels from the back into the leg. Most of the time, it is unclear to doctors what exactly causes the episode of low back pain. However, it is most often due to a muscle strain, or an injured tendon or ligament. A slipped or herniated disc is also a possible cause. Fortunately, in any of these cases, initial treatment is the same. Pain usually goes away within 4-6 weeks, often sooner.

Lower back arthritis

Osteoarthritis, most often simply called arthritis, is a disease of cartilage. In joints, where bones touch and move against one another, cartilage helps provide lubrication for smooth movement, and acts as a shock absorber. Cartilage is also present in between vertebrae, which are the bones comprising the spine. Osteoarthritis of the spine, also known as degenerative joint disease, happens when the cartilage between vertebrae dries out and shrinks. The vertebrae are thus not as able to move smoothly against one another. The ability to walk and perform normal daily activities can be impaired due to inflammation and pain in the lower back.

Rarity: Common

Top Symptoms: lower back pain, spontaneous back pain, back pain that gets worse when straightening it, back pain from overuse

Urgency: Primary care doctor

Herniated (slipped) disk in the lower back

A herniated, ruptured, or "slipped" disc means that a vertebral disc – one of the soft pads of tissue that sit between each of the vertebral bones – has becomes squeezed out of shape. Its cushioning material has been forced against, and possibly through, the ring of fibrous tissue that normally contains it. This causes pain, numbness, and weakness in the legs.

The normal aging process causes the discs lose moisture and become thinner, making them more vulnerable to "slipping."

Most susceptible are men from ages 30 to 50. Smoking, obesity, lack of exercise, and improper lifting are also risk factors.

Symptoms include pain, weakness, numbness, and tingling in the back, leg, and foot.

Diagnosis is made through patient history, neurological examination, and MRI scan.

Treatment begins with rest, nonsteroidal anti-inflammatory drugs, physical therapy, and sometimes epidural steroid injections into the back to ease pain and inflammation.

Surgery to remove the herniated part of the disc – the part that was squeezed out of place – can also be helpful.

Rarity: Common

Top Symptoms: lower back pain, moderate back pain, back pain that shoots down the leg, back pain that gets worse when sitting, leg weakness

Urgency: Primary care doctor

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Fibromyalgia

Fibromyalgia is a set of chronic symptoms that include ongoing fatigue, diffuse tenderness to touch, musculoskeletal pain, and usually some degree of depression.

The cause is not known. When fibromyalgia appears, it is usually after a stressful physical or emotional event such as an automobile accident or a divorce. It may include a genetic component where the person experiences normal sensation as pain.

Almost 90% of fibromyalgia sufferers are women. Anyone with rheumatic disease, such as rheumatoid arthritis or lupus, may be more prone to fibromyalgia.

Poor sleep is often a symptom, along with foggy thinking, headaches, painful menstrual periods, and increased sensitivity to heat, cold, bright lights, and loud noises.

There is no standard test for fibromyalgia. The diagnosis is usually made when the above symptoms go on for three months or more with no apparent cause.

Fibromyalgia does not go away on its own but does not get worse, either.

Treatment involves easing symptoms and improving the patient's quality of life through pain medications, exercise, improved diet, and help with managing stressful situations.

Diffuse idiopathic skeletal hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH) is calcification or a bony hardening of ligaments in areas where they attach to the spine. Ligaments are supposed to be flexible, so DISH can cause symptoms such as pain, stiffness, and restricted movement.

You should visit your primary care physician who will be able to confirm the diagnosis with X-ray, and localize the problem to specific areas in your spine. This disease is managed with pain medication, physiotherapy, and, in rare cases, surgery.

Rarity: Rare

Top Symptoms: joint pain, upper back pain, stiff neck, stiff back, trouble swallowing

Urgency: Primary care doctor

Ankylosing spondylitis

"Ankylosing" means a joint has become stiffened and fixed in one position due to injury or disease. "Spondylitis" means inflammation in the joints of the spine.

In ankylosing spondylitis, inflammation has damaged the vertebrae of the low back and caused a form of arthritis, leaving the lower spine inflexible.

The exact cause is unknown. It is thought to be an inherited, abnormal immune response that is triggered following damage to the lining of the intestines.

Most susceptible are those with a family history of ankylosing spondylitis and a history of intestinal damage from illness. However, anyone can be affected at any age.

Symptoms include pain and stiffness in the back and hips, and sometimes in the neck and shoulders. The pain will be worse during sleep and rest.

Early treatment can help to manage the symptoms, prevent complications, and improve quality of life.

Diagnosis is made through physical examination and x-rays.

Treatment involves nonsteroidal anti-inflammatory drugs; new forms of biologic medications; physical therapy; and, in some cases, surgery to repair damaged joints.

Stiff back treatments and relief

Back stiffness alone is unlikely to require emergency treatment. However, it can indicate a serious injury or infection when accompanied by other symptoms.

When it is an emergency

You should seek emergency treatment for the following.

  • The stiffness and pain after an acute injury are so severe that you are unable to move
  • Changes in vision or eye pain
  • Weakness in your legs, sensation changes in your legs or groin, and/or loss of control over bowel and bladder function
  • Systemic symptoms such as fever and fatigue along with severe back pain

When to see a doctor

In some cases, even though emergency treatment isn't necessary, you may need medical evaluation and treatment. Make an appointment with a doctor for the following.

  • Your back stiffness lasts more than two weeks
  • You are unable to carry out your usual activities
  • Your back stiffness is particularly severe in the mornings
  • You have pain and stiffness in other joints and/or muscles
  • You have been diagnosed with arthritis or a pain syndrome previously and your symptoms are worsening

Medical treatments

Your doctor may recommend one or more of the following treatments, depending on the cause of your stiff back:

  • Physical therapy
  • Anti-inflammatory medications
  • Steroid injections into joints affected by arthritis
  • Antidepressant medications: These can help improve pain, stiffness, and sleep if a pain syndrome is a cause.
  • Referral for surgical management

At-home treatments

Some home treatments may help with a stiff back, such as the following.

  • Heat for muscle pain: A heating pad can help with muscle stiffness and pain.
  • Ice for injury: If your stiffness occurs after an acute back injury, applying ice can help prevent swelling.
  • Continue light activity as much as possible: Bedrest can worsen back pain and stiffness.
  • Pain medication: Ibuprofen (Advil, Motrin) or other NSAIDs can help with pain and stiffness.
  • Relaxation techniques: Meditation can help relax your back muscles, resulting in decreased stiffness and discomfort.
  • Massage: This can help make back muscles less stiff.

FAQs about stiff back

Can back stiffness in a young person be caused by arthritis?

Yes, certain types of arthritis associated with back stiffness typically occur in young people. These conditions are associated with inflammation in the joints of the spine. Ankylosing spondylitis is strongly associated with back stiffness and typically occurs in young men. Rheumatoid arthritis is often diagnosed in children and young adults; like ankylosing spondylitis, it can cause back stiffness and pain.

Is my back stiffness likely to improve?

Many causes of back stiffness will resolve over time without treatment, or with simple home treatments such as heating pads and massage. For example, a muscle strain will likely get better within weeks to months. However, back stiffness caused by a chronic medical condition such as arthritis may persist or worsen over time. See your physician if your back stiffness has not improved after a few weeks.

Do I need imaging to diagnose the cause of my stiff back?

Imaging is not typically the first step in evaluating a stiff back. Often, back stiffness will resolve without treatment and is not caused by a serious underlying medical condition. However, in some cases, it is a good idea to get imaging. If back stiffness occurs along with sudden pain and other worrying symptoms such as leg weakness or fevers, imaging of the back should be performed to see if spinal cord compression or infection is the cause. If arthritis is suspected, imaging can be helpful to establish a diagnosis and determine disease severity.

Why is my back particularly stiff in the morning?

Several conditions cause back pain and stiffness that are particularly severe in the morning. These include inflammatory arthritis, such as ankylosing spondylitis or rheumatoid arthritis, and the musculoskeletal inflammatory disorder polymyalgia rheumatica. If you have one of these conditions, you will likely notice stiffness lasting an hour or more after waking up in the morning, and stiffness may recur if you spend a long time in one position.

Why am I having visual changes in addition to back stiffness?

Uveitis is a common complication of ankylosing spondylitis and inflammatory arthritis. This condition involves inflammation of one of the layers of the eye, leading to eye pain, redness, and blurred vision. On the other hand, polymyalgia rheumatica, a musculoskeletal inflammatory condition, can be associated with temporal arteritis. Inflammation of the temporal artery can cause blood vessel damage that ultimately leads to vision loss. Any changes in vision occurring in association with back pain or stiffness should be evaluated immediately.

Questions your doctor may ask about stiff back

  • Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
  • Is your spinal stiffness worse in the morning?
  • Does your back pain radiate anywhere?
  • Do food or drinks get stuck when you swallow?
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Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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