Healthy snacks do not always have to be complicated. Sometimes the best options are the ones that feel fun, look colourful, and can be prepared ahead of time. Frozen yogurt bark is a simple snack idea that works well for kids, busy families, and anyone looking for something cool, sweet, and refreshing.

This “unicorn” version is especially fun because it uses colourful yogurt, berries, and a small amount of sprinkles to create a snack that feels more like a treat. It can be made in advance, stored in the freezer, and broken into pieces when needed.

The key is to keep it balanced. Frozen yogurt bark can be a better option than many packaged desserts, but it still depends on the ingredients you choose. Sweetened yogurt, large amounts of honey, candy toppings, chocolate chips, and sprinkles can quickly turn it into more of a dessert than a snack. With a few simple choices, you can make it colourful and fun while still keeping it nutritious.

Why Greek Yogurt Works Well

Greek yogurt is a good base for frozen yogurt bark because it is thicker than regular yogurt. This helps it spread nicely on a tray and freeze into pieces that can be picked up and eaten. Greek yogurt also usually contains more protein than regular yogurt, which can make the snack more filling.

For a healthier version, plain Greek yogurt is usually the best starting point. If your kids prefer something sweeter, you can mix in a small amount of honey or maple syrup instead of starting with a heavily sweetened yogurt. This gives you more control over the sweetness.

Whole-milk Greek yogurt can give a creamier texture, while lower-fat versions may freeze harder and taste a little icier. Either can work, but the texture will be different.

Making It Colourful Without Going Overboard

The unicorn look comes from colour. One way to do this is by mixing in freeze-dried fruit powder, such as raspberry or strawberry powder. This can add colour and flavour without relying only on artificial food colouring.

You can also swirl different colours lightly through the yogurt instead of fully mixing them in. This creates a fun marbled look. The goal is not perfection. In fact, the uneven swirls are what make it look more playful.

If you use food colouring, a small amount is usually enough. Too much can make the snack look artificial and may not be necessary if you already have colourful fruit on top.

Best Toppings to Use

Fresh berries work especially well for frozen yogurt bark. Blueberries, raspberries, sliced strawberries, and blackberries all add colour, texture, and natural sweetness. Freeze-dried berries can also work well because they add crunch and a stronger fruit flavour.

Sprinkles can make the bark look fun, especially for kids, but they should be used lightly. A small amount gives the unicorn look without adding too much extra sugar.

Other topping ideas include shredded coconut, chopped nuts for older children and adults, pumpkin seeds, chia seeds, hemp hearts, or a few mini dark chocolate chips. For young children, be mindful of choking risks and allergy concerns.

Simple Unicorn Frozen Yogurt Bark

Start by lining a rimmed baking sheet with parchment paper. This makes it much easier to remove the bark once it is frozen.

Spread a layer of Greek yogurt over the parchment paper. Aim for a thin but sturdy layer, about a quarter-inch thick. If the yogurt is spread too thin, it may break too easily. If it is too thick, it may take longer to freeze and may be harder to bite.

Add your colour by gently swirling in freeze-dried raspberry or strawberry powder. You can mix it fully for an even colour or leave some swirls for a unicorn effect.

Top the yogurt with berries and a light sprinkle of colourful toppings. Cover the tray and place it in the freezer until firm. Once frozen, let it sit for a few minutes, then break it into pieces.

Store the pieces in a freezer-safe container with parchment paper between layers so they do not stick together.

A Few Practical Tips

Use parchment paper rather than foil, because frozen yogurt can stick and become frustrating to remove.

Do not overload the bark with fruit. Too much fruit adds moisture and can make the bark softer or icier in spots.

Let the bark sit for a few minutes before breaking it. If it is too hard straight from the freezer, it may crack unevenly or be difficult to bite.

Eat it fairly soon after taking it out of the freezer. Frozen yogurt bark softens quickly at room temperature, especially in warm weather.

If packing it for school or daycare, remember that it melts. This snack works best at home or in a lunch container with a good ice pack, depending on how long it will be out of the freezer.

How to Make It More Balanced

To make frozen yogurt bark more nutritious, start with plain Greek yogurt and add sweetness yourself. This helps reduce added sugar compared with many flavoured yogurts.

Add berries generously, but keep candy toppings small. You can also add seeds or nuts if appropriate for the person eating it. For extra protein, some people mix a small amount of protein powder into the yogurt, although this can change the taste and texture.

For children, the goal is not to make every snack perfect. The goal is to build habits around foods that are colourful, enjoyable, and nourishing most of the time.

Why This Can Be a Good Family Snack

Frozen yogurt bark is easy to make with kids. They can help spread the yogurt, add berries, sprinkle toppings, and break the bark into pieces once frozen. Getting children involved in food preparation can make them more interested in trying healthier options.

It is also a useful snack for busy households because it can be made ahead. Instead of reaching for packaged sweets, you can keep a container in the freezer for a quick afternoon snack or after-dinner treat.

This can also be a good summer option when kids want something cold, colourful, and sweet.

The Bottom Line

Unicorn frozen yogurt bark is a simple, fun, make-ahead snack that can be customized for different tastes. With Greek yogurt, berries, and a small amount of colourful toppings, it can feel like a treat while still offering more nutrition than many packaged desserts.

The healthiest version starts with plain Greek yogurt, uses fruit for colour and sweetness, and keeps sprinkles or candy toppings light. It is not about making food boring. It is about making healthier choices more appealing and easier to enjoy.

References

Government of Canada. (2024). Canada’s food guide: Healthy snacks.

https://food-guide.canada.ca/

Dietitians of Canada. (2026). Healthy eating for children.

https://www.dietitians.ca/

Menopause is a normal life transition, but that does not mean it is always easy. Many people associate menopause with hot flashes, sleep changes, mood changes, brain fog, fatigue, and changes in weight. These symptoms can be frustrating and disruptive, but there is another area that often receives less attention: the muscles, joints, bones, tendons, ligaments, and overall movement system.

During perimenopause, menopause, and post-menopause, many women begin to notice new aches and pains. Some describe morning stiffness that was not there before. Others notice joint discomfort, muscle soreness, reduced strength, slower recovery after exercise, or feeling less mobile than they used to. For some, activities that once felt easy, walking, climbing stairs, lifting, exercising, gardening, or getting up from the floor, may start to feel harder.

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These changes are increasingly being discussed under the term Musculoskeletal Syndrome of Menopause. This term refers to a group of muscle, joint, tendon, ligament, cartilage, and bone-related symptoms that may occur during the menopausal transition. The Canadian Menopause Society notes that this cluster can include joint pain, joint stiffness, frozen shoulder, and changes affecting bone, muscle, tendon, cartilage, ligament, and adipose tissue.

Menopause Is Normal, But Symptoms Still Matter

Menopause is often described as a natural transition, and that is true. However, calling something natural should not lead people to ignore symptoms that affect their quality of life. Sleep disruption, pain, stiffness, weakness, and reduced confidence with movement can have a real impact on work, family life, exercise, mood, and independence.

The average age of menopause is often reported around 51, although the timing varies. Menopause before age 45 is generally considered early, while menopause before age 40 is considered premature. Some people also enter menopause suddenly because of surgery, medications, chemotherapy, or other medical factors. The Canadian Chiropractic Association describes menopause as a major biological milestone that can affect physical health, mental health, work, relationships, and long-term wellness.

It is also important to recognize that menopause is not one single moment for most people. Perimenopause can begin years before the final menstrual period. Hormonal changes may fluctuate during this stage, and symptoms may come and go. Post-menopause refers to the years after menopause, when longer-term issues such as bone density, strength, mobility, and cardiovascular health become especially important.

Why Muscles and Joints Can Feel Different During Menopause

Estrogen has effects throughout the body, including the musculoskeletal system. As estrogen levels change and eventually decline, some women may notice changes in joint comfort, soft tissue sensitivity, muscle mass, tendon health, and bone density. A recent review in Climacteric describes musculoskeletal syndrome of menopause as a collection of symptoms influenced by estrogen changes, including arthralgia, loss of muscle mass, loss of bone density, and progression of osteoarthritis.

This does not mean every ache or pain during menopause is caused by menopause. That point is important. A sore knee may be related to osteoarthritis, a meniscus issue, a previous injury, a change in training, footwear, weight changes, or reduced strength. Shoulder pain may be related to rotator cuff irritation, frozen shoulder, posture, sleep position, or repetitive strain. Low back pain may be related to spinal joints, discs, muscles, hip mobility, stress, or activity changes.

Menopause may be one part of the picture, but it should not become a catch-all explanation. A proper musculoskeletal assessment still matters.

Common Musculoskeletal Symptoms During Midlife

Many women describe a general sense that their body feels different. The symptoms may be mild at first and easy to dismiss. Over time, they may become more noticeable.

Joint stiffness is common. Some people feel stiff when they wake up, after sitting, or when starting movement after rest. The hands, knees, hips, shoulders, neck, and low back may all be affected. Muscle aches can also occur, sometimes without a clear injury. People may feel sore after activities that previously caused no problem.

Strength changes may also become noticeable. Carrying groceries, climbing stairs, lifting laundry baskets, exercising, or getting up from a low chair may feel more difficult. This can be related to reduced muscle mass, decreased activity, poor sleep, pain inhibition, or reduced confidence with movement.

Mobility changes can also appear. A person may notice reduced shoulder range of motion, tighter hips, more back stiffness, or a sense that movement requires more effort. Balance and coordination can also become important, especially as people move into later midlife and beyond.

Bone Health Becomes More Important

One of the most important long-term musculoskeletal concerns after menopause is bone health. Estrogen plays a role in maintaining bone density. After menopause, bone loss can accelerate, increasing the risk of osteopenia and osteoporosis.

Osteoporosis matters because it can increase fracture risk. A fall that may have caused only a bruise in earlier years can become more serious when bone density is reduced. This is why weight-bearing activity, resistance training, balance exercise, adequate nutrition, vitamin D status, and medical screening may all become important parts of care.

Chiropractors do not diagnose or treat menopause itself, but they can play a role in recognizing risk factors, modifying care when bone density is a concern, encouraging appropriate exercise, and referring for further assessment when needed.

Muscle Strength Is Not Optional

One of the biggest messages for midlife health is that strength training matters. It is not only for athletes, bodybuilders, or people trying to change their appearance. Strength training supports joints, helps maintain muscle mass, improves function, supports bone health, and may reduce the risk of falls later in life.

During midlife, muscle loss can slowly accumulate if it is not actively addressed. This can affect metabolism, posture, balance, joint loading, and independence. The phrase “move like it matters” is appropriate because movement is not simply about fitness. It is about preserving the ability to live well.

Resistance training can include weights, machines, resistance bands, bodyweight exercises, Pilates-style strengthening, supervised rehabilitation, or functional training. The best program is the one that is safe, progressive, realistic, and sustainable.

For someone who is deconditioned, in pain, or nervous about exercise, the starting point may be very simple. Sit-to-stand exercises, step-ups, wall push-ups, band rows, bridges, heel raises, and gentle mobility work can be enough to begin rebuilding confidence.

Movement Helps More Than Just Pain

Physical activity can help support more than joints and muscles. Regular movement can improve sleep quality, mood, energy, balance, cardiovascular health, and overall function. For many women, movement also helps them feel more in control during a stage of life that can otherwise feel unpredictable.

That does not mean every person should push through pain. Pain is information. The goal is to find the right dose of movement. Too little movement can lead to stiffness, weakness, and loss of confidence. Too much too soon can flare symptoms. A good plan respects both sides.

This is where individualized care matters. Two people may both be going through menopause and both have knee pain, but their needs may be completely different. One may need strengthening. Another may need mobility work. Another may need load management. Another may need medical investigation. Another may need reassurance and a gradual return to activity.

The Role of Chiropractic Care

Chiropractic care is not about treating menopause itself. Menopause is a normal biological transition, not a condition that needs to be “fixed” by spinal treatment. The role of chiropractic care is different.

Chiropractors are musculoskeletal health professionals. During perimenopause, menopause, and post-menopause, chiropractic care may help patients understand and manage pain, stiffness, mobility limitations, and movement-related concerns. The Canadian Chiropractic Association states that chiropractic care during this stage may include strategies to manage musculoskeletal pain and stiffness, improve movement and physical function, and identify when further assessment or referral may be appropriate.

At The Muscle and Joint Clinic, that may include assessing the spine, hips, knees, shoulders, muscles, joints, movement patterns, balance, strength, posture, and activity tolerance. Care may include hands-on treatment, soft tissue therapy, joint mobilization or manipulation when appropriate, exercise prescription, strengthening, stretching, ergonomic advice, and guidance around daily movement.

The goal is not simply temporary pain relief. The bigger goal is helping patients move better, stay active, preserve strength, and feel confident using their body.

Not Every Pain Is “Just Menopause”

One of the risks during midlife is that symptoms may be dismissed. A woman may be told that pain, fatigue, stiffness, or reduced function is just part of aging or just part of menopause. That can lead to missed opportunities for proper assessment and treatment.

Some pain may be related to menopause-associated changes. Some may be related to osteoarthritis, tendinopathy, inflammatory arthritis, nerve irritation, frozen shoulder, spinal stenosis, disc-related pain, or another condition. Some symptoms may also be influenced by stress, sleep disruption, reduced activity, or changes in body composition.

A careful clinical history and physical exam can help separate these possibilities. This matters because treatment should be based on the actual presentation, not assumptions.

When Further Assessment May Be Needed

Most musculoskeletal aches and pains are not dangerous, but certain symptoms should be assessed more carefully. These may include unexplained weight loss, fever, night sweats, progressive night pain, unexplained fracture, new neurological symptoms, significant weakness, major trauma, severe unrelenting pain, or symptoms that do not follow a typical musculoskeletal pattern.

The Canadian Chiropractic Guidelines emphasize that menopause-related symptoms, regional musculoskeletal problems, and other health conditions can coexist. They also highlight the importance of identifying concerning features that may require referral or further medical assessment.

This is especially important after menopause because issues such as osteoporosis, inflammatory disease, cancer history, cardiovascular concerns, and neurological symptoms may change how a clinician approaches assessment and treatment.

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Practical Movement Priorities Through Midlife

A strong midlife movement plan should include several pieces.

Strength training is essential. This helps maintain muscle mass, support joints, and protect long-term function. Weight-bearing exercise is also important for bone health. This may include walking, stair climbing, resistance training, and other activities where the body works against gravity.

Mobility work helps maintain joint range of motion and reduce stiffness. Balance training becomes increasingly important with age and can be built into simple exercises. Cardiovascular activity supports heart health, energy, and endurance.

Recovery also matters. Sleep disruption is common during menopause, and poor sleep can increase pain sensitivity, reduce energy, and make exercise harder. A plan that ignores sleep, stress, and recovery is incomplete.

Nutrition should also be considered. Adequate protein intake supports muscle maintenance. Calcium and vitamin D are important for bone health. Patients with concerns about hormone therapy, supplements, bone density, or menopause symptoms should discuss those issues with their physician, nurse practitioner, gynecologist, naturopathic doctor, pharmacist, or another qualified healthcare provider.

How We Can Help at The Muscle and Joint Clinic

At The Muscle and Joint Clinic, we help patients who are dealing with neck pain, back pain, hip pain, knee pain, shoulder pain, stiffness, reduced mobility, headaches, and movement-related concerns. For women in perimenopause, menopause, or post-menopause, we take a practical approach.

We assess what hurts, how it behaves, what movements are limited, what activities are affected, and what goals matter to the patient. We also consider whether symptoms may require referral, imaging, medical assessment, or coordinated care with another provider.

Treatment may include chiropractic care, physiotherapy, massage therapy, acupuncture, soft tissue therapy, mobility work, strengthening exercises, posture and ergonomic guidance, and education about safe movement. The focus is helping patients move with more confidence and stay active through midlife and beyond.

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The Bottom Line

Menopause is natural, but pain, stiffness, weakness, and loss of mobility should not be ignored. The menopausal transition can affect the musculoskeletal system, but every symptom still deserves a proper assessment.

The most important message is simple: movement matters. Strength matters. Bone health matters. Mobility matters. Confidence matters.

If you are noticing new joint pain, stiffness, muscle aches, back pain, neck pain, shoulder problems, or reduced strength during midlife, support is available. Chiropractic care can be part of a broader healthcare plan to help manage musculoskeletal symptoms, improve function, and keep you moving.

To book an appointment or a free consultation, visit:

www.muscleandjoint.ca

References

Canadian Chiropractic Association. (2026, September 25). Menopause & musculoskeletal health: “Move like it matters” through midlife & beyond. https://chiropractic.ca/menopause-msk-health-guide/

Canadian Chiropractic Guidelines. (2026). Menopause & musculoskeletal health. https://www.canadianchiropracticguidelines.ca/guidance/menopause-musculoskeletal-health/

Canadian Menopause Society. (2026). Menopause symptoms. https://www.canadianmenopausesociety.org/professionals/menopause-hub/symptoms/

Harper, J. C., Phillips, S., Biswakarma, R., Yasmin, E., Saridogan, E., Radhakrishnan, S., & Davies, M. C. (2024). The musculoskeletal syndrome of menopause. Climacteric. https://pubmed.ncbi.nlm.nih.gov/39077777/

Migliore, S., & Taylor, H. S. (2025). Joint pain and menopause. Menopause. https://pmc.ncbi.nlm.nih.gov/articles/PMC12915535/

Szoeke, C., et al. (2026). Musculoskeletal manifestations of perimenopause: A systematic review and meta-analysis of 93,021 women. JBJS Open Access. https://pubmed.ncbi.nlm.nih.gov/41523660/

It sounds simple, but pillow choice can make a noticeable difference for some people with neck pain, headaches, shoulder tension, or morning stiffness. The right pillow is not about buying the most expensive one or choosing the one with the most impressive marketing label. It is about finding a pillow that supports your neck in a position your body can tolerate through the night.

At The Muscle and Joint Clinic, we often see patients who wake up with neck stiffness, tension headaches, upper back tightness, or discomfort that seems worse first thing in the morning. In some cases, the pillow is not the only cause, but it can be one piece of the puzzle.

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Why Your Pillow Matters

Your neck is not meant to be held in an awkward position for hours at a time. During sleep, the goal is to keep the neck reasonably supported so it is not excessively bent forward, tilted sideways, rotated, or extended backward.

If a pillow is too high, the neck may be pushed upward or forward. If it is too low, the head may drop down toward the mattress. If it loses shape during the night, the neck may start in a supported position but end up strained by morning.

This is why some people feel fine when they fall asleep but wake up with stiffness, aching, or a headache.

Research on pillows is not perfect, and no single pillow works for everyone. A systematic review and meta-analysis published in Clinical Biomechanics found that pillow design may influence neck pain, waking symptoms, neck disability, and pillow satisfaction. The review suggested that spring and rubber pillows may perform better than feather pillows for some people with chronic neck pain, but it also found that pillow design did not clearly improve sleep quality overall.

In other words, the pillow can matter, but it is not a guaranteed cure.

Start With Your Sleep Position

One of the most important factors is how you sleep.

Side sleepers, back sleepers, and stomach sleepers usually need different levels of support. The goal is not to force everyone into the same “perfect” posture. The goal is to reduce unnecessary strain on the neck.

Side Sleepers

For side sleepers, pillow height is especially important. The pillow needs to fill the space between the side of the head and the mattress so the neck stays relatively level.

A person with broader shoulders usually needs a thicker pillow, especially if sleeping on a firm mattress. If the pillow is too thin, the head may drop downward. If the pillow is too thick, the head may be pushed upward.

Mattress firmness also matters. On a softer mattress, the shoulder may sink in more, which can reduce the amount of pillow height needed. On a firmer mattress, the shoulder may not sink much, so a thicker pillow may be needed to keep the neck supported.

A useful rule is this: when lying on your side, your nose, chin, breastbone, and spine should feel roughly lined up rather than twisted or tilted.

Back Sleepers

Back sleepers usually need a pillow that supports the natural curve of the neck without pushing the head too far forward.

Some people have a more rounded upper back or a more forward head position, especially as they age or after years of desk work. These patients may feel more comfortable with slightly more support. Others with a flatter upper back may need a lower pillow.

If you sleep on your back and wake up with your chin tucked toward your chest, the pillow may be too high. If your head feels like it falls backward, the pillow may be too low or not supportive enough under the neck.

Stomach Sleepers

Stomach sleeping is often the hardest position on the neck. This is because the head is usually turned to one side for a long period of time. That sustained rotation can irritate muscles, joints, ligaments, and nerves in the neck.

For people with recurring neck pain, headaches, or shoulder tension, stomach sleeping may be worth reconsidering. Changing sleep position can be difficult, but even gradually shifting toward side sleeping may reduce strain for some people.

The Mattress Changes the Pillow

A pillow cannot be judged separately from the mattress.

If your mattress is soft, your body sinks in more. If your mattress is firm, your body stays higher. This changes the distance between your head and the bed, especially when lying on your side.

This is why the same pillow may feel perfect on one bed and terrible on another. It also explains why hotel pillows can feel uncomfortable even when they look thick and soft.

A Simple Test: The Towel Trick

Before buying a new pillow, try a simple experiment.

If your pillow feels too low, place a folded towel underneath it. Adjust the number of folds until your neck feels more supported. If you are a side sleeper, you can also try placing a small rolled towel near the lower edge of the pillow so it supports the curve of the neck.

This is not meant to be a permanent solution for everyone. It is a way to test whether pillow height or neck support is part of the problem before spending money on a new pillow.

If a small height change makes your morning neck pain noticeably better, that is useful information.

What About Contoured, Orthopedic, or Ergonomic Pillows?

Many pillows are marketed as orthopedic, ergonomic, cervical, or contoured. Some patients do well with them. Others find them uncomfortable.

A contour can be helpful if it supports the neck without forcing the head into an awkward position. But the label itself does not guarantee that the pillow is right for you. The shape, height, firmness, your sleeping position, your body size, and your mattress all matter.

For side sleepers, a pillow with slightly more support under the neck may help. For back sleepers, a pillow with a gentle neck support area and a slight head cradle may feel comfortable. But if the pillow feels restrictive or forces your posture, it may not be the right match.

Feather, Foam, Latex, or Fibre?

Different materials behave differently.

Feather and down pillows can feel soft and cool, but they may lose shape during the night. If the pillow bunches up, the neck may end up kinked or unsupported.

Foam and latex pillows tend to hold their shape better. Some people like the consistent support. Others find them too firm or too warm.

Microfibre and hollow-fibre pillows may be a middle ground. They can provide support and are often more affordable, but quality varies.

The best material depends on what your neck tolerates, whether you sleep hot, and whether the pillow maintains its shape through the night.

Signs Your Pillow May Not Be Working for You

Your pillow may be contributing to symptoms if you regularly wake up with neck stiffness, headaches, shoulder tension, upper back tightness, numbness or tingling in the arm, or pain that is worse first thing in the morning.

That does not automatically mean the pillow is the only problem. Neck pain can come from joints, discs, muscles, nerves, posture, stress, workstation setup, previous injuries, and other health factors. But the pillow is worth considering, especially if symptoms are consistently worse after sleep.

When Neck Pain Needs Assessment

If neck pain is persistent, worsening, or associated with arm pain, numbness, tingling, weakness, dizziness, balance changes, fever, unexplained weight loss, trauma, or severe headache, it should be assessed by a healthcare professional.

For many patients, a proper assessment can help determine whether symptoms are mainly mechanical, posture-related, nerve-related, headache-related, or linked to another cause.

How Chiropractic Care May Help

At The Muscle and Joint Clinic, we assess more than just where the pain is. We look at neck mobility, joint irritation, muscle tension, posture, shoulder mechanics, nerve symptoms, headache patterns, sleeping habits, workstation setup, and daily activities.

Treatment may include hands-on care, soft tissue therapy, mobilization or adjustment when appropriate, stretching, strengthening, posture advice, ergonomic recommendations, and practical guidance on sleep positioning.

For some patients, improving pillow setup helps. For others, the bigger issue is neck mobility, muscle tension, stress, desk posture, or weakness in the upper back and shoulder region. The key is figuring out what is actually driving the symptoms.

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The Bottom Line

There is no perfect pillow for everyone.

The right pillow depends on your sleeping position, shoulder width, neck shape, mattress firmness, body size, comfort preference, and symptoms. A good pillow should help your neck feel supported without forcing it into an awkward position.

If you are waking up with neck pain, headaches, or shoulder tension, your pillow may be part of the problem, but it should not be the only thing you consider.

At The Muscle and Joint Clinic, we help patients with neck pain, headaches, upper back tension, shoulder discomfort, and sleep-related stiffness. If you are unsure whether your pillow, posture, or neck mechanics are contributing to your symptoms, we can assess the area and help you build a practical plan.

References

Pang, J. C.-Y., Tsang, S. M.-H., & Fu, A. C.-L. (2021). The effects of pillow designs on neck pain, waking symptoms, neck disability, sleep quality and spinal alignment in adults: A systematic review and meta-analysis. Clinical Biomechanics, 85, 105353. https://doi.org/10.1016/j.clinbiomech.2021.105353

Sandeman, G. (2026, September 28). How to find your perfect pillow — according to an expert. BBC News.

Hurwitz, E. L., Carragee, E. J., van der Velde, G., Carroll, L. J., Nordin, M., Guzman, J., Peloso, P. M., Holm, L. W., Côté, P., Hogg-Johnson, S., Cassidy, J. D., & Haldeman, S. (2008). Treatment of neck pain: Noninvasive interventions: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine, 33(4 Suppl), S123–S152.

Pain travelling from the lower back or buttock into the leg is commonly described as sciatica. It may feel sharp, burning or electric and can sometimes be accompanied by numbness, tingling or weakness.

One important point is that sciatica is not a diagnosis by itself. It describes a pattern of symptoms that may have several possible causes. Identifying the source of the symptoms is important because an exercise that helps one person may aggravate another person’s condition.

At the Muscle & Joint Clinic, we assess how symptoms began, where they travel, what movements aggravate or relieve them, and whether there are any changes in strength, sensation or reflexes. This information helps us determine whether conservative treatment is appropriate and which exercises may be safest.

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What Causes Sciatica?

The sciatic nerve is the body’s largest nerve. It is formed by nerve roots that leave the lower spine and eventually travel through the buttock and down the leg. Sciatic symptoms may develop when one of these nerve roots, or the sciatic nerve itself, is irritated or compressed.

A lumbar disc injury or herniation may irritate a nearby nerve root. Age-related changes such as spinal stenosis or osteoarthritis can reduce the space available for the nerves. In other cases, muscles or other structures in the buttock may irritate the sciatic nerve, sometimes referred to as deep gluteal syndrome.

These conditions can produce similar symptoms but may respond differently to movement. For example, repeated backward bending may help some people with disc-related symptoms but aggravate someone whose symptoms are related to spinal stenosis. This is why treatment and exercise recommendations should be based on an individual assessment rather than symptoms alone.

Who Can Develop Sciatic Symptoms?

Sciatica can affect people at many stages of life. Younger adults may develop symptoms after lifting, sports, repetitive bending or a sudden injury. Older adults may be more likely to experience symptoms related to degenerative changes or narrowing around the spinal nerves.

People with physically demanding jobs may be exposed to repeated lifting, twisting, carrying or prolonged standing. However, symptoms can also occur in people who spend much of the day sitting at a desk or driving.

Prolonged postures, sudden increases in physical activity, repetitive loading, reduced conditioning and previous episodes of back pain may all contribute. Genetics and individual anatomy can also influence a person’s susceptibility to disc degeneration or narrowing around the nerves.

Can Sciatica Be Prevented?

Not every episode is preventable, but maintaining regular physical activity may improve the body’s capacity to manage everyday demands. A balanced program may include strengthening, cardiovascular activity, mobility exercises and gradual exposure to lifting or other work-related movements.

Changing positions regularly can also be helpful. If you sit for long periods, consider taking brief movement breaks rather than waiting until stiffness or pain becomes severe. When lifting, keep the object close to your body, use your hips and knees, and avoid combining heavy lifting with sudden twisting whenever possible.

There is no single “perfect” posture that must be maintained throughout the day. The ability to change positions and move comfortably is often more valuable than trying to hold one rigid posture for several hours.

How Can a Chiropractor Help?

A chiropractor can assess the spine, hips and lower extremities while also evaluating muscle strength, sensation, reflexes and movements that change the symptoms. If necessary, the chiropractor may recommend further medical assessment or diagnostic imaging.

When conservative care is appropriate, treatment may involve education, activity modification, manual therapy, spinal mobilization or manipulation, and an individualized exercise program. The objective is not simply to provide temporary relief, but to help the patient restore movement, build physical capacity and return to meaningful daily activities.

The World Health Organization recommends a person-centred approach to chronic primary low back pain. Depending on the individual, care may include education, exercise, certain physical therapies such as spinal manipulation or massage, psychological interventions and appropriate medications. These options are generally intended to be selected and combined according to the patient’s needs rather than used as isolated treatments.

Exercises That May Be Used for Sciatic Symptoms

The following exercises are commonly included in rehabilitation programs, but they are not appropriate for every person or every cause of sciatica. An exercise should not cause pain to travel farther down the leg or produce new numbness, tingling or weakness.

Bird Dog

The bird dog is used to develop trunk control and coordination. Begin on your hands and knees with your spine in a comfortable, neutral position. Slowly extend one leg behind you while reaching the opposite arm forward. Avoid twisting your trunk or excessively arching your lower back.

Hold the position briefly before returning to the starting position and changing sides. The movement should be controlled, and the goal is stability rather than lifting the arm or leg as high as possible.

Gentle Sciatic Nerve Glide

A nerve glide is intended to move the nerve gently through the surrounding tissues. It should not be treated as an aggressive hamstring stretch.

While seated upright, slowly straighten one knee as you lift your head and look slightly upward. Then bend the knee while gently lowering your chin. Move between the two positions comfortably without holding the end position.

Stop if the movement increases leg pain, numbness or tingling. Nerve glides should feel gentle and should not be forced.

Figure-Four Stretch

This exercise may be used when tightness around the hip or buttock is contributing to discomfort. Lie on your back with both knees bent. Place one ankle across the opposite thigh, creating a figure-four position. If comfortable, gently draw the supporting thigh toward your body until you feel a mild stretch in the buttock.

Do not force the position or continue if it increases symptoms travelling down the leg.

Prone Extension

Prone extension exercises are sometimes used when backward bending reduces or centralizes leg symptoms. Begin by lying on your stomach and resting on your forearms. If this position is comfortable, you may gradually press through your hands to lift your upper body while keeping your hips relaxed.

This exercise is not appropriate for everyone. Stop if the pain travels farther into the buttock, thigh, calf or foot. If leg symptoms move closer to the lower back, this may represent a more favourable response, but the exercise should still be reviewed with a healthcare professional.

When Should You Seek Immediate Medical Attention?

Most episodes of sciatic pain can be assessed through routine care, but certain symptoms require urgent medical attention. Seek immediate assessment if you experience a new loss of bowel or bladder control, numbness around the groin or inner thighs, rapidly worsening leg weakness, symptoms affecting both legs, severe pain following significant trauma, fever with back pain or unexplained weight loss.

Progressive foot drop or increasing difficulty walking should also be assessed promptly.

The Right Exercise Depends on the Cause

Sciatica does not have a universal exercise program. The direction of movement, type of exercise and appropriate starting level depend on the suspected cause, symptom behaviour and the individual’s physical capacity.

The goal is to find movements that reduce or centralize symptoms, restore confidence and gradually improve the ability to sit, stand, walk, work and exercise. If an activity repeatedly causes symptoms to travel farther down the leg, it may need to be modified or temporarily avoided.

If back or leg pain is affecting your sleep, work or daily activities, the team at the Muscle & Joint Clinic can assess your symptoms and develop an individualized treatment and rehabilitation plan.

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References

World Health Organization. WHO Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings. 2023. View the WHO guideline.

This article is provided for general educational purposes. It is not intended to diagnose a condition, prescribe treatment or replace an assessment by a qualified healthcare professional. Stop an exercise and seek professional advice if it worsens radiating pain or causes new numbness, tingling or weakness.

Chronic low back pain can make exercise feel confusing. Should you strengthen your core, practise yoga, walk, stretch or perform balance exercises? How hard should you exercise, and how many times per week should you do it?

A recent systematic review published in the Journal of Orthopaedic & Sports Physical Therapy examined these questions using the FITT principle. FITT stands for frequency, intensity, time and type, the four main factors healthcare providers consider when prescribing exercise.

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The researchers reviewed 70 randomized controlled trials involving 3,991 adults with nonspecific chronic low back pain. “Nonspecific” means the pain had lasted longer than three months but was not attributed to a particular condition such as a fracture, inflammatory disease or another clearly identifiable structural problem.

The researchers wanted to determine whether changing the frequency, intensity, duration or type of exercise could improve disability associated with chronic low back pain. Disability in this context refers to how back pain affects activities such as walking, working, lifting, sleeping and completing everyday tasks.

Exercising more frequently may provide a small benefit

Of the four FITT components, exercise frequency produced the most consistent signal of benefit. Programs prescribing at least three exercise sessions per week were associated with slightly better long-term disability outcomes than programs involving only one or two weekly sessions.

However, the average improvement was small. Although the difference was statistically significant, it did not reach the threshold the researchers had established for a clinically meaningful change. In other words, the results favoured more frequent exercise, but the average difference between the groups may not have been large enough to produce a noticeable improvement in everyday function.

The researchers also found no clear difference between exercising once per week and twice per week. This raises the possibility that increasing exercise from once to twice weekly may not provide a meaningful additional benefit. However, only a small number of studies directly compared exercise frequency, so three sessions per week should not be viewed as a proven minimum for every patient.

It is also important to understand that the study examined how often participants exercised. Exercise sessions could include activities completed independently at home as part of a prescribed program. The practical goal is to create a safe and realistic exercise routine that encourages regular participation and can be maintained over time.

Does exercise intensity matter?

The review did not find convincing evidence that vigorous exercise was better than light- or moderate-intensity exercise for reducing disability.

This does not mean exercise intensity is unimportant. Higher-intensity exercise may still help improve strength, cardiovascular fitness and overall physical capacity. Instead, the available studies were not consistent enough to establish that exercising harder leads to better disability outcomes for people with chronic low back pain.

The appropriate intensity will also vary from person to person. Someone who has avoided movement because of pain may need to begin with gentle, controlled exercises. Another person who is already physically active may benefit from a progressively more challenging strengthening program.

Exercise should feel purposeful and appropriately challenging, but it does not need to be exhausting to be helpful. Gradual progression is usually more sustainable than beginning with an overly demanding program that increases soreness, fear or frustration.

Is one type of exercise better than the others?

The researchers examined numerous approaches, including core stabilization, resistance training, Pilates, yoga, stretching, aerobic exercise, aquatic exercise and sensorimotor training.

Sensorimotor exercise demonstrated small improvements in disability in both the short and long term. These exercises focus on coordination, balance, body awareness, posture and the controlled activation of muscles supporting the spine.

Yoga showed a modest short-term benefit, while assisted or supervised exercise showed a small long-term benefit. Nevertheless, none of these improvements reached the review’s threshold for clinical importance, and much of the evidence was rated as low or very low certainty.

The review therefore does not establish one universally superior form of exercise. An exercise that works well for one person may be uncomfortable, impractical or uninteresting to someone else. Personal preference, physical ability, confidence, access to equipment and the likelihood of continuing the program all matter.

The best exercise may be the one you can continue

One of the most useful conclusions from this research is that regular participation may be more important than the specific exercise selected.

People are more likely to continue an exercise program when it fits their schedule, feels manageable and relates to activities they value. A program might include walking, mobility exercises, progressive strengthening, yoga-inspired movements or exercises that improve balance and spinal control.

A person who enjoys walking and performs it consistently may benefit more than someone who receives a complicated strengthening program but rarely completes it. Similarly, a brief home program performed several times per week may be more practical than a longer routine that becomes difficult to maintain.

The goal is not simply to complete exercises for a few weeks. Long-term improvement often requires building movement into everyday life and gradually increasing the body’s tolerance for work, recreation and household activities.

Exercise should still be individualized

Chronic low back pain is influenced by more than muscles and joints. Sleep, stress, work demands, previous injuries, fear of movement and general health can all affect symptoms and recovery.

An individualized assessment can help determine which movements are limited, which activities aggravate the condition and which exercises are appropriate. A clinician can also monitor progress, modify the program and identify symptoms that may require further medical investigation.

New bowel or bladder problems, progressive leg weakness, numbness around the groin, unexplained weight loss, fever, significant trauma or severe unrelenting pain require prompt medical attention and should not be managed through exercise alone.

What should patients take from this research?

Exercise remains an important part of managing nonspecific chronic low back pain, but there is no single program that works best for everyone. Exercising regularly, potentially three or more times per week, may offer a small advantage, but the program must remain realistic and sustainable.

The most effective plan is usually one that is matched to the patient’s abilities, progressed gradually and performed consistently. Instead of searching for the perfect exercise, focus on developing a routine you can safely maintain.

If low back pain is limiting your work, sleep or daily activities, the team at the Muscle & Joint Clinic can assess your condition and help develop an individualized treatment and exercise plan.

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Research source: Blanco-Heras L, Rebollo-Salas M, Cardellat-González M, et al. The Efficacy of Exercise Therapy for Nonspecific Chronic Low Back Pain According to the FITT Principle: A Systematic Review With Meta-analyses.Journal of Orthopaedic & Sports Physical Therapy. 2026;56(9):566–623. https://doi.org/10.2519/jospt.2026.14098

This article is intended for general educational purposes and does not replace an individualized medical or rehabilitation assessment.

A simple, low-intensity home program improved overall fibromyalgia symptoms, stiffness, mobility, mental well-being, and pressure-pain tolerance

Fibromyalgia is a complex chronic condition commonly associated with widespread pain, fatigue, muscle tenderness, sleep disruption, cognitive difficulties, and heightened sensitivity to pressure. Although exercise is consistently recommended as part of fibromyalgia management, many people find conventional exercise programs difficult to begin or maintain.

Pain flares, fatigue, fear of aggravating symptoms, limited access to supervised rehabilitation, and the cost of ongoing treatment can all interfere with participation. This creates an important clinical question: could a very short, gentle, home-based stretching routine provide meaningful benefits without demanding too much from the patient?

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A 2026 randomized controlled trial published in the Archives of Physical Medicine and Rehabilitation examined exactly that question. The researchers studied whether six minutes of low-intensity stretching per day could improve symptoms in adults with fibromyalgia.

The results were encouraging. After six weeks, participants completing the stretching program reported a clinically meaningful improvement in the overall impact of fibromyalgia. They also experienced improvements in stiffness, mobility, mental health, and pressure-pain tolerance.

Understanding Fibromyalgia

Fibromyalgia is characterized by widespread pain and increased sensitivity to sensory input. People with the condition may experience pain in multiple areas without evidence of a single localized injury that explains the full symptom pattern.

Symptoms can vary considerably between individuals and may fluctuate from one day to another. In addition to pain, fibromyalgia may involve fatigue, disturbed sleep, difficulty concentrating, reduced activity tolerance, mood changes, and tenderness throughout the body.

The exact cause remains uncertain. Current research suggests that altered pain processing within the nervous system plays an important role. This means that the brain and nervous system may become more responsive to signals that would not normally produce significant pain.

Because fibromyalgia affects several aspects of physical and emotional health, there is no single treatment that works for everyone. Management commonly involves education, appropriately paced exercise, sleep and stress strategies, psychological support, medication when indicated, and individualized rehabilitation.

Why Exercise Can Be Difficult With Fibromyalgia

Physical activity is generally considered an important part of fibromyalgia management. However, exercise can be particularly challenging for people who experience widespread pain and fatigue.

Beginning a new exercise program can sometimes temporarily aggravate symptoms. If the program is too intense or progresses too quickly, a person may experience a flare and become hesitant to continue. This can contribute to a cycle of reduced activity, declining physical capacity, and greater difficulty tolerating everyday demands.

The type, intensity, frequency, and duration of exercise therefore matter. An effective program must provide enough stimulus to be beneficial while remaining manageable enough for the patient to perform consistently.

The researchers behind this study developed a low-dose, high-frequency program with this challenge in mind. Instead of asking participants to complete lengthy exercise sessions, the program required only six minutes of gentle stretching each day.

How the Study Was Conducted

The randomized controlled trial enrolled 58 adults between the ages of 18 and 65 who had been diagnosed with fibromyalgia according to established clinical criteria.

Participants were randomly assigned to one of two groups. The intervention group completed the six-week home stretching program, while the control group continued with usual care and was placed on a waiting list to receive the program after the study’s main assessment period.

The average participant was approximately 50 years old. Fifty-five of the 58 participants, almost 95%, were women. Participants had experienced symptoms for an average of approximately 16 to 19 years and had generally been living with a formal fibromyalgia diagnosis for several years.

The stretching group was asked to maintain its usual daily routine and avoid beginning another exercise program or changing medication during the trial. The control group received similar instructions but did not perform the study’s stretching routine.

What Did the Stretching Program Include?

Participants completed approximately six minutes of static stretching every day for six weeks.

The program targeted three areas:

• The knee flexors, primarily the hamstrings

• The hip abductors, located around the outer hip

• The shoulder elevators, including muscles such as the upper trapezius and levator scapulae

Participants completed two 30-second stretching bouts on each side for every targeted muscle group. At least 30 seconds of rest was provided between bouts.

The stretches were intentionally low intensity. Participants were instructed to apply tension only until they experienced a stretching sensation. The goal was not to force the body into the greatest possible range or create pain.

Exercise order was flexible, and minor adjustments could be made based on individual needs.

Participants used a mobile health application to view exercise videos and written instructions, record completed sessions, and communicate with the investigator. The investigator contacted participants approximately once a week to monitor how the program was going and support correct implementation.

The published article identifies the muscles targeted but does not provide the exact exercise positions in its main text. Consequently, specific seated, standing, or lying techniques should not be presented as the exact study protocol unless the study’s original videos or supplementary exercise instructions are available.

Overall Fibromyalgia Symptoms Improved

The study’s primary outcome was the Revised Fibromyalgia Impact Questionnaire, commonly called the FIQ-R.

The FIQ-R evaluates the overall effect of fibromyalgia across symptoms, daily function, and quality of life. Scores range from zero to 100, with higher scores representing a greater impact from the condition.

After six weeks, the stretching group’s average FIQ-R score decreased by 9.7 points. This represented an 18.7% improvement from baseline.

The usual-care group improved by only 0.8 points, which was not statistically significant.

A change of approximately 14% is considered the minimum clinically important difference for the FIQ-R. The stretching group’s 18.7% improvement exceeded this threshold, suggesting that the average change was not only statistically detectable but also potentially meaningful to patients.

The absolute improvement was still modest, and the program should not be interpreted as a cure. Nevertheless, obtaining a clinically meaningful improvement from only six minutes of gentle daily stretching is a notable result.

Stiffness Decreased by More Than 20%

Stiffness is a frequent and sometimes disabling feature of fibromyalgia. It can make it difficult to get moving in the morning, remain in one posture, transition between activities, or exercise comfortably.

Participants in the stretching group experienced an average 1.4-point reduction in stiffness, corresponding to a 22.4% improvement.

The control group’s stiffness score changed by only 0.14 points and did not improve significantly.

This finding suggests that regular, gentle stretching may help some people feel less physically restricted, even when the total daily exercise dose is quite small.

Mobility Improved

The researchers measured passive knee-extension range of motion using specialized laboratory equipment. The knee was gradually extended until the participant reported that the sensation had changed from stretching to pain.

The stretching group improved its average range of motion by 13.6 degrees after six weeks. The control group experienced a nonsignificant average decrease of approximately six degrees.

This improvement may reflect increased stretch tolerance, changes in muscle-tendon flexibility, altered sensitivity to stretching, or a combination of these factors.

The test does not prove that participants became more flexible throughout the entire body. It does, however, provide an objective measurement that supports the self-reported improvements in stiffness and overall symptoms.

Pressure-Pain Tolerance Increased

The investigators also used a pressure device called an algometer to measure pressure-pain thresholds. Pressure was gradually applied to the upper trapezius and tibialis anterior until the participant indicated that the sensation had become painful.

After six weeks, the pressure-pain threshold increased by 16.8% at the upper trapezius and 22.2% at the tibialis anterior in the stretching group. No significant changes occurred in the control group.

A higher pressure-pain threshold means that more pressure could be applied before the participant identified the sensation as painful.

Because fibromyalgia is associated with heightened pain sensitivity, this result is particularly interesting. The changes occurred at both an upper-body and a lower-body location, raising the possibility that the program affected more than the specific tissues being stretched.

However, the trial was not designed to determine the precise mechanism behind these changes. It would therefore be premature to claim that stretching “resets” the nervous system or reverses central sensitization.

Mental Health Scores Improved

Participants completed the Short Form-36 questionnaire, which includes physical and mental health components.

The stretching group’s mental component score improved by an average of five points, while the control group showed virtually no change. The difference between groups was statistically significant and fell within commonly reported thresholds for a clinically meaningful improvement.

This does not mean that stretching should replace psychological care, medication, or other mental health treatment when those interventions are needed. It does suggest that successfully completing a manageable daily activity may have benefits extending beyond physical flexibility.

Gentle movement may support confidence, self-efficacy, body awareness, routine, and a greater sense of control over symptoms. These potential explanations are plausible, but the study did not directly determine why mental health scores improved.

Physical Health and Pain Results Were More Complicated

Not every measured outcome showed a clear advantage for stretching.

The physical component of the Short Form-36 did not demonstrate a significant difference in change between the stretching and control groups. This means that the program’s measurable benefits did not translate into a clearly superior improvement in this broader physical health score over six weeks.

Pain scores also did not show a statistically significant group-by-time interaction. Although pain changed over time, the study did not establish that the stretching group’s pain improvement was significantly greater than the control group’s change.

This is an important distinction. The program improved the overall fibromyalgia impact score, stiffness, range of motion, mental health, and pressure-pain threshold, but it did not produce a clearly demonstrated group-specific reduction in the pain subscore.

Patients should therefore not be told that this program has been proven to directly reduce pain. Its most convincing benefits involved overall symptom impact, stiffness, mobility, mental well-being, and tolerance to pressure.

Participants Maintained High Adherence

The average self-reported adherence rate was 83%. In other words, participants reported completing most of the prescribed daily sessions.

This is an important finding because exercise adherence is often difficult for people with fibromyalgia. A theoretically effective program provides little real-world value if it is too demanding to perform consistently.

The six-minute format may have helped make the routine more manageable. Participants did not need to travel to a facility, purchase extensive equipment, or complete a long workout.

The program also included video guidance, written instructions, activity tracking, weekly communication, and individual adjustments. These supports may have contributed to the high adherence rate. It is therefore unclear whether the same results would occur if patients were simply handed a sheet of exercises without follow-up.

Was the Program Safe?

No serious adverse events occurred during the study.

A few participants reported mild, temporary neck-muscle tenderness during the first days of the program. These symptoms did not cause them to withdraw.

One participant developed increased widespread pain during the initial weeks. The symptoms were familiar to that individual and continued even after temporarily stopping the program. Other health conditions may have contributed, but the researchers could not exclude the possibility that the stretching intervention played a role. The participant ultimately withdrew.

The intervention group had a discontinuation rate of approximately 7%. Overall, the researchers considered the low-intensity program feasible and generally well tolerated.

Still, “gentle” does not mean universally appropriate. People with fibromyalgia can respond differently to exercise, and symptoms should be monitored. A program may need to begin with shorter holds, fewer repetitions, a smaller range, or additional rest.

Why Might Gentle Stretching Help?

Several mechanisms could potentially contribute to the observed benefits.

Repeated low-intensity stretching provides sensory input to muscles, joints, and the nervous system. Over time, this may influence stretch tolerance, movement confidence, muscle tension, and pain processing.

Stretching may also activate the body’s internal pain-modulating systems or influence autonomic nervous system activity. These mechanisms are particularly relevant to fibromyalgia because altered pain inhibition and autonomic regulation have been proposed as features of the condition.

The study did not directly measure these processes, so they remain possible explanations rather than proven mechanisms.

The program’s low-dose, high-frequency design may also be important. Short daily exposure may allow the nervous system and musculoskeletal system to adapt without creating the fatigue associated with a longer workout. Regular repetition may be more useful than occasional high-intensity sessions, particularly for someone with limited activity tolerance.

Important Study Limitations

Although this was a randomized controlled trial, several limitations should be considered.

The study included only 58 participants, making it a relatively small trial. Almost 95% of participants were women, so the findings may not apply equally to men with fibromyalgia.

The intervention lasted only six weeks. The study does not tell us whether improvements continued, increased, or disappeared after the program ended.

Participants knew whether they were stretching or receiving usual care. Their expectations may have influenced symptom reporting. The waitlist control group did not receive an active comparison treatment, such as relaxation exercises, general movement, education, or another form of stretching. This makes it difficult to separate the specific effects of stretching from attention, expectation, routine, app support, and weekly contact.

Adherence was also self-reported through the mobile application and was not independently verified.

Some outcomes, particularly pressure-pain thresholds, may have been influenced by the assessor’s knowledge of group assignment. The authors recognized that this could potentially favour the intervention.

These limitations do not invalidate the findings, but they mean that larger and longer trials with active comparison groups are needed.

What Does This Mean for Patients?

The study provides encouraging evidence that exercise for fibromyalgia does not necessarily need to be lengthy or strenuous to be worthwhile.

A short program may be a realistic starting point for people who feel overwhelmed by conventional exercise recommendations or who have previously experienced symptom flares after doing too much too soon.

The central principles appear to be more important than forcing a particular position: keep the intensity low, stretch only to gentle tension, remain consistent, monitor the response, and adjust the program when necessary.

Patients should not interpret the study as an instruction to push through significant pain. Fibromyalgia management often requires pacing. If symptoms remain substantially aggravated after stretching, the dosage, range, frequency, or exercise selection may need to be modified.

The Importance of Individualized Care

Although participants followed a standardized program, the researchers allowed minor individual adjustments. This reflects an important principle in clinical practice: people with fibromyalgia do not all respond in the same way.

A physiotherapist can assess mobility, strength, balance, functional limitations, pain sensitivity, and activity tolerance before developing an appropriate program. The starting dosage can then be adjusted according to the patient’s symptoms and goals.

For some patients, a six-minute routine may be manageable immediately. Others may need to start with only one or two stretches, shorter holds, or fewer days per week before progressing gradually.

Stretching may also be combined with strengthening, aerobic activity, education, pacing, sleep strategies, and other treatments. It should be viewed as one potentially helpful part of a broader management plan rather than a complete solution by itself.

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The Bottom Line

This 2026 randomized controlled trial found that six minutes of gentle daily stretching for six weeks produced a clinically meaningful improvement in the overall impact of fibromyalgia compared with usual care.

Participants also experienced meaningful reductions in stiffness, improved knee-extension range of motion, increased pressure-pain thresholds, and better mental health scores. The program had an adherence rate of 83% and was generally well tolerated.

However, the program did not demonstrate a clearly superior improvement in the study’s pain subscore or broader physical health score. The trial was small, short-term, predominantly female, and used a waitlist rather than an active control group.

The findings are promising, but they should not be presented as proof that stretching cures fibromyalgia. Instead, they suggest that a brief, low-intensity, consistently performed program may provide meaningful benefits without requiring a lengthy or strenuous workout.

Sometimes an effective first step does not need to be intense. It needs to be manageable, repeatable, and appropriately tailored to the person performing it.

At The Muscle & Joint Clinic, our physiotherapists can assess your mobility, symptoms, and exercise tolerance and develop an individualized stretching and rehabilitation program. The goal is to help you begin at a manageable level, progress gradually, and build confidence in movement without unnecessarily aggravating your symptoms.

This article is intended for general educational purposes and is not a substitute for individualized medical advice, diagnosis, or treatment.

Study reviewed: Støve MP, Magnusson SP, Thomsen JL, and Riis A. “Efficacy of a Novel Home-Based Stretching Program on Fibromyalgia Symptoms: A Randomized Controlled Trial.” Archives of Physical Medicine and Rehabilitation. 2026.

View the published study.

Neck pain is one of the most common musculoskeletal complaints and a major cause of pain, disability, and reduced quality of life worldwide. For some people, neck pain is temporary and settles with movement, exercise, or activity modification. For others, it becomes chronic, affecting sleep, work, concentration, driving, exercise, and everyday activities.

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Manual therapy is frequently included in the management of chronic mechanical neck pain. Two commonly used techniques are spinal manipulation and spinal mobilization. Although these treatments are sometimes grouped together under the general term “manual therapy,” they are performed differently and may produce different responses in the body.

A 2026 study published in Chiropractic & Manual Therapies compared the immediate clinical and neuromechanical effects of cervical spinal manipulation and cervical spinal mobilization in people with chronic neck pain. Its findings provide useful insight into how the body responds to each treatment and how clinicians may select an approach based on an individual patient’s needs and preferences.

What Is Chronic Mechanical Neck Pain?

Mechanical neck pain generally refers to pain arising from structures in and around the cervical spine, including the joints, muscles, connective tissues, and surrounding soft tissues. Symptoms may be influenced by movement, sustained posture, physical activity, muscle tension, or joint stiffness.

Common symptoms can include neck aching, stiffness, restricted movement, discomfort when turning the head, and pain extending into the upper shoulders or shoulder-blade region. Some people may also experience headaches associated with the neck.

“Chronic” neck pain typically means that symptoms have been present for at least 12 weeks. Chronic pain is not always a sign of ongoing tissue damage. It can involve a combination of joint and muscle dysfunction, reduced activity tolerance, altered pain processing, occupational demands, sleep, stress, and other individual factors.

Because chronic neck pain can have several contributing factors, treatment is generally most effective when it is individualized rather than based on a single technique.

What Is Cervical Spinal Manipulation?

Cervical spinal manipulation is a manual therapy technique involving a controlled, high-velocity, low-amplitude thrust directed toward a specific cervical joint. The movement is quick but small and is performed within the joint’s available range.

Patients may hear a popping or clicking sound during manipulation. This sound is generally associated with a rapid pressure change within the joint and is not the sound of bones moving back into place. A sound is also not required for the treatment to have an effect.

Manipulation is intended to influence joint mobility, muscle activity, movement, and pain processing. It should only be performed after an appropriate clinical assessment, screening for contraindications, informed consent, and a discussion of reasonable treatment alternatives.

What Is Cervical Spinal Mobilization?

Cervical mobilization is a gentler and generally slower manual therapy approach. Instead of delivering a rapid thrust, the clinician applies repeated or sustained movements to a joint. The speed, direction, force, and size of these movements may be adjusted according to the patient’s comfort, symptoms, and mobility.

Mobilization may be selected when a patient prefers a lower-velocity technique, is uncomfortable with manipulation, is particularly sensitive or guarded, or has clinical circumstances in which a more gradual approach is appropriate.

Both manipulation and mobilization aim to improve movement and reduce symptoms. The main difference is how the force is delivered—not necessarily the overall purpose of treatment.

How Was the Study Conducted?

The researchers recruited 89 adults between the ages of 18 and 65 who had experienced mechanical neck pain for at least 12 weeks. Recruitment occurred at research sites in Zurich, Switzerland, and Trois-Rivières, Quebec.

This was a randomized crossover trial. Each participant attended two sessions conducted 72 hours apart. During one session, the participant received cervical spinal manipulation. During the other, the same participant received cervical mobilization. The order of the interventions was randomized.

This design allowed researchers to compare how the same person responded to both techniques. It can reduce some of the variability that occurs when two completely separate groups are compared.

Before treatment, participants underwent a focused history and examination to identify contraindications or warning signs. The clinician then identified the most painful cervical level, and the same area was targeted during both study sessions.

The manipulation consisted of one controlled high-velocity, low-amplitude thrust. The mobilization consisted of repeated posterior-to-anterior joint movements performed for 30 seconds.

Researchers measured pain intensity, cervical range of motion, pressure-pain threshold and grip strength before and immediately after each treatment. They also recorded muscle activity during the procedures using surface electromyography.

Both Treatments Improved Neck Range of Motion

The study found that neck movement increased immediately after both manipulation and mobilization.

Combined cervical flexion and extension improved by an average of 4.6 degrees after manipulation and 3.7 degrees after mobilization. Both changes reached the study’s threshold for a clinically meaningful improvement.

Combined right and left lateral flexion improved by approximately 4 degrees after manipulation and 2.6 degrees after mobilization. The improvement following manipulation reached the clinical threshold used by the researchers, whereas the change following mobilization did not.

Combined cervical rotation improved by approximately 1.6 degrees after manipulation and 1.4 degrees after mobilization. Although rotation increased statistically over time, these changes were small and were not meaningfully different between treatments.

Overall, manipulation did not demonstrate a statistically significant advantage over mobilization for range of motion. Both approaches produced an immediate improvement, particularly in flexion and extension.

This finding is clinically relevant because it supports the idea that more than one manual therapy option may help a patient move more comfortably. A rapid thrust is not necessarily required to obtain an immediate mobility improvement.

Manipulation Produced Greater Immediate Pain Reduction

Pain intensity decreased after both treatments, but the reduction was greater following manipulation.

On a 0-to-10 numerical pain scale, pain decreased by an average of approximately 0.79 points after manipulation and 0.37 points after mobilization. The difference between treatments was about 0.41 points and was statistically significant.

The researchers identified a reduction of 1.3 points as the minimum clinically important difference for pain. Neither treatment reached that threshold after one session. Therefore, manipulation produced greater immediate pain relief than mobilization, but the average improvement was still relatively modest.

This does not mean the treatments were ineffective. It means that a single treatment, measured immediately afterward, did not produce a large average reduction in pain. Some individual participants may have responded more strongly, while others may have experienced little change.

Participants’ Overall Impression Slightly Favoured Manipulation

Following each treatment, participants completed a Patient Global Impression of Change questionnaire. The distribution of responses favoured manipulation, suggesting that participants generally perceived somewhat greater improvement after that intervention.

Participants could not be fully blinded because the two procedures felt noticeably different. A rapid manipulation is easily distinguished from slower, repeated mobilization. Expectations and previous experiences may therefore have influenced how participants perceived their response, even though their measured expectations before treatment were similar.

Manipulation Produced a Stronger Local Muscular Response

The researchers used electromyography to measure muscle activity during treatment. Electrodes were placed over the sternocleidomastoid, upper trapezius, and tibialis anterior muscles on both sides of the body.

Manipulation produced substantially greater activity in the sternocleidomastoid and upper trapezius muscles than mobilization. This was likely related to the faster rate at which force was applied during manipulation.

The rapid thrust may generate a stronger short-term sensory and neuromuscular response around the treated region. This helps researchers understand that manipulation and mobilization do not affect the body in exactly the same way, even when their immediate effects on movement are similar.

The lower-leg muscle showed a different pattern, with slightly greater activity during mobilization. The researchers did not identify a clear physiological explanation for this result, and the recorded response was very small.

Pressure-Pain Sensitivity Showed Mixed Results

Pressure-pain threshold measures how much pressure can be applied before the sensation begins to feel painful. A higher threshold suggests that the person is temporarily less sensitive to pressure.

The study found increased pressure-pain thresholds in portions of the neck and upper trapezius after treatment. Some measurements favoured manipulation, particularly in the right sternocleidomastoid. However, the changes were not consistent between the right and left sides or across all muscles tested.

Measurements taken at the tibialis anterior in the lower leg were also inconsistent. Some thresholds increased while others decreased.

Because the pattern was not consistently reproduced across both sides of the body, the authors cautioned that some statistically significant results could represent normal measurement variability or statistical noise rather than a dependable treatment effect.

These findings offer preliminary information about how manual therapy may temporarily influence pain processing, but they do not establish a consistent body-wide pain-relieving effect.

What Might Explain the Immediate Effects?

Manual therapy may affect symptoms through several interacting mechanisms.

Joint movement provides sensory information to the nervous system. This input may temporarily alter pain processing, muscle activity, movement confidence, and the way a person perceives stiffness. Treatment may also reduce protective muscle guarding and make movement feel easier.

Manipulation delivers force more rapidly than mobilization, which may explain its stronger muscular response and slightly greater immediate effect on pain. Mobilization provides slower, repeated input and may achieve similar movement improvements through a more gradual process.

These effects should not be reduced to the idea of a joint being “put back into place.” Modern research suggests that manual therapy works through a combination of mechanical, neurological, sensory, contextual, and psychological influences.

The interaction between the patient and clinician, expectations, reassurance, treatment preference, and confidence in movement may also contribute to the response.

Why Individual Treatment Selection Matters

Some patients enjoy manipulation and feel that it helps them move more comfortably. Others prefer the slower and gentler feeling of mobilization. Certain patients may begin with mobilization because of sensitivity, muscle guarding, anxiety, health considerations, or personal preference.

The treatment selected should depend on the patient’s history, clinical findings, goals, health status, comfort level, and response to care. If a patient does not want manipulation, mobilization remains a reasonable manual therapy option. Treatment should never be performed without the patient’s informed consent.

Clinicians can also modify the treatment plan over time. A patient may initially receive gentler mobilization and later progress to manipulation, or they may continue with mobilization if it provides the desired response.

Manual Therapy Works Best as Part of a Complete Plan

Chronic neck pain is rarely addressed by one treatment alone. Clinical guidelines generally support a multimodal approach combining appropriate manual therapy with active care.

A complete rehabilitation plan may include mobility exercises, strengthening of the neck and shoulder girdle, postural and ergonomic strategies, activity modification, education, and a gradual return to normal movement.

Manual therapy may help reduce pain or stiffness sufficiently for a patient to participate more comfortably in exercise and daily activity. Exercise and self-management strategies can then help build capacity, confidence, strength, and longer-term resilience.

The goal should not simply be to create a temporary change on the treatment table. It should be to help the patient move better, function more confidently, and become less dependent on passive care.

The Bottom Line

This 2026 randomized crossover study found that both cervical manipulation and mobilization improved neck range of motion immediately after treatment.

Manipulation produced a slightly greater reduction in pain and a stronger response in local neck and upper-trapezius muscles. However, the difference in pain relief did not reach the threshold considered clinically meaningful. Neither intervention produced a meaningful improvement in grip strength, and changes in pressure-pain sensitivity were inconsistent.

The study supports both manipulation and mobilization as potentially useful components of care, but it does not prove that either technique is superior over the long term. Treatment should be individualized and ideally combined with exercise, education, and strategies that address the factors contributing to persistent neck pain.

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At The Muscle & Joint Clinic, our physiotherapists and chiropractor provide both spinal mobilization and manipulation when clinically appropriate. Following an assessment, they can discuss the differences between the techniques, consider your health history and preferences, and determine which approach may be most suitable for you. These treatments can also be combined with personalized exercises, soft-tissue therapy, education, and other rehabilitation strategies to create a comprehensive plan for your neck pain.

This article is intended for general educational purposes and is not a substitute for an individualized assessment, diagnosis, or medical advice.

Study reviewed: Bouqartacha S, Conconi D, Schwendenmann Y, et al. “Immediate clinical and neuromechanical effects of cervical spine manipulation compared to cervical spine mobilization among individuals with chronic neck pain: a randomized mechanistic cross-over trial.” Chiropractic & Manual Therapies. 2026;34:49. Read the published study.

Low back pain is one of the most common reasons people seek care. For some people, it comes on after lifting, bending, prolonged sitting, yard work, sports, or a busy work week. For others, it seems to return again and again without one clear cause.

Most low back pain is considered nonspecific low back pain, meaning the pain is not clearly explained by one serious underlying condition such as fracture, infection, cancer, inflammatory disease, or major nerve compression. In these cases, pain may be influenced by muscles, joints, discs, ligaments, posture, activity level, stress, sleep, strength, movement habits, and overall health.

A recent randomized clinical trial published in JAMA Network Open looked at whether adding a nonrigid lumbar beltto usual care could help adults with nonspecific low back pain lasting one to six months. The findings are interesting because lumbar belts are commonly used, but guidelines have often been cautious because the evidence has been mixed.

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What Kind of Belt Was Studied?

The study did not use a rigid brace. It used an adjustable, nonrigid lumbar belt called LombaStab by Thuasne. The belt was described as having two back panels connected to front panels by elasticated fabric, with handles to adjust tightness. In simple terms, this was a flexible lumbar support designed to provide comfortable support rather than fully immobilize the spine.

This distinction matters. When many people think of a back brace, they imagine something stiff, bulky, and restrictive. The belt used in this study was different. It was a soft, adjustable support intended to be worn during daytime activities.

Patients in the belt group were instructed to wear it for 4 to 8 hours per day during the day for 12 weeks. They were told to adjust it so that it felt supportive but not excessively tight, and they were instructed not to wear it while sleeping. Both groups were also advised to remain physically active and continue usual care.

What Did the Study Find?

The trial included 168 adults with nonspecific low back pain lasting one to six months. Patients were randomly assigned either to usual care alone or to usual care plus the lumbar belt.

After 12 weeks, the group using the lumbar belt had greater improvement in function compared with the usual-care group. Function was measured using the Oswestry Disability Index, a commonly used questionnaire for low back pain-related disability.

The belt group improved by about 10 points, while the control group improved by about 5.3 points. The difference between groups was 4.7 points. This was statistically significant, although smaller than the 10-point difference the researchers had originally used for their study design.

The study also found that 60.5% of patients in the belt group achieved at least a 30% improvement in disability, compared with 40.5% in the control group. That is clinically relevant because it suggests more patients experienced meaningful improvement when the belt was added to usual care.

Pain also improved more in the belt group. At 12 weeks, mean pain at rest and mean pain during activity decreased more in the belt group compared with the control group. Pain during activity is especially important because movement-related pain can make people avoid bending, walking, lifting, working, or exercising. If a support helps reduce pain during activity, it may help some patients stay more active during recovery.

Did People Use Less Medication?

One of the interesting findings was that fewer people in the belt group used medication for low back pain during the study period. About 50.6% of patients in the belt group used low back pain medication compared with 67.6% in the control group. NSAID use was also lower in the belt group.

This does not mean a lumbar belt replaces medical care or medication when medication is appropriate. But it does suggest that, for some patients, a lumbar belt may be a useful non-drug option as part of a broader low back pain plan.

How Might a Lumbar Belt Help?

A lumbar belt does not “fix” the spine. It does not put discs back in place, cure arthritis, or permanently correct posture. Its role is more practical.

A nonrigid lumbar belt may help by providing a sense of support, improving body awareness, offering proprioceptive feedback, and reducing the feeling of strain during movement. Some people feel more confident bending, walking, standing, or doing daily activities when the low back feels supported.

The study authors discussed possible mechanisms such as improved postural control, proprioceptive feedback, and reduced mechanical load, while also noting that the exact clinical importance of these mechanisms is still uncertain.

For patients, the simple explanation is this: a lumbar belt may help some people feel supported enough to move more comfortably while their back settles down.

A Belt Should Not Replace Movement

One of the most important messages is that a lumbar belt should not be used as a reason to stop moving.

Current low back pain care generally emphasizes education, staying active, exercise, physical therapy, and addressing lifestyle and psychosocial factors where relevant. The study also notes that low back pain is influenced by biological, psychological, social, and lifestyle factors.

This is why a lumbar belt should be viewed as an adjunct, not a standalone solution. It may help reduce pain during activity, but the long-term goal is still to restore movement, confidence, strength, mobility, and function.

In other words, the belt may help you get through the painful phase, but your body still needs appropriate exercise, gradual loading, and good movement habits.

Should Everyone With Low Back Pain Wear One?

No. A lumbar belt is not necessary for every case of low back pain.

The study looked at adults with nonspecific low back pain lasting one to six months. It excluded people with lumbar radicular syndrome, recent spinal or lower-limb surgery, pregnancy, certain contraindications, and other factors. That means the findings apply best to people with nonspecific low back pain similar to the patients included in the study.

A belt may be more useful for people who feel worse during activity, have difficulty with daily tasks, need temporary support during work or movement, or are trying to stay active while symptoms improve.

A belt may be less appropriate if pain is severe and unexplained, associated with neurological symptoms, related to a specific medical condition, or if the person becomes fearful of moving without it.

What About Dependence or Weakness?

A common concern is that wearing a lumbar belt will make the back weak. This is one reason some guidelines have been cautious about recommending belts routinely, especially for chronic low back pain.

The article notes that concerns about lumbar supports causing muscle weakness or delayed recovery have not been consistently supported, but it also acknowledges potential concerns with long-term routine use, including dependence, fear avoidance, and deconditioning.

This is why the way a belt is used matters. The study used the belt for a defined period of 12 weeks, during daytime activities, for several hours per day. It was not used as a permanent brace and was not worn while sleeping.

Clinically, this is the most reasonable way to think about lumbar belts: temporary support during the painful phase, paired with activity and rehabilitation.

What Were the Limitations of the Study?

The study is useful, but it should not be overinterpreted.

It was an open-label trial, meaning patients knew whether they were wearing a belt. There was no sham belt. That means placebo effects, expectation effects, or the reassurance of receiving a device could have influenced results.

The study also did not prove that every type of lumbar belt will work the same way. Device type matters. A soft, adjustable, nonrigid belt may not have the same effects as a rigid brace or a poorly fitted support.

The researchers also noted that the main disability improvement was statistically significant but smaller than the 10-point target difference used when planning the trial. Secondary outcomes, such as pain measures, were supportive but should still be interpreted with some caution.

So the best interpretation is balanced: this study suggests that a nonrigid lumbar belt may help selected patients with nonspecific low back pain, but it should be used appropriately and as part of a broader care plan.

How We May Use This Information in Clinic

At The Muscle and Joint Clinic, we often see patients with nonspecific low back pain. Some patients are dealing with a new flare-up. Others have recurrent episodes. Some feel pain during work, lifting, standing, walking, bending, or getting in and out of chairs.

For the right patient, a lumbar belt may be considered as one part of care. It may be helpful during painful activities, work demands, travel, flare-ups, or periods where the person is trying to remain active but needs temporary support.

However, we would not want patients to rely on a belt alone. A proper low back pain plan may include assessment, education, chiropractic care, physiotherapy, soft tissue therapy, mobility work, strengthening, ergonomic advice, activity modification, and a gradual return to normal activity.

The goal is not to make someone dependent on a support. The goal is to help them move better, feel better, and return to function with more confidence.

Practical Advice for Patients

If a lumbar belt is recommended, it should fit comfortably and provide support without being overly tight. It should not cause numbness, tingling, skin irritation, breathing restriction, increased pain, or discomfort.

It is usually best used during activity rather than while resting all day. The study instructed patients to wear the belt during daytime activities and not while sleeping. That is a useful practical guideline.

Patients should also continue moving within tolerance. Short walks, gentle mobility, progressive strengthening, and avoiding prolonged bed rest are still important for most nonspecific low back pain presentations.

If the belt helps you move with less pain, that can be useful. But if you feel you cannot move without it, or you become afraid to take it off, it is time to reassess the plan.

When to Get Assessed

Low back pain should be assessed if it is severe, worsening, persistent, recurrent, or affecting work, sleep, walking, or daily activities.

Seek medical attention promptly if low back pain is associated with new bowel or bladder changes, saddle numbness, progressive leg weakness, fever, unexplained weight loss, history of cancer, major trauma, night pain that does not ease, or significant neurological symptoms such as numbness, tingling, or radiating leg pain that is worsening.

A lumbar belt may help some patients, but it should not be used to cover up symptoms that need proper evaluation. This does not mean everyone with low back pain needs a belt. It also does not mean a belt should replace exercise, treatment, movement, or proper assessment.

But for selected patients, a soft adjustable lumbar belt may be a reasonable short-term tool to help manage symptoms, reduce activity-related pain, and support function while the back recovers.

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At The Muscle and Joint Clinic, we believe the best approach is individualized care. For some patients, that may include temporary lumbar support. For others, the focus may be mobility, strengthening, hands-on care, education, or a combination of strategies.

The key is using the right tool for the right person at the right time.

Disclaimer

This article is for general educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Low back pain can have many causes, and treatment should be based on an individualized assessment. If you have severe, worsening, persistent, unusual, or concerning symptoms, please seek care from a qualified healthcare professional.

Reference

Grange, L., Calmels, P., Pers, Y.-M., Laustriat, G., Wieczorek, V., Saih, N., De-Sèze, M., Nguyen, C., Daste, C., Fayolle-Minon, I., Coudeyre, E., & Rannou, F. (2026). Lumbar belt for nonspecific low back pain: A randomized clinical trial. JAMA Network Open, 9(8), e2629793. https://doi.org/10.1001/jamanetworkopen.2026.29793

There is something nostalgic about soft, warm school-style dinner rolls. They remind many people of lunch trays, busy school days, packed lunches, and simple homemade comfort food.

These cafeteria-style rolls are soft, fluffy, slightly sweet, and perfect for back-to-school season. They can be served with dinner, packed with turkey and cheese for an easy lunch, or enjoyed warm with butter or jam after school.

They do take a little time because the dough needs to rise, but the steps are simple and the recipe makes a large batch. That makes them great for meal prep, family dinners, lunchbox sandwiches, or freezing for busy weekdays.

Why We Like This Recipe

Back-to-school routines can get hectic quickly. Between mornings, lunches, homework, activities, and evening schedules, having simple staples ready can make the week easier.

These rolls are useful because they can be made ahead, packed for lunches, warmed up with soup, or used as mini sandwich buns. They are also a fun weekend baking project to do with kids before the school week begins.

Ingredients

• 3 cups warm water

• 1 tablespoon sugar, for activating the yeast

• 3 envelopes active dry yeast

• 1/4 cup milk

• 2 eggs

• 1 tablespoon salt

• 10 cups all-purpose flour

• 2/3 cup sugar

• 1/4 cup shortening

• 1/4 cup melted butter

Instructions

• In a large mixing bowl, combine the warm water and 1 tablespoon of sugar. Sprinkle the yeast over top and let it sit for about 10 minutes, or until the mixture becomes foamy.

• Add the milk, eggs, and salt to the yeast mixture and stir to combine.

• In a separate large bowl, mix the flour and 2/3 cup sugar. Add the shortening and gently work it into the flour mixture until it is well distributed.

• Gradually add the flour mixture into the wet ingredients. Stir until the dough begins to come together and pulls away from the sides of the bowl.

• Cover the bowl with a clean warm damp towel and place it in a warm area. Let the dough rise until it has doubled in size, about 45 minutes.

• Once the dough has risen, pour the melted butter over the dough and knead for about 2 minutes.

• Let the dough rest briefly, then transfer it to a lightly floured surface.

• Roll the dough to about 1 inch thick. Cut into small squares, then shape each piece into a ball.

• Place the rolls into greased baking pans, leaving a little space between each roll.

• Let the rolls rise again until doubled in size.

• Preheat the oven to 400°F.

• Bake for about 12 minutes, or until the rolls are golden brown.

• Serve warm, or let cool and store for lunches during the week.

Back-to-School Lunch Ideas

Use the rolls as mini turkey and cheese sandwiches.

Serve with soup in a thermos for a warm school lunch.

Add egg, cheese, or chicken for a quick breakfast sandwich.

Pack with fruit, yogurt, and veggies for a balanced lunchbox.

Use leftovers as sliders for an easy weeknight dinner.

Make-Ahead Tip

The dough can be prepared ahead and refrigerated overnight before baking the next day. This can make the recipe easier for busy families who want fresh rolls without doing all the prep at once.

You can also freeze baked rolls. Once cooled, place them in a freezer-safe bag. Reheat as needed for lunches, dinners, or after-school snacks.

The Muscle and Joint Clinic Tip

Back-to-school season is not just about supplies, schedules, and lunches. It is also about getting families back into healthy routines.

Simple meal prep can reduce stress during the week and make it easier to fuel busy school days. Pairing carbohydrates with protein, fruits, vegetables, and healthy fats can help keep kids full, focused, and energized.

These rolls can be part of a balanced lunch when paired with protein and colourful fruits or vegetables.

Pelvic floor physiotherapy is now being offered at The Muscle and Joint Clinic, and it is an important addition to the way we support patients with pain, movement, recovery, and function.

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Many people have heard of pelvic floor exercises, often called Kegels, but pelvic floor therapy is much more than simply “doing Kegels.” The pelvic floor is a group of muscles, connective tissues, nerves, and supporting structures at the base of the pelvis. These muscles help support the bladder, bowel, pelvic organs, hips, low back, and core. They also play an important role in continence, sexual function, pregnancy, postpartum recovery, breathing mechanics, and spinal stability.

When the pelvic floor is not functioning well, symptoms can show up in many different ways. Some patients experience urinary leakage, urgency, frequency, pelvic pressure, constipation, pain with intercourse, pregnancy-related pelvic pain, postpartum weakness, low back pain, hip pain, tailbone pain, or a feeling that the core is not working properly. Because these symptoms can feel private or embarrassing, many people delay asking for help. But pelvic floor concerns are common, treatable, and deserve proper care.

What Is the Pelvic Floor?

The pelvic floor is often described as a hammock or sling of muscles that sits at the bottom of the pelvis. These muscles help support the bladder, uterus or prostate, rectum, and surrounding pelvic organs. They also work with the diaphragm, abdominal muscles, deep back muscles, and hips to help control pressure through the trunk and pelvis.

A healthy pelvic floor needs to be able to contract, relax, coordinate, and respond to load. This is important because pelvic floor dysfunction is not always about weakness. Some patients do need strengthening, but others may have pelvic floor muscles that are overactive, tense, painful, poorly coordinated, or unable to relax properly. That is why an individualized assessment is so important.

Pelvic floor therapy looks at how these muscles are functioning within the larger system of the body. The goal is not only to strengthen the pelvic floor, but to improve control, coordination, confidence, and function.

Who Can Benefit From Pelvic Floor Physiotherapy?

Pelvic floor physiotherapy may help people experiencing bladder, bowel, pelvic, pregnancy, postpartum, hip, or low back concerns. One of the most common reasons patients seek pelvic floor therapy is urinary incontinence. This may include leakage with coughing, laughing, sneezing, jumping, running, lifting, or exercise. This is often called stress urinary incontinence.

Pelvic floor therapy may also help with urgency and frequency, where a person feels the need to urinate often or has difficulty delaying the urge to go. It may help patients with mixed urinary incontinence, where both stress leakage and urgency symptoms are present. It may also support people with pelvic pain, pain with intercourse, postpartum recovery concerns, diastasis recti, pelvic organ prolapse symptoms, constipation, tailbone pain, hip pain, and certain types of low back pain.

The important point is that pelvic floor therapy is not only for postpartum patients. It can be helpful for women at many stages of life, including pregnancy, postpartum, perimenopause, menopause, and beyond. It may also be relevant for athletes, active individuals, desk workers, and people recovering from surgery or managing chronic pain.

Pelvic Floor Therapy and Urinary Incontinence

Pelvic floor muscle training is considered a first-line conservative treatment for urinary incontinence. A Cochrane review by Dumoulin, Cacciari, and Hay-Smith (2018) found that women with stress urinary incontinence who completed pelvic floor muscle training were much more likely to report cure or improvement compared with women who received no treatment or inactive control treatment. The strongest evidence is for stress urinary incontinence, although pelvic floor muscle training may also help urgency and mixed incontinence symptoms.

This is important because urinary leakage is common, but it should not be dismissed as normal. Many people are told that leakage after childbirth, with aging, or during exercise is just something they have to accept. While it is common, it is not something patients simply need to tolerate.

Pelvic floor physiotherapy can help patients understand why leakage is happening. For some people, the issue may be pelvic floor weakness. For others, the issue may involve poor timing, poor pressure control, breathing mechanics, hip and core weakness, constipation, scar tissue, or muscle overactivity. A proper assessment helps guide the right plan.

Stress Incontinence, Urgency, and Mixed Symptoms

Stress urinary incontinence refers to leakage with pressure or impact, such as coughing, laughing, sneezing, lifting, jumping, or running. This is where pelvic floor muscle training appears to have the strongest benefit. Reviews have found that structured pelvic floor muscle training can improve symptoms, especially when the exercises are supervised and performed consistently over time (Dumoulin et al., 2018; Wu, 2021).

Urgency and overactive bladder symptoms are different. These symptoms may include a sudden strong urge to urinate, frequent urination, or difficulty delaying urination. Pelvic floor muscle training may help by improving the ability to calm bladder urgency through what is sometimes described as a guarding reflex, where pelvic floor contraction can help inhibit unwanted bladder contractions. However, research suggests results for urgency symptoms are more variable than for stress urinary incontinence (Bø et al., 2020).

For urgency and frequency, pelvic floor physiotherapy may also include bladder training. Bladder training can involve scheduled voiding, urge suppression strategies, fluid and caffeine education, and gradually increasing the time between bathroom visits when appropriate. A Cochrane review on bladder training supports its use as a conservative treatment for overactive bladder symptoms (Funada et al., 2023).

Mixed incontinence includes both stress leakage and urgency symptoms. In these cases, treatment often needs to address both pelvic floor muscle function and bladder habits. Pelvic floor therapy is helpful because it can be individualized to the person’s symptom pattern rather than relying on one generic exercise.

Pelvic Floor Therapy and Low Back Pain

Pelvic floor therapy can also be relevant for some patients with low back pain. The pelvic floor does not work alone. It functions with the diaphragm, abdominal wall, deep spinal muscles, hips, and pelvis. When this system is not coordinating well, some patients may experience difficulty with core control, pelvic stability, breathing, lifting, or returning to exercise.

A systematic review and meta-analysis by Kazeminia, Rajati, and Rajati (2023) examined randomized clinical trials on pelvic floor muscle-strengthening exercises and low back pain. The review included 19 randomized clinical trials and found that pelvic floor muscle-strengthening exercises significantly reduced low back pain intensity compared with control groups. The authors concluded that these exercises may be considered as part of a low back pain management plan.

The results were especially notable in postpartum and pregnant populations, although the authors cautioned that the studies had high heterogeneity. This means the findings are promising, but they should be interpreted carefully. Pelvic floor exercises are not a magic fix for all low back pain, but they may be an important part of care for selected patients, especially when symptoms involve pregnancy, postpartum recovery, pelvic control, hip function, or core weakness.

At The Muscle and Joint Clinic, this connection is important because many patients present with overlapping symptoms. Someone may come in for low back pain, but also report pelvic heaviness, urinary leakage, difficulty returning to exercise, hip tightness, or postpartum weakness. Pelvic floor physiotherapy allows us to assess and support these concerns more fully.

Pregnancy and Postpartum Recovery

Pregnancy and birth place significant demands on the pelvis, abdomen, pelvic floor, hips, and low back. The body adapts to changes in posture, weight distribution, hormones, abdominal wall tension, pelvic loading, and delivery-related stress. After birth, patients may also be recovering while feeding, carrying, lifting, bending, sleeping less, and caring for a newborn.

Pelvic floor physiotherapy can be helpful during pregnancy and postpartum because it supports education, strength, coordination, relaxation, breathing, pressure management, and gradual return to movement. Some patients need help strengthening the pelvic floor. Others need help relaxing and coordinating the pelvic floor. Some need scar care, core retraining, hip and back strengthening, or guidance on returning to exercise safely.

Postpartum symptoms such as urinary leakage, pelvic pressure, pain with intercourse, heaviness, low back pain, hip pain, or difficulty reconnecting with the core should not be ignored. They are common, but they are not something patients simply have to live with.

It Is Not Just About Kegels

One of the biggest misconceptions about pelvic floor therapy is that it only involves Kegels. Kegels can be helpful for some people, but they are not appropriate for everyone and they are not always enough.

Some patients have pelvic floor muscles that are too tense or overactive. In those cases, repeatedly strengthening without learning how to relax may make symptoms worse. Other patients may be doing pelvic floor contractions incorrectly, using the glutes, inner thighs, or abdominal muscles instead of the pelvic floor. Some may hold their breath or increase pressure downward, which can aggravate symptoms.

Pelvic floor therapy helps determine what the patient actually needs. Treatment may include strengthening, relaxation, coordination training, breathing strategies, bladder training, education, hip and core exercises, manual therapy, scar tissue work, posture and movement strategies, and lifestyle guidance.

The goal is not simply to squeeze harder. The goal is to restore better pelvic floor function.

What Pelvic Floor Physiotherapy May Include

Pelvic floor physiotherapy begins with a detailed assessment. This may include discussing bladder symptoms, bowel habits, pain, pregnancy and birth history, surgery history, sexual health concerns, exercise goals, posture, breathing, low back or hip symptoms, and daily activities.

Treatment is individualized and based on consent, comfort, and clinical need. It may include education about pelvic floor anatomy, pelvic floor muscle training, relaxation strategies, breathing and pressure control, bladder retraining, core and hip strengthening, mobility exercises, manual therapy, posture and ergonomic advice, scar tissue support, and return-to-exercise guidance.

Supervision matters. Research suggests supervised pelvic floor muscle training is often more effective than unsupervised exercise, especially for patients who are unsure whether they are contracting the correct muscles or who have more complex symptoms (Dumoulin et al., 2018; Wu, 2021).

Lifestyle Factors That Can Support Pelvic Floor Health

Pelvic floor symptoms are influenced by more than muscle strength alone. Constipation, chronic coughing, heavy lifting, high-impact exercise, poor sleep, stress, caffeine intake, fluid habits, and breathing patterns can all affect pelvic floor function.

For urinary urgency or frequency, reducing bladder irritants such as excessive caffeine may help some patients. For pelvic pressure or leakage, learning how to manage pressure during lifting, exercise, coughing, and sneezing may be important. For constipation, improving bowel habits and avoiding repeated straining can reduce stress on the pelvic floor.

These changes are not about restriction or fear. They are about giving patients practical tools to feel more in control of their symptoms.

When Should You Seek Pelvic Floor Physiotherapy?

You may benefit from pelvic floor physiotherapy if you experience urinary leakage, urgency, frequent urination, difficulty emptying the bladder, pelvic pressure, heaviness, constipation, pain with intercourse, pelvic pain, tailbone pain, pregnancy-related pelvic pain, postpartum weakness, diastasis recti concerns, hip pain, or low back pain that seems connected to core or pelvic control.

You should also consider an assessment if you are pregnant, recently postpartum, returning to exercise after childbirth, preparing for birth, recovering from pelvic or abdominal surgery, or feeling unsure how to safely strengthen your core and pelvic floor.

Patients should seek medical assessment if symptoms include blood in the urine or stool, unexplained weight loss, fever, severe pelvic or abdominal pain, new neurological symptoms, sudden loss of bladder or bowel control, or any concerning or worsening symptoms.

How Pelvic Floor Therapy Fits at The Muscle and Joint Clinic

At The Muscle and Joint Clinic, we are excited to now offer pelvic floor physiotherapy as part of our services. This allows us to support patients in a more complete way, especially those dealing with pregnancy and postpartum concerns, urinary leakage, pelvic discomfort, low back pain, hip pain, core weakness, and movement-related symptoms.

Our approach is patient-centred, respectful, and evidence-informed. We understand that pelvic floor symptoms can be personal and sometimes difficult to talk about. The goal is to create a comfortable space where patients can ask questions, understand what may be contributing to their symptoms, and receive care that fits their needs and goals.

Pelvic floor physiotherapy can also work alongside chiropractic care, physiotherapy, massage therapy, exercise rehabilitation, and other services when appropriate. For example, a patient with postpartum low back pain may benefit from both spinal and pelvic assessment, core retraining, hip strengthening, and pelvic floor rehabilitation. A patient with desk-related hip and back tension may need mobility work, ergonomic advice, and pelvic floor relaxation or coordination strategies. A patient returning to running after childbirth may need progressive strengthening, impact preparation, and pressure-management training.

The key is individualized care.

The Bottom Line

Pelvic floor physiotherapy is about much more than Kegels. It is a specialized area of care that helps assess and treat concerns related to bladder control, pelvic pain, postpartum recovery, pregnancy, core function, hip function, and low back pain.

The evidence supports pelvic floor muscle training as a first-line conservative treatment for urinary incontinence, especially stress urinary incontinence (Dumoulin et al., 2018; Wu, 2021). Research also suggests pelvic floor muscle-strengthening exercises may help reduce low back pain intensity in selected patients, particularly when pelvic and core function are part of the clinical picture (Kazeminia et al., 2023).

If you have been dealing with leakage, urgency, pelvic pressure, postpartum symptoms, pelvic pain, or low back pain that has not fully resolved, pelvic floor physiotherapy may be an important next step.

Pelvic floor therapy is now available at The Muscle and Joint Clinic.

Book Your Free Consultation

Disclaimer

This article is for general educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Pelvic floor symptoms can have many causes, and care should be based on an individualized assessment. If you have severe, worsening, persistent, unusual, or concerning symptoms, please seek medical care from a qualified healthcare professional.

References

Bø, K., Fernandes, A. C. N. L., Duarte, T. B., Brito, L. G. O., & Ferreira, C. H. J. (2020). Is pelvic floor muscle training effective for symptoms of overactive bladder in women? A systematic review. Physiotherapy, 106, 65–76.

Dumoulin, C., Cacciari, L. P., & Hay-Smith, E. J. C. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, 2018(10), CD005654.

Funada, S., Yoshioka, T., Luo, Y., et al. (2023). Bladder training for treating overactive bladder in adults. Cochrane Database of Systematic Reviews, 2023(10), CD013571.

Kazeminia, M., Rajati, F., & Rajati, M. (2023). The effect of pelvic floor muscle-strengthening exercises on low back pain: A systematic review and meta-analysis on randomized clinical trials. Neurological Sciences, 44(3), 859–872. https://doi.org/10.1007/s10072-022-06430-z

Lukacz, E. S., Santiago-Lastra, Y., Albo, M. E., & Brubaker, L. (2017). Urinary incontinence in women: A review. JAMA, 318(16), 1592–1604.

Wu, J. M. (2021). Stress incontinence in women. New England Journal of Medicine, 384(25), 2428–2436.

Back pain is often thought of as an adult problem, something that develops after years of working at a desk, lifting, driving, or simply getting older. But that assumption is increasingly outdated. Children and teenagers can experience back pain too, and research suggests that spinal pain becomes progressively more common as children move through school and adolescence.

At The Muscle & Joint Clinic, we often see families surprised when a child or teenager begins complaining of back, neck, or shoulder pain. Parents may initially assume that the discomfort is temporary, related to a growth spurt, or simply the result of carrying a school bag. Sometimes that is part of the picture, but usually there is more going on.

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The broader reality is that student back pain is often multifactorial. School-aged children spend long periods sitting, use laptops and tablets for hours, carry school supplies, participate in sports, go through rapid periods of growth, and often move between very sedentary school days and intense recreational or athletic activity. All of these factors can influence how the spine and surrounding muscles are loaded.

Research published in JAMA Pediatrics has shown that low back pain is uncommon in very young children but becomes progressively more prevalent with age. By late adolescence, the prevalence begins to resemble what is seen in adults (MacDonald et al., 2017). That alone should change the way we think about back pain in children. It is not necessarily rare, and it should not always be dismissed as something a child will simply “grow out of.”

A Canadian prospective study published in Scientific Reports followed children between the ages of 6 and 12 for eight months. Among the children who completed follow-up, almost half reported at least one episode of back pain during that period (Henriot-Jéhel et al., 2022). That is a remarkably high number for an age group many people assume should be essentially pain-free.

Back Pain in Children Is Usually Musculoskeletal

The reassuring part is that most back pain in school-aged children and adolescents is musculoskeletal and benign in nature. In other words, the pain is usually related to muscles, joints, movement, loading, overuse, or other non-serious mechanical factors rather than a dangerous underlying disease.

MacDonald and colleagues noted that although clinicians must remain alert for more serious causes of pediatric back pain, the majority of cases are nonspecific and musculoskeletal in nature (MacDonald et al., 2017). That means there may not always be one damaged structure that explains the pain

.

This is important because parents often feel that every episode of back pain requires an X-ray, MRI, or a highly specific diagnosis. In many cases, the better approach is to understand the overall pattern: when the pain started, what makes it worse, how the child sits, how much they are moving, whether they participate in sports, whether they are going through a growth period, whether the pain has occurred before, and whether there are any concerning neurological or systemic symptoms.

The objective is not simply to put a label on the pain. It is to understand what is contributing to it and whether the child is safe to remain active.

Why Are More Students Complaining About Their Backs?

There is unlikely to be one universal explanation, but modern student life places children in a very different physical environment than previous generations.

A typical student may sit for several hours during the school day, travel home by car or bus, sit again to complete homework, then spend additional time on a laptop, tablet, phone, or gaming device. Even children who participate in sports can spend a large portion of the rest of their day relatively sedentary.

Prolonged sitting itself is not automatically harmful, but spending hours in one position without movement can contribute to stiffness, fatigue, and discomfort. The human body tends to tolerate movement and variation better than staying in one fixed position for long periods.

We therefore try not to teach students that there is one “perfect posture” they must hold all day. That message can actually create unnecessary fear around normal posture. A much more useful principle is postural variety.

Students should be encouraged to move regularly, change positions, stand up between homework sessions, walk around, stretch, and avoid remaining in one position for hours at a time. The body generally does better when it has the opportunity to change load rather than continuously tolerating the same one.

The Backpack Gets Blamed for Almost Everything

Every September, backpacks become one of the most discussed causes of student back pain. It makes sense. A student may leave home carrying textbooks, a laptop, a lunch bag, a water bottle, sports equipment, and several items they probably did not need to bring in the first place.

When the bag becomes too heavy or poorly fitted, children may respond by leaning forward, shrugging their shoulders, or changing the way they walk. They may complain of shoulder pressure, neck fatigue, or back discomfort by the end of the day.

However, it is important to separate what seems intuitive from what the research can actually prove.

There is not strong evidence showing that backpack weight by itself is a consistent cause of chronic back pain or spinal deformity in children. The relationship appears more complicated. Backpack use can certainly contribute to discomfort, especially when combined with long walking distances, poor fit, fatigue, or an already sensitive back, but it should be considered one factor rather than the entire explanation.

That said, common-sense backpack habits are still worthwhile.

A student should generally use both shoulder straps rather than carrying a backpack over one shoulder. The straps should be adjusted so that the bag sits relatively close to the body instead of hanging low and pulling backward. Heavier items should be positioned closer to the child’s back where possible, and unnecessary items should be removed regularly.

One of the simplest things parents can do is actually empty the backpack once a week. It is surprising how quickly backpacks accumulate extra books, old worksheets, sports equipment, electronics, water bottles, and other unnecessary weight.

The goal is not to make children afraid of carrying a backpack. The goal is simply to reduce avoidable load.

Growth Changes the Equation

Another factor that often gets overlooked is growth.

Children do not grow evenly. Adolescence in particular can involve periods of rapid height change over relatively short periods of time. Bones, muscles, tendons, coordination, and strength are all adapting at once.

Research suggests that pubertal development and periods of rapid growth may be associated with an increased likelihood of spinal pain (Hebert et al., 2019).

Parents sometimes describe this phase by saying that their teenager suddenly looks taller, tighter, or less coordinated. A student who was moving comfortably several months earlier may suddenly feel stiff through the hamstrings, hips, back, or shoulders.

That does not necessarily mean something is wrong. It may simply mean their body is adapting to new proportions and new physical demands.

The issue becomes more important when rapid growth is combined with sport.

Student Athletes Have Their Own Set of Risks

Sports are generally good for children. We do not want parents interpreting back pain research as a reason to reduce activity unnecessarily.

Physical activity helps support cardiovascular health, bone strength, muscular development, coordination, mental health, and social development.

However, training load matters.

A teenager playing competitive soccer four days per week, attending weekend tournaments, doing strength training, and participating in school sports is experiencing very different physical demands than a student who exercises casually a few times a week.

Back pain can emerge when training volume or intensity increases faster than the body adapts. This is especially relevant in sports involving repeated extension, rotation, impact, sprinting, jumping, or heavy loading.

Gymnastics, football, hockey, dance, soccer, diving, track, and weight training can all place different demands on the spine.

One of the more important structural conditions clinicians consider in adolescent athletes with persistent back pain is spondylolysis, a stress injury involving part of the vertebra called the pars interarticularis. It is particularly important to consider when back pain is aggravated by extension or repetitive athletic activity.

This does not mean every athletic teenager with back pain needs imaging. It means persistent, focal, or activity-related pain deserves a proper examination rather than being dismissed.

Previous Back Pain Matters More Than Most Parents Realize

One of the most interesting findings in pediatric back pain research is the importance of previous symptoms.

In the Canadian prospective study by Henriot-Jéhel and colleagues, children with a previous history of back pain were substantially more likely to experience another episode during follow-up. The reported odds were more than six times higher compared with children without a prior history (Henriot-Jéhel et al., 2022).

This matters because parents often think of each episode as an isolated event.

A child may complain of back pain for several days, improve, return to normal activity, and then experience another episode several months later. If this pattern keeps repeating, it may be more useful to think about the underlying contributors rather than treating each flare as something completely new.

Movement habits, training load, sleep, strength, stress, recovery, school ergonomics, and previous injury can all influence recurrence.

That does not mean a child with back pain is destined to have chronic pain as an adult. It simply means that recurring symptoms deserve attention.

What About Phones, Tablets and “Tech Neck”?

Parents frequently ask whether screens are damaging their child’s spine.

The phrase “tech neck” is commonly used, but it can sometimes create unnecessary fear. Looking down at a phone does not automatically damage the neck.

The more relevant issue is duration.

A student who spends two or three hours continuously looking at a phone, tablet, or laptop may experience muscular fatigue and stiffness simply because the neck and upper back have been held in a relatively static position.

Instead of telling children that looking down is dangerous, we recommend helping them build better movement habits.

Raise the screen when practical. Change positions. Use a desk when doing longer periods of schoolwork. Take short movement breaks. Avoid doing homework curled up on a bed for three hours without moving.

The body generally tolerates many different postures. It simply does not like being stuck in one posture forever.

Stress and Sleep Can Influence Pain Too

Student back pain is not purely mechanical.

Pain is influenced by the nervous system, sleep, mood, stress, physical activity, expectations, and a number of psychosocial factors.

Students today may be balancing school demands, extracurricular activities, competitive sports, social pressures, and increasingly high levels of screen exposure. Older students may also be managing exams, university applications, part-time work, or significant academic pressure.

A student who is sleeping poorly and feeling stressed may become more sensitive to physical discomfort.

That does not mean the pain is “in their head.” Pain is real. It simply means that pain is influenced by more than muscles and joints alone.

A complete approach should therefore consider the student’s overall routine, not just what their spine looks like.

When Should Parents Be Concerned?

Most student back pain is not dangerous, but certain patterns deserve closer attention.

Pain that is mild, short-lived, and clearly linked to an unusual activity may simply settle with time and normal movement.

Persistent pain is different.

Parents should consider having their child assessed when back pain lasts for several weeks, keeps returning, interferes with sport or normal activity, leads the child to avoid movement, follows a significant injury, or is associated with pain travelling into an arm or leg.

Numbness, tingling, weakness, significant changes in coordination, or progressive neurological symptoms should also be evaluated.

More urgent medical assessment may be required when back pain is accompanied by significant neurological deficits, bowel or bladder changes, unexplained fever, unexplained weight loss, major trauma, or persistent severe night pain.

These presentations are uncommon, but they are exactly why a proper clinical history and physical examination are important.

Imaging Is Not Always the First Step

Parents often assume that back pain means an MRI should be ordered immediately.

In many musculoskeletal presentations without concerning features, imaging is not necessary at the beginning.

A detailed history and physical examination can often provide enough information to determine whether conservative care is appropriate.

Imaging becomes more important when there is significant trauma, neurological involvement, persistent pain that is not responding as expected, suspected stress injury, suspected inflammatory disease, or another clinical reason to investigate further.

The decision should be based on the presentation rather than fear.

What We Look at During an Assessment

At The Muscle & Joint Clinic, our goal is not simply to identify where a student hurts.

We want to understand the entire context.

We may ask about when the pain started, whether there was an injury, which movements aggravate it, how much time the student spends sitting, how they use their backpack, which sports they participate in, whether training volume has changed, whether they recently went through a growth spurt, how well they sleep, and whether the problem has happened before.

The physical examination may include spinal movement, joint mobility, strength, flexibility, neurological screening, movement patterns, balance, and other tests depending on the presentation.

The purpose of the assessment is to determine whether the symptoms appear musculoskeletal and suitable for conservative care or whether further medical assessment is needed.

Treatment Should Be More Than “Fixing Posture”

One of the biggest mistakes in treating student back pain is focusing exclusively on posture.

There is rarely one posture that causes every problem, and there is no perfect position that protects the spine from pain.

A more useful treatment plan often focuses on movement, strength, confidence, and gradually returning to normal activity.

Depending on the student, management may include education, activity modification, mobility work, strengthening exercises, rehabilitation, changes to study habits, temporary adjustments to sports training, and manual therapy when appropriate.

The objective should be to help the student become more capable, not more fearful.

Children and teenagers should generally be encouraged to stay active rather than being told that their spine is fragile.

Where Chiropractic Care Can Fit

Chiropractic care can be one part of a conservative approach for appropriately selected children and adolescents with musculoskeletal back pain.

It is important, however, to describe chiropractic care accurately.

Good chiropractic care for a student should not simply involve repeatedly manipulating the spine and sending the patient home.

An evidence-informed approach may include clinical assessment, education, exercise, movement rehabilitation, activity modification, mobility work, and manual therapy where appropriate.

Research specifically examining spinal manipulation in adolescents is still developing and is not as extensive as the adult literature.

One randomized trial published in Pain examined adolescents between the ages of 12 and 18 with chronic low back pain. The study found that combining spinal manipulation with exercise therapy produced greater improvement in pain compared with exercise alone over the study period, with the largest differences appearing later in follow-up (Evans et al., 2018).

Chiropractic care is most useful when it forms part of a broader rehabilitation strategy rather than being viewed as a standalone “fix.”

For many students, the long-term goal is to understand why the symptoms developed, improve movement and strength where needed, manage activity appropriately, and reduce the chance that the same pattern keeps returning.

What Parents Can Do at Home

Parents do not need to redesign their child’s entire life to support spinal health.

Small changes can make a meaningful difference.

Encourage regular movement throughout the day. Avoid having a child sit for hours without interruption. Keep backpacks reasonably organized and properly fitted. Make sure students are getting enough sleep. Watch for sudden jumps in sports training volume. Encourage activity rather than unnecessary rest.

For homework, a simple rhythm can help: work for a period, then stand up, walk around, stretch, or change position before returning.

Even two or three minutes of movement between study blocks can break up long periods of sitting.

The goal is not perfection.

The goal is variety.

The Bigger Picture

Student back pain should not be treated as an adult problem occurring in a smaller body.

Children and adolescents are growing, adapting, learning movement, participating in sports, sitting through long school days, and navigating changing physical and psychological demands.

The best approach is therefore rarely one-dimensional.

A heavy backpack may contribute, but it is rarely the whole story.

Posture may play a role, but there is no perfect posture.

Sports may aggravate symptoms, but physical activity remains essential.

Growth may contribute to stiffness and changing movement patterns, but growth itself is not a disease.

The key is recognizing when discomfort is becoming persistent, recurrent, or limiting.

Back pain during childhood is common enough that parents should take it seriously, but not fear it.

Most cases are manageable.

The more useful question is not simply, “Why does my child’s back hurt?”

It is:

What factors in this student’s day, movement, growth, training, recovery, or previous history may be contributing to the problem, and what can we do to improve them?

At The Muscle & Joint Clinic, we take that broader approach when assessing students with back, neck, and musculoskeletal pain. When chiropractic care is appropriate, we combine it with education, exercise, rehabilitation, and practical strategies designed to help students remain active and confident in their bodies.

Thanks for reading!

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References

Evans, R., Haas, M., Schulz, C., Leininger, B., Hanson, L., Bronfort, G., et al. (2018). Spinal manipulation and exercise for low back pain in adolescents: A randomized trial. Pain, 159(7), 1297–1307.

Hebert, J. J., Leboeuf-Yde, C., Franz, C., Lardon, A., Hestbaek, L., Manson, N., & Wedderkopp, N. (2019). Pubertal development and growth are prospectively associated with spinal pain in young people: The CHAMPS Study-DK. European Spine Journal, 28, 1565–1571.

Henriot-Jéhel, C., Lemire, J., Teulier, C., Bussières, A., & Lardon, A. (2022). Factors associated with back pain in children aged 6 to 12 years of age, an eight months prospective study. Scientific Reports, 12, 603. https://doi.org/10.1038/s41598-021-04060-7

MacDonald, J., Stuart, E., & Rodenberg, R. (2017). Musculoskeletal low back pain in school-aged children: A review. JAMA Pediatrics, 171(3), 280–287. https://doi.org/10.1001/jamapediatrics.2016.3334

Many people have been told that cracking their knuckles will cause arthritis. It is one of those health warnings that gets repeated so often that many people assume it must be true. The sound can be loud, sharp, and uncomfortable for others to hear, so it is easy to imagine that something damaging must be happening inside the joint.

But what does the evidence actually show?

Based on the available research, gentle knuckle cracking does not appear to cause hand osteoarthritis for most people. It may sound dramatic, but the sound itself is not a sign that the joint is being damaged. That said, there are still situations where joint cracking deserves attention, especially when it is painful, forceful, associated with swelling, or involves the neck.

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What Makes the Cracking Sound?

A joint is where two bones meet. Many joints, including the knuckles, are surrounded by synovial fluid. This fluid helps lubricate the joint so movement can occur more smoothly.

When you pull, bend, or distract a joint, the space inside the joint temporarily changes. This alters pressure within the joint. Gases within the synovial fluid can form bubbles, and the familiar “pop” or “crack” is related to a process called cavitation.

A BBC Future article described this process in simple terms, explaining that when a joint is pulled or bent, the pressure in the synovial fluid falls and gases can emerge as bubbles. The sound can be surprisingly loud, but the noise itself does not automatically mean damage is occurring.

Does Knuckle Cracking Cause Arthritis?

This is the biggest concern patients usually have.

The short answer is that habitual knuckle cracking does not appear to be a risk factor for hand osteoarthritis.

One study published in the Journal of the American Board of Family Medicine looked at adults between 50 and 89 years old who had hand X-rays. The researchers compared people with radiographic hand osteoarthritis to controls without osteoarthritis and asked about their knuckle-cracking history. The prevalence of osteoarthritis was similar between people who cracked their knuckles and those who did not. The researchers also found that the total duration and total cumulative exposure to knuckle cracking were not significantly associated with osteoarthritis in the joints studied.

This is important because many people worry that years of cracking will “wear out” the cartilage. Osteoarthritis is often associated with age, genetics, previous injury, repetitive loading, and other risk factors, but the evidence does not support knuckle cracking as a major cause.

What Did the Ultrasound Study Find?

A 2017 study published in Clinical Orthopaedics and Related Research looked more closely at what happens during knuckle cracking. Researchers studied 400 metacarpophalangeal joints in 40 asymptomatic adults. Thirty of the participants were habitual knuckle crackers, meaning they cracked their knuckles daily.

The researchers used physical examination and ultrasound imaging. Two orthopedic surgeons examined the participants while blinded to whether they were habitual knuckle crackers. They assessed swelling, grip strength, range of motion, and hand function. The study found no meaningful differences in QuickDASH disability scores, swelling, grip strength, or joint laxity between habitual knuckle crackers and non-crackers.

The study did find a small increase in range of motion immediately after a documented crack. In other words, some joints moved slightly more after cracking. This may help explain why people often describe a temporary feeling of relief or looseness after cracking a joint.

On ultrasound, the researchers observed a characteristic bright focus appearing dynamically in the joint during the cracking event. This supports the idea that the cracking sound is related to a joint cavitation event rather than bones grinding together.

Does Knuckle Cracking Weaken Your Grip?

Another common concern is that knuckle cracking may weaken the hands.

Older research raised the possibility that habitual knuckle crackers may have more hand swelling and weaker grip strength. However, later research did not support a clear relationship between knuckle cracking and reduced grip strength.

The 2017 ultrasound study found no significant difference in grip strength between habitual knuckle crackers and non-crackers. This suggests that, for most people, painless knuckle cracking is unlikely to be a major cause of hand weakness.

That said, if someone notices true weakness, reduced grip, swelling, pain, numbness, tingling, or difficulty using the hand, that should not be dismissed as “just cracking.” Those symptoms deserve a proper assessment.

Can Knuckle Cracking Ever Cause Injury?

Yes, but this appears to be uncommon and usually relates to force.

The concern is not gentle, painless knuckle cracking. The concern is aggressive pulling, twisting, or forcing a joint to crack. Case reports have described acute soft tissue injuries from attempts to force a knuckle to pop.

This is a useful distinction for patients. A gentle pop that happens easily and without pain is very different from yanking on a finger or repeatedly forcing a joint past its comfortable range just to hear a sound.

A joint should not need excessive force to move. If cracking causes pain, swelling, bruising, numbness, tingling, or reduced motion, stop and have it assessed.

Why Do People Crack Their Knuckles?

People crack their knuckles for different reasons. Some do it without thinking. Some do it when they are stressed, bored, or concentrating. Others do it because the joint feels stiff or full, and the crack gives a temporary feeling of relief.

The 2017 study found a small immediate increase in range of motion after cracking, which may help explain why some people feel looser afterward. However, that short-term relief does not necessarily mean the underlying reason for stiffness has been addressed.

For example, someone who works at a computer all day may crack their fingers because their hands feel stiff from typing, mouse use, gripping, or repetitive tasks. Someone else may crack their joints because of stress or habit. The sound may feel satisfying, but the bigger question is why the joint feels like it needs relief so often.

Knuckles Are Different From the Neck

Knuckle cracking and neck cracking should not be treated the same way.

The knuckles are smaller peripheral joints. Gentle cracking of the fingers is usually low risk. The neck is more complex. It contains the spinal cord, nerve roots, muscles, ligaments, and important blood vessels.

Forceful self-cracking of the neck is not recommended. Repeatedly twisting or forcing the neck to pop can irritate joints, muscles, ligaments, or nerves. In some cases, people may experience symptoms such as dizziness, tingling, radiating pain, headache, or worsening stiffness after forceful neck manipulation.

This does not mean every neck sound is dangerous. Necks can click, pop, or make noise during normal movement. But deliberately forcing the neck to crack, especially with high force or rotation, is different.

If your neck constantly feels like it “needs” to crack, it may be a sign of muscle tension, joint restriction, posture-related strain, poor movement control, or another issue that should be properly assessed.

When Should You Be Concerned About Joint Cracking?

Most painless joint cracking is not a problem. Many healthy joints make noise.

However, cracking should be assessed when it is associated with pain, swelling, redness, warmth, locking, catching, weakness, numbness, tingling, loss of grip strength, reduced range of motion, or a recent injury.

You should also seek care if the cracking begins suddenly after trauma, if the joint looks deformed, or if the area becomes painful afterward.

For the neck or back, be more cautious. Seek medical attention if cracking or manipulation is followed by dizziness, severe headache, visual changes, nausea, faintness, radiating arm or leg pain, weakness, numbness, tingling, balance problems, or difficulty walking.

Do You Need to Stop Cracking Your Knuckles?

For most people, no.

If your knuckle cracking is gentle, painless, and not associated with swelling or reduced function, the evidence does not suggest that it causes arthritis. The bigger issue may be whether the habit bothers you or the people around you.

If you want to stop, it may help to notice your triggers. Do you crack your knuckles when you are stressed, bored, tired, working, driving, studying, or sitting at a desk? Replacing the habit with another behaviour may help. You could try hand mobility exercises, a stress ball, a fidget tool, short movement breaks, or stretching the hands and forearms.

If you crack your hands because they feel stiff, sore, or tired, look at what your hands are doing throughout the day. Computer work, phone use, tools, gripping, sports, weight training, repetitive tasks, and poor ergonomics can all contribute to hand or wrist discomfort.

How Chiropractic Care May Help

At The Muscle and Joint Clinic, we often see patients who are worried about joint noises, cracking, popping, clicking, stiffness, or tension. Many people assume that a noisy joint must be unhealthy, but that is not always true. Joints can make noise and still be completely normal.

A proper assessment can help determine whether the sound is harmless joint cavitation, tendon movement, muscle tension, joint stiffness, irritation, or something that needs further attention.

For patients with hand, wrist, neck, shoulder, or back discomfort, care may include joint and movement assessment, soft tissue therapy, mobility work, strengthening exercises, ergonomic advice, posture education, and strategies to reduce repetitive strain.

The goal is not to make every joint silent. The goal is to help you move well, feel better, reduce irritation, and improve function.

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The Bottom Line

Cracking your knuckles may sound dramatic, but the current evidence suggests that gentle, painless knuckle cracking does not appear to cause hand osteoarthritis.

Research has also shown no clear difference in hand disability, swelling, or grip strength between habitual knuckle crackers and non-crackers. Some people may experience a small temporary increase in range of motion after cracking, which may explain why it feels relieving.

The key message is that sound alone is not the problem. Pain, swelling, weakness, numbness, tingling, reduced movement, or forceful cracking are the warning signs.

Do not panic about harmless joint sounds, but do not ignore symptoms.

Disclaimer

This article is for general educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. If you have persistent joint pain, swelling, weakness, numbness, tingling, reduced movement, dizziness, severe headache, or symptoms after forceful neck or back cracking, seek assessment from a qualified healthcare professional.

References

Boutin, R. D., Netto, A. P., Nakamura, D., Bateni, C., Szabo, R. M., Cronan, M., Foster, B., Barfield, W. R., Seibert, J. A., & Chaudhari, A. J. (2017). “Knuckle cracking”: Can blinded observers detect changes with physical examination and sonography? Clinical Orthopaedics and Related Research, 475(4), 1265–1271. https://doi.org/10.1007/s11999-016-5215-3

Deweber, K., Olszewski, M., & Ortolano, R. (2011). Knuckle cracking and hand osteoarthritis. Journal of the American Board of Family Medicine, 24(2), 169–174. https://doi.org/10.3122/jabfm.2011.02.100156

Ong, S. (2026, August 8). Should you stop cracking your knuckles? BBC Future.

Powers, T., Kelsberg, G., & Safranek, S. (2016). Does knuckle popping lead to arthritis? The Journal of Family Practice, 65(10), 725–726.

Inflammatory bowel disease, often called IBD, is usually thought of as a digestive condition. That makes sense because IBD causes chronic inflammation in the digestive tract and includes Crohn’s disease and ulcerative colitis. Crohn’s disease can affect different parts of the gastrointestinal tract, while ulcerative colitis most often affects the large intestine. But IBD can also affect life far beyond digestion, including energy, sleep, mood, joints, bones, and daily function.

A new nationwide Swedish study adds to a growing body of research showing that people with IBD face a higher risk of psychiatric disorders before and after diagnosis. The study followed 43,862 people with IBD diagnosed between 2007 and 2023 and compared them with matched reference individuals and IBD-free siblings. Researchers found that the risk of any psychiatric disorder began to rise about two to three years before IBD diagnosis, peaked shortly after diagnosis, and remained elevated even 10 years later.

This finding is important because it reinforces something many patients and clinicians already recognize: chronic inflammatory conditions do not affect only one body system. They can affect the whole person.

What Is Inflammatory Bowel Disease?

IBD is not the same as irritable bowel syndrome, or IBS. IBS can cause abdominal discomfort and bowel changes, but it does not cause the same inflammatory damage to the bowel. IBD involves inflammation and can lead to symptoms such as abdominal pain, cramping, chronic diarrhea, blood in the stool, fatigue, fever, appetite changes, weight loss, mouth ulcers, arthritis, and growth concerns in children.

Because IBD can affect everyday activities, it can also affect emotional health. Living with unpredictable symptoms, fatigue, pain, urgency, dietary concerns, medical appointments, medication decisions, and uncertainty about flares can create a significant psychological burden.

What the Swedish Study Found

The Swedish study looked at psychiatric disorders before and after IBD diagnosis. The researchers found that the risk began rising before the official diagnosis. At two years before diagnosis, the hazard ratio for any psychiatric disorder was 1.15, meaning the risk was already higher compared with reference individuals. The risk peaked shortly after diagnosis, with a hazard ratio of 1.50 at about six months after diagnosis. Even 10 years after diagnosis, the risk remained elevated, with a hazard ratio of 1.19.

The increased risk was mainly driven by major depressive disorder, anxiety disorders, and substance misuse. The researchers also performed a sibling comparison, which helped account for shared genetic and early-life environmental factors. Similar patterns were still observed, suggesting the relationship could not be fully explained by family background alone.

The study does not prove that IBD directly causes psychiatric disorders, or that psychiatric disorders directly cause IBD. However, it does show a meaningful association over time, including during the years before diagnosis.

Canadian Research Tells a Similar Story

The Swedish findings are consistent with Canadian research and patient-care priorities. Crohn’s and Colitis Canada reports that psychiatric disorders are 1.5 to 2 times more common in people with IBD than in the general population. Their 2023 Impact of IBD in Canada report estimates that 21% of people with IBD are diagnosed with clinical anxiety and 15% are diagnosed with depression. It also notes that nearly one third experience elevated anxiety symptoms and one quarter experience depression symptoms.

Crohn’s and Colitis Canada also notes that depression and generalized anxiety disorders are twice as likely in people with IBD compared with those without IBD, and that mental health, diet, and nutrition needs are often not included in regular IBD care plans.

This matters because mental health is not separate from physical health. Depression, anxiety, stress, fatigue, poor sleep, pain, and inflammation can interact in ways that affect quality of life, function, activity levels, and recovery.

The Gut-Brain Connection

The gut and brain communicate through what is often called the gut-brain axis. This includes the nervous system, immune system, hormones, inflammatory pathways, the microbiome, and stress-response systems. When the digestive tract is inflamed, the effects may not stay limited to the bowel.

For someone living with IBD, a flare can affect more than digestion. It may change sleep, appetite, energy, concentration, mood, social activity, and confidence. At the same time, emotional stress can make symptoms feel harder to manage. This does not mean symptoms are “all in someone’s head.” It means the body is interconnected.

The Swedish study supports the idea that mental health should be considered early, even during the diagnostic workup for IBD. The researchers emphasized the importance of mental health awareness and integrating psychological care into IBD management.

Why This Matters for Patients

Many people with chronic health conditions feel pressure to separate their symptoms into categories. Digestive symptoms go to one doctor. Joint pain goes to another provider. Stress and mood are treated as separate issues. But patients do not experience their health in separate compartments.

A person with IBD may also experience joint pain, back pain, muscle tension, fatigue, reduced activity, poor sleep, stress, and changes in daily function. Canada’s public health information notes that IBD can affect other parts of the body, including the skin, liver, joints, and bones.

This is why whole-person care matters. It does not mean every symptom has the same cause. It means each symptom deserves to be understood in context.

Where Chiropractic Care Fits In

Chiropractic care does not treat IBD itself. IBD is a medical condition that should be managed by a family doctor, gastroenterologist, and appropriate medical specialists. Medications, investigations, colonoscopy, imaging, bloodwork, and medical monitoring are outside the role of chiropractic care.

However, chiropractors often support patients with musculoskeletal symptoms that may occur alongside chronic health conditions. At The Muscle and Joint Clinic, this may include helping patients with neck pain, back pain, joint stiffness, muscle tension, headaches, posture-related discomfort, reduced mobility, or activity limitations.

For patients living with chronic illness, conservative musculoskeletal care may help improve comfort, movement, confidence, and day-to-day function. Care may include assessment, spinal or joint treatment when appropriate, soft tissue therapy, mobility exercises, strengthening exercises, posture and ergonomic advice, pacing strategies, and education around safe movement.

The goal is not to replace medical IBD care. The goal is to support the musculoskeletal side of health while encouraging patients to remain connected with the appropriate medical team.

Mental Health Should Be Part of the Conversation

One of the most important messages from this research is that mental health should not be treated as an afterthought. If someone with IBD is experiencing anxiety, depression, stress, sleep disruption, low motivation, social withdrawal, or difficulty coping, those concerns deserve care.

Crohn’s and Colitis Canada’s 2023 report states that mental health must be addressed as part of comprehensive IBD care for children and adults, and that multidisciplinary IBD clinics with mental health specialists are a recommended model.

Patients should feel comfortable speaking with their family physician, gastroenterologist, psychologist, psychotherapist, or other qualified mental health professional. Support can include counselling, psychological therapy, medication when appropriate, peer support, education, stress-management strategies, and practical help with daily routines.

Practical Takeaways

If you or someone you know lives with IBD, it may be helpful to think beyond digestive symptoms alone. Pay attention to mood, stress, sleep, fatigue, pain, activity levels, and quality of life.

If anxiety or depression symptoms appear before or after an IBD diagnosis, they should not be dismissed. They may be part of the broader health picture and deserve proper support.

If joint pain, back pain, stiffness, or muscle tension is limiting daily activity, a musculoskeletal assessment may help determine whether conservative care is appropriate.

Most importantly, patients should not feel that they have to manage everything alone. IBD can be complex, and care is often strongest when it is collaborative.

The Bottom Line

IBD is more than a digestive condition. Research from Sweden and Canada shows a strong association between IBD and mental-health challenges, especially anxiety and depression. The Swedish study is particularly important because it found increased psychiatric risk starting two to three years before IBD diagnosis and lasting up to 10 years afterward.

For patients, the message is clear: physical health and mental health are connected. Digestive symptoms, inflammation, pain, fatigue, stress, sleep, and movement all matter. Good care should recognize the whole person, not just one diagnosis.

Disclaimer

This article is for general educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Inflammatory bowel disease should be assessed and managed by a qualified medical doctor and, when appropriate, a gastroenterologist. If you have symptoms such as blood in the stool, unexplained weight loss, persistent diarrhea, fever, severe abdominal pain, or worsening fatigue, seek medical care. If you are experiencing significant anxiety, depression, thoughts of self-harm, or difficulty coping, please contact a qualified mental health professional or seek urgent support.

References

Crohn’s and Colitis Canada. (2023). The 2023 impact of inflammatory bowel disease in Canada: Mental health and inflammatory bowel disease. https://pmc.ncbi.nlm.nih.gov/articles/PMC10478810/

CTV News. (2026). Swedish study reinforces what Canadian IBD experts have been seeing for years. https://apple.news/AdpqB5jlIQ46nNaK2iGK8jA

Government of Canada. (2026). Inflammatory bowel disease. https://www.canada.ca/en/public-health/services/chronic-diseases/inflammatory-bowel-disease.html

Sun, J., Li, L., Chang, Z., Butwicka, A., Bergman, D., Sun, S., Marxer, C. A., Halfvarson, J., Olén, O., & Ludvigsson, J. F. (2026). Psychiatric disorders before and after inflammatory bowel disease diagnosis: A nationwide cohort study in Sweden 2007 to 2023. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2026.05.034

Knee pain can make ordinary activities such as walking, climbing stairs, getting out of a chair or exercising, feel uncertain. Many people respond by becoming less active because they worry that movement will cause further damage. Others assume that knee pain is simply an unavoidable sign that the joint is “wearing out.”

The reality is more encouraging. Your knees are not passive mechanical parts with a fixed expiry date. The bones, cartilage, muscles, tendons and ligaments around the knee are living tissues that respond to how they are used. Appropriate movement can improve strength, confidence, balance and physical capacity. Too much activity too quickly can aggravate symptoms, but too little activity can also contribute to weakness, stiffness and reduced tolerance.

At Muscle and Joint Clinic, our goal is not simply to tell patients to rest or push through their discomfort. We help identify what may be contributing to the problem, determine which activities are currently manageable and build a gradual plan for returning to the things that matter.

The following principles form a practical foundation for maintaining healthier knees.

Book Your Free Knee Pain Consultation

Knee pain does not always mean serious damage

Pain is important, but it is not a precise measurement of tissue damage. Two people with similar findings on an X-ray can experience very different symptoms. One may have considerable pain and functional limitation, while the other remains active with little discomfort.

Knee pain can be influenced by several factors, including muscle strength, joint mobility, previous injury, activity level, sleep, stress, body weight, metabolic health and the amount of load recently placed on the joint. A sudden increase in walking, running, stairs, squatting or recreational activity may exceed the knee’s present capacity even when no major injury has occurred.

This does not mean pain should be ignored. Persistent pain, swelling, instability or loss of function deserves an appropriate assessment. However, it does mean that the presence of pain does not automatically require complete rest or surgery.

Many common knee complaints respond well to a combination of education, activity modification, progressive exercise and appropriate hands-on care.

1. Build strength around the knee

The knee does not work alone. It functions as part of a larger movement system involving the hips, thighs, lower legs, feet and trunk. When the muscles surrounding the knee are strong and coordinated, they help absorb force and control how the joint moves during walking, stairs, lifting, squatting and exercise.

The quadriceps at the front of the thigh help straighten the knee and control the body as it lowers during stairs, squats and sitting. The hamstrings at the back of the thigh assist with bending the knee and controlling the hip. The calf muscles contribute to walking, balance and propulsion. The gluteal muscles help control the position of the pelvis and thigh, which can influence how forces travel through the knee.

Weakness in one area does not necessarily mean that it is the sole cause of pain. However, improving the capacity of these muscle groups often makes daily movement easier and gives the knee more support.

Begin at the appropriate level

Effective strengthening does not require starting with deep squats, heavy weights or difficult lunges. The correct starting point depends on the person’s symptoms, confidence, mobility and current strength.

Early exercises might include:

• Repeatedly standing from a higher chair

• A shallow squat while holding a stable support

• A short wall sit

• A low step-up

• A bridge for the hip and gluteal muscles

• A controlled calf raise

• Gentle hamstring strengthening

• Isometric exercises in which the muscle contracts without substantial joint movement

An exercise should feel challenging enough to stimulate improvement without causing a significant flare. As the body adapts, resistance, repetitions, range of motion or exercise complexity can be increased gradually.

For example, a person might begin with a partial squat using a countertop for support. Once that becomes comfortable, the squat can become slightly deeper. Later, resistance can be added, followed by step exercises or carefully selected lunges.

The progression should be based on how the knee responds, not on an arbitrary schedule.

Strength is protective, but consistency matters

One intense workout will not meaningfully change knee capacity. Strength develops through repeated exposure over time. Two or three appropriately designed strengthening sessions each week may be more useful than occasional strenuous activity followed by long periods of inactivity.

Recovery is part of the process. Muscles need time to adapt, particularly when someone is returning to exercise after a long break.

2. Keep moving without overwhelming the joint

Regular movement supports circulation, mobility, muscle function, balance and general health. For many people, the greater long-term risk is not reasonable movement but gradually becoming more sedentary because of fear.

Walking, cycling, swimming, water exercise and strength training can all be helpful. The best activity is one that is appropriate for your present condition and sustainable enough to perform consistently.

Running does not automatically destroy healthy knees. However, running may need to be adjusted when a person has recently increased mileage, changed terrain, returned after a long break or developed symptoms that do not settle between sessions.

The same principle applies to gardening, prolonged standing, repetitive stairs, recreational sports and physically demanding work. The activity itself may not be inherently harmful; the issue may be a temporary mismatch between the amount of demand and the body’s current capacity.

Think about total load

Your knee responds to the combined amount of stress placed on it—not merely one exercise. A person may tolerate a workout well but become symptomatic when that workout is combined with a long workday, several flights of stairs, poor sleep and another demanding activity the following day.

Load can be adjusted by changing:

• The number of exercise sessions

• The length of each session

• The intensity or resistance

• The walking or running distance

• The speed

• The surface

• The depth of a squat or lunge

• The number of hills or stairs

• The amount of recovery between sessions

Changing one factor at a time makes it easier to determine what the knee can currently tolerate.

Use lower-impact exercise strategically

Lower-impact does not mean ineffective. Cycling, swimming, pool walking and elliptical exercise can challenge the cardiovascular system while reducing some of the impact associated with running and jumping.

These activities may help a person remain fit while gradually rebuilding enough strength and tolerance for higher-impact activity. They can also be used between more demanding sessions to support recovery.

The goal is not necessarily to avoid impact forever. It is to select the appropriate level of impact for the current stage of recovery.

3. Understand the difference between acceptable discomfort and a warning sign

Patients often ask whether an exercise should be completely pain-free. The answer depends on the condition, the type of pain and what happens afterward.

A mild, temporary increase in familiar discomfort does not always mean that damage is occurring. In some rehabilitation programs, a small and controlled amount of discomfort may be acceptable when it settles promptly and does not cause a meaningful loss of function.

The response during the following hours and the next day is often more informative than the sensation during one repetition.

Consider reducing or modifying an activity when:

• Pain becomes sharp, severe or unfamiliar

• Your movement pattern changes substantially

• You begin limping

• Swelling increases

• The knee feels unstable or repeatedly gives way

• Symptoms remain significantly elevated later that day

• The knee is noticeably worse the following morning

• Your ability to perform ordinary activities declines

If symptoms settle quickly and normal function is maintained, the activity may have been within a reasonable range. If symptoms accumulate from one session to the next, the amount of exercise may need to be reduced temporarily.

Avoid the all-or-nothing cycle

A common pattern is to stop all activity during pain, feel slightly better, attempt too much at once and then experience another flare. This can lead to frustration and loss of confidence.

A more useful strategy is often to maintain a tolerable baseline of activity. Instead of cancelling a walk completely, it might be shortened. Instead of performing deep squats, a shallower version may be used. Instead of running, cycling or swimming might be substituted temporarily.

Modification allows the body to remain active while symptoms settle.

4. Consider body weight, nutrition and metabolic health

Body weight can influence the amount of force passing through the knees during walking, stairs and other weight-bearing activities. For someone carrying excess weight, even a modest and sustainable reduction may make movement more comfortable and improve physical function.

Knee pain occurs in people of every size, and weight is rarely the only factor involved. Strength, previous injury, anatomy, occupational demands, activity level and general health may all contribute.

The goal is not rapid weight loss. It is to support long-term health through realistic habits such as regular movement, adequate protein, fibre-rich foods, balanced meals, sufficient hydration and appropriate portion sizes.

Metabolic health may also matter. Blood sugar regulation, blood pressure, sleep, systemic inflammation and body composition can influence how a person feels and recovers. Improving these areas may support knee health while also reducing the risk of diabetes and cardiovascular disease.

Anyone considering major dietary changes, particularly someone with diabetes, kidney disease, cardiovascular disease or another medical condition, should seek individualized advice from an appropriate healthcare professional.

5. Pay attention to the kneecap

Pain around or behind the kneecap is common. It may be especially noticeable during stairs, squatting, prolonged sitting, kneeling or rising from a chair.

The kneecap sits within the quadriceps tendon and moves along the front of the knee as the joint bends and straightens. Its comfort can be influenced by the amount of load placed on the knee, the strength and coordination of the thigh and hip muscles, mobility, training habits and the total volume of repetitive activity.

Kneecap pain does not automatically mean that surgery is required. Many cases can be managed conservatively with an individualized exercise program, activity modification and gradual improvement in strength and movement tolerance.

Temporary changes might include reducing deep knee bending, limiting repeated stairs or avoiding sudden increases in running hills. These modifications should generally be paired with a plan for rebuilding capacity, not simply avoiding the activity indefinitely.

6. Do not overlook the hips, ankles and feet

The location of pain is not always the only area that deserves attention. Restrictions or weakness elsewhere in the movement chain can change how the knee is loaded.

For example, reduced ankle mobility may alter how someone squats or descends stairs. Hip weakness may affect control of the thigh during single-leg activities. Foot discomfort may cause a person to shift weight and walk differently.

This does not mean every knee problem originates elsewhere. It means that a comprehensive assessment should look beyond the painful area and consider how the entire lower limb moves.

Footwear may also matter. A worn-out or poorly fitting shoe can affect comfort, particularly when activity levels increase. There is no single perfect shoe for everyone, but footwear should generally feel comfortable, fit properly and suit the activity being performed.

7. Approach supplements realistically

Glucosamine, chondroitin, turmeric, curcumin and other supplements are frequently marketed for joint pain. Research findings are mixed, and these products do not consistently produce major improvements for everyone.

Some people report that a particular supplement helps them. Others notice no difference. A personal improvement may be meaningful, but supplements should not replace progressive exercise, healthy nutrition, sleep, weight management where appropriate or proper assessment of persistent symptoms.

“Natural” does not necessarily mean risk-free. Supplements may interact with prescription medication, affect bleeding, aggravate certain medical conditions or vary in quality between manufacturers.

Speak with a physician or pharmacist before starting a supplement if you:

• Take blood thinners or multiple medications

• Have diabetes, kidney disease or liver disease

• Are pregnant or breastfeeding

• Are preparing for surgery

• Have a history of medication or supplement reactions

8. Recovery, sleep and stress are part of joint health

Exercise is only one part of adaptation. Sleep and recovery influence pain sensitivity, energy, muscle repair and the ability to tolerate activity.

Poor sleep can make pain feel more intense and reduce motivation to exercise. Persistent stress may also increase muscle tension and affect how the nervous system processes discomfort.

This does not mean knee pain is “in your head.” It means that pain is shaped by the entire health of the person, not only one structure on an imaging report.

A balanced plan may include improving sleep routines, spacing demanding activities, taking short movement breaks during prolonged sitting and using relaxation or breathing strategies when stress is high.

9. Know when knee pain needs assessment

Occasional mild discomfort after unfamiliar activity may settle with temporary modification. An assessment is appropriate when symptoms persist, recur or interfere with daily life.

Consider booking an appointment if you have:

• Pain that is not improving

• Recurrent swelling

• Difficulty with stairs, walking or rising from a chair

• Reduced knee movement

• A feeling that the knee may give way

• Pain that limits work, exercise or sleep

• Symptoms following a sports or workplace injury

• Uncertainty about which exercises are safe

• A previous knee injury that is becoming troublesome again

Seek prompt medical assessment for:

• Inability to bear weight following an injury

• Significant or rapidly developing swelling

• Obvious deformity

• A hot, red and very painful joint

• Knee pain accompanied by fever or systemic illness

• True locking in which the knee cannot move normally

• Repeated collapse or marked instability

• New calf swelling, warmth or unexplained shortness of breath

• Progressive neurological symptoms or substantial weakness

A personalized plan is better than a generic exercise list

Two people with knee pain may need very different approaches. One may benefit from improving quadriceps strength. Another may need better hip control, reduced training volume, improved ankle mobility or a more gradual return to activity.

A useful assessment considers:

• How and when the symptoms began

• The precise location and behaviour of the pain

• Swelling, locking or instability

• Previous injuries and treatment

• Current activity and recent changes in activity

• Strength, mobility and balance

• Walking and functional movement

• Work and recreational demands

• General health, medication and relevant medical history

• The patient’s goals and concerns

The purpose is not merely to name the painful structure. It is to understand what the knee currently tolerates and create a realistic path forward.

Book Your Free Knee Pain Consultation

Healthy knees are supported by strong muscles, regular movement, gradual progression and adequate recovery. Pain should be respected, but fear of movement can also become a barrier to recovery.

You do not need to begin with intense exercise. Start with what you can manage, observe how your knee responds and progress in small steps. If symptoms persist or you are unsure how to begin, an individualized assessment can help remove uncertainty.

At Muscle and Joint Clinic, we help patients understand their symptoms and develop practical treatment and exercise plans based on their current abilities and personal goals.

This information is intended for general education and does not replace individualized medical assessment, diagnosis or treatment. Exercise recommendations should be modified for your health history and current condition.

This Mediterranean-inspired orzo vegetable soup is a great option when you want something warm, nourishing, and easy to make. It is packed with vegetables, includes a small amount of orzo for texture, and has bright flavour from tomatoes, garlic, herbs, and a splash of lemon.

It is also flexible. You can change the vegetables based on what you have at home, add more greens, or make it heartier with beans or shredded chicken.

Why We Like It

This soup is light but satisfying. The vegetables provide fibre, vitamins, minerals, and antioxidants, while the orzo adds a comforting pasta texture without making the soup too heavy.

Meals like this can be helpful during busy weeks because they are easy to prepare, warm up well, and can support a balanced diet. Good nutrition plays an important role in energy, recovery, immune function, and overall musculoskeletal health.

Ingredients

• 2 teaspoons olive oil

• 1/2 onion, diced

• 5 cloves garlic, minced

• 1/4 cup orzo

• 1 cup vegetable broth

• 1 zucchini, sliced into half-moons

• 1 yellow summer squash, sliced

• 1 carrot, peeled and sliced

• 1/2 cup frozen green beans

• 1 cup crushed tomatoes

• 2 handfuls baby spinach

• 1/2 teaspoon garlic powder

• 1/2 teaspoon Greek seasoning

• Splash of lemon juice, optional

• Salt and black pepper, to taste

  Instant Pot Instructions

• Set the Instant Pot to sauté.

• Add olive oil and let it warm.

• Add the diced onion and cook for about 2 minutes, until softened.

• Add the garlic and cook briefly, just until fragrant.

• Add the orzo and stir for about 30 seconds.

• Turn off the sauté setting.

• Add the vegetable broth and gently stir.

• Add the zucchini, squash, carrot, and green beans.

• Pour the crushed tomatoes on top. Do not stir after adding the tomatoes.

• Close the lid and set the Instant Pot to high pressure for 2 minutes.

• Allow the pressure to build, then carefully quick-release according to your machine’s instructions.

• Open the lid carefully.

• Stir in the spinach until wilted.

• Add garlic powder, Greek seasoning, lemon juice, salt, and pepper.

• Taste and adjust seasoning before serving.

Stovetop Instructions

• Warm the olive oil in a large pot over medium heat.

• Add the onion and cook for 2 to 3 minutes, until softened.

• Add the garlic and cook for about 30 seconds.

• Add the orzo, broth, zucchini, squash, carrot, green beans, and crushed tomatoes.

• Bring to a gentle boil, then reduce heat and simmer until the orzo and vegetables are tender, about 10 to 15 minutes.

• Stir in the spinach near the end of cooking.

• Add garlic powder, Greek seasoning, lemon juice, salt, and pepper.

• Taste and adjust seasoning before serving.

Optional Add-Ins

• For extra protein, add chickpeas, white beans, lentils, or shredded chicken.

• For more greens, add kale, Swiss chard, or extra spinach.

• For more Mediterranean flavour, top with fresh parsley, basil, feta, or a drizzle of olive oil.

• For a heartier soup, add extra broth and more vegetables.

  The Bottom Line

This Mediterranean orzo vegetable soup is simple, flexible, and full of flavour. It is a great recipe for busy nights when you want something warm, colourful, and nourishing without spending too much time in the kitchen.

Many people think ergonomics means buying an expensive chair or forcing themselves to sit perfectly straight all day. In reality, ergonomics is much broader. It is about designing your workstation, tools, posture, movement habits, and work routine so that your body is not placed under unnecessary strain for hours at a time.

This matters because many people now spend a large part of the day working at a computer. Whether you work in an office, work from home, study on a laptop, answer emails, use a mouse, or spend hours typing, your workstation can influence how your neck, shoulders, back, wrists, and hands feel by the end of the day.

Computer-related discomfort is not always caused by one dramatic injury. More often, it develops from small repeated stresses: reaching for a mouse, typing with the wrists bent, looking down at a screen, sitting too long, using a laptop without support, or holding the shoulders tense while working. Over time, these habits may contribute to neck pain, shoulder tension, upper back stiffness, low back pain, headaches, wrist discomfort, forearm tightness, and hand symptoms.

The good news is that many ergonomic issues can be improved with simple changes. The important point is that ergonomics should not be seen as one magic solution. It works best when combined with movement breaks, strengthening, stretching, workload management, and individualized care when symptoms persist.

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Why Ergonomics Is Important

Ergonomics is important because the body was not designed to stay in one fixed position for hours. Muscles, joints, tendons, and nerves tolerate movement well, but they can become irritated when the same posture or repetitive task is sustained for long periods.

Work-related neck and upper limb musculoskeletal disorders are common among office workers. A Cochrane review on ergonomic interventions for office workers noted that work-related upper limb and neck musculoskeletal disorders are among the most common occupational disorders worldwide, with studies reporting that approximately 20% to 60% of office workers experience musculoskeletal disorders (Hoe et al., 2018).

This does not mean every office worker will develop pain. It means that computer-based work can create physical demands that deserve attention. The neck, shoulders, wrists, hands, upper back, and low back are all exposed to repeated or sustained loading during desk work.

In a major prospective study of newly hired computer users, researchers followed workers who used video display terminals, or computer workstations, for more than 15 hours per week. The study found that upper-extremity musculoskeletal symptoms were common among computer users. Neck and shoulder symptoms were especially frequent, and neck and shoulder disorders were more common than hand and arm disorders (Gerr, 2001).

The same report found that many computer users worked in non-neutral postures. Approximately 61% were observed in non-neutral shoulder postures and 41% were observed in non-neutral wrist postures (Gerr, 2001). This is important because it suggests that many people are not simply “sitting badly” because they are careless. Their workstation setup, equipment placement, work demands, and habits may be encouraging awkward positions.

Ergonomics matters because those awkward positions can add up.

Ergonomics Is Not One-Size-Fits-All

One of the most important points from the ergonomics literature is that workstation recommendations are not always consistent. A review of global ergonomics standards and guidelines for computer workstation design found considerable disagreement between different standards, especially when comparing current guidelines with prior ergonomics research (Woo et al., 2016).

This is a key point. There is no single perfect desk setup that works for everyone. Body size, job duties, equipment, vision needs, typing volume, mouse use, chair design, desk height, monitor size, and work habits all influence what setup is best.

A tall person and a shorter person may need different chair and monitor heights. A person who types all day may need different support than someone who mainly reads documents. A laptop user may need a different setup than someone using two large monitors. Someone with neck pain may need different adjustments than someone with wrist discomfort.

This is why ergonomics should be practical and individualized. The goal is not to copy a diagram perfectly. The goal is to reduce strain, support comfort, and make it easier for your body to move well through the day.

The Evidence Is Helpful, But Not Perfect

Ergonomics is commonly recommended for office-related neck, shoulder, arm, and wrist pain. However, the research is more nuanced than many people realize.

A Cochrane review examined randomized controlled trials of ergonomic interventions for preventing work-related upper limb and neck musculoskeletal disorders among office workers. The review included 15 studies with 2,165 workers and looked at physical ergonomic changes, organizational changes, ergonomic training, and multifaceted interventions (Hoe et al., 2018).

The authors found that the evidence was mixed. Arm supports combined with an alternative mouse may reduce the incidence of neck or shoulder disorders, but the evidence for other physical ergonomic interventions was less clear. Workstation adjustment and sit-stand desks did not show a clear effect on upper limb pain or discomfort compared with no intervention in the studies included. Ergonomic training alone also did not clearly prevent upper limb or neck musculoskeletal disorders (Hoe et al., 2018).

This does not mean ergonomics is useless. It means we should be careful not to oversell any one intervention. A new chair, a sit-stand desk, a vertical mouse, or a single training session may not be enough on its own.

The most practical interpretation is that ergonomics is one important part of a bigger musculoskeletal health strategy. Equipment matters. Workstation setup matters. Breaks matter. Strength matters. Movement matters. Recovery matters. The best results usually come from combining several of these factors rather than relying on one change alone.

The Myth of the “Perfect Posture”

Many people have been taught that proper computer posture means sitting upright with the elbows at 90 degrees, forearms parallel to the floor, wrists straight, and the monitor directly ahead. While these ideas can be useful starting points, they should not be treated as rigid rules.

The NIOSH-funded prospective study challenged some traditional assumptions about “ideal” computer posture. The researchers found that the commonly recommended seated position, with the upper arms perpendicular to the floor, elbows at a right angle, forearms parallel to the floor, and keyboard at or above elbow height near the desk edge, may not be as protective as commonly believed. In fact, the report recommended that this traditional posture be viewed with caution and studied further (Gerr, 2001).

This does not mean posture does not matter. It means posture is more complex than a single diagram.

A better message is this: the best posture is one that changes often. Sitting upright can be useful. Leaning back with support can be useful. Standing can be useful. Walking away from the desk can be useful. Problems tend to occur when one position is held too long or when a workstation repeatedly forces the body into strain.

Monitor Position and Neck Strain

Monitor position is one of the most important parts of an ergonomic setup. If the screen is too low, you may spend the day looking down. If it is too high, you may extend your neck upward. If it is too far away, you may lean forward. If it is off to one side, you may rotate your neck for long periods.

The Woo et al. review found that global ergonomics standards differ in their workstation recommendations, including monitor position and viewing angles (Woo et al., 2016). This inconsistency matters because monitor height and distance can influence head and neck posture.

The NIOSH report also found that workstation design and adjustment practices appeared to give more attention to keyboard position than monitor position. The researchers found a stronger relationship between elbow height and keyboard height than between eye height and monitor height, suggesting that monitor placement may be neglected compared with keyboard placement (Gerr, 2001).

Clinically, this makes sense. Many people adjust their chair and keyboard so they can type comfortably, but they leave the monitor too low, too high, or too far away. Over a full workday, this can contribute to neck and shoulder tension.

A practical rule is to keep your main screen directly in front of you, roughly at arm’s length, with the top of the screen near eye level or slightly below. You should be able to view the screen without craning your neck forward, looking sharply downward, or rotating your head for long periods.

For laptop users, this is especially important. Laptops are convenient, but they create an ergonomic compromise because the screen and keyboard are attached. For longer work sessions, using a laptop stand with an external keyboard and mouse is usually much better than working hunched over the laptop.

Keyboard Height and Elbow Position

Keyboard position matters because it affects the shoulders, elbows, forearms, wrists, and hands. If the keyboard is too high, the shoulders may elevate and the wrists may extend. If it is too far away, the arms may reach forward and the shoulders may tense. If it is too close to the desk edge, the wrists and forearms may lack support.

In the NIOSH report, keying with elbow height below the height of the “J” key was associated with increased risk of neck and shoulder symptoms. The same report found that an inner elbow angle greater than 121 degrees was associated with reduced risk of both neck and shoulder symptoms and neck and shoulder disorders, although this protective effect decreased as weekly keying hours increased (Gerr, 2001).

This is a useful reminder that the common “elbows at exactly 90 degrees” rule may be too simplistic. For some people, a slightly more open elbow angle and a keyboard position that does not force the shoulders to elevate or the wrists to strain may be more comfortable.

The keyboard should generally be positioned so the shoulders feel relaxed, the elbows can rest near the body, and the wrists do not have to bend sharply upward or sideways. The exact position may vary depending on your body size, chair, desk, and work tasks.

Mouse Position: A Common Source of Shoulder and Wrist Strain

Mouse use is one of the most overlooked ergonomic issues. Many people keep the mouse too far to the side or too far forward. This forces the shoulder to reach repeatedly throughout the day.

The NIOSH report found that reaching for and using the mouse increased shoulder flexion, shoulder abduction, and inner elbow angle (Gerr, 2001). In plain language, using the mouse often made people reach their arm away from the body. Over time, repeated reaching can contribute to shoulder, neck, forearm, or wrist discomfort.

The report also found that radial deviation of more than 5 degrees while using a mouse was associated with increased risk of hand and arm disorders (Gerr, 2001). Radial deviation refers to the wrist bending toward the thumb side. This kind of repeated or sustained wrist position may increase strain in the wrist and forearm.

A practical solution is to keep the mouse close to the keyboard, at the same height, and within easy reach. Your elbow should stay near your side. Your wrist should remain relatively neutral, not bent sharply to one side. If your shoulder feels like it is reaching all day, your mouse is probably too far away.

Some people may benefit from a different mouse design, a smaller keyboard, keyboard shortcuts, or alternating mouse hands, depending on the situation.

Arm Supports and Alternative Mouse Designs

The Cochrane review found moderate-quality evidence that using an arm support together with an alternative computer mouse reduced the incidence of neck or shoulder disorders compared with a conventional mouse alone. The reported risk ratio was 0.52, meaning the intervention group had a lower risk of neck or shoulder disorders in the included studies (Hoe et al., 2018).

The same review found low-quality evidence that this combination reduced neck or shoulder discomfort and right upper limb discomfort. However, the evidence was not as strong for reducing right upper limb disorders, and alternative mouse use alone did not clearly reduce disorders compared with a conventional mouse (Hoe et al., 2018).

For patients, this means that arm support and mouse changes may help some people, especially if they reduce reaching, shoulder tension, or wrist strain. But they should not be seen as guaranteed solutions. They work best when matched to the person’s symptoms, workstation, and daily work demands.

Wrist Rests: Helpful or Harmful?

Wrist rests are commonly recommended, but they are not always used properly. A wrist rest should not be used as a place to press the wrist heavily while typing. It is better used lightly during pauses, not as a constant pressure point.

The NIOSH report found that use of a wrist rest was associated with decreased wrist flexion in posture measurements, but in some analyses, the presence of a keyboard wrist rest was associated with increased risk of hand and arm symptoms and disorders (Gerr, 2001). The authors interpreted this carefully and did not conclude that all wrist rests are harmful. The relationship appeared to depend on how the wrist rest and keyboard were positioned.

The practical message is that wrist rests are not automatically good or bad. They must be used correctly. Avoid planting the wrist heavily on a hard surface while typing. Keep the wrists neutral, float the hands lightly when typing, and use support during pauses if helpful.

If a wrist rest increases pressure, numbness, tingling, or discomfort, it may need to be removed or repositioned.

Sit-Stand Desks: Useful, But Not Magic

Sit-stand desks have become popular, especially for people who sit for long periods. They can be helpful because they allow position changes throughout the day. However, standing all day is not automatically better than sitting all day.

The Cochrane review found very low-quality evidence from one study that sit-stand workstations did not clearly reduce neck and shoulder discomfort or pain compared with usual working conditions (Hoe et al., 2018). This does not mean sit-stand desks have no value. It means that simply replacing a sitting desk with a sit-stand desk may not be enough to prevent pain.

The key is how the desk is used. Alternating between sitting and standing, taking walking breaks, adjusting monitor height, keeping the keyboard and mouse at comfortable levels, and avoiding prolonged static standing are all important.

A sit-stand desk should be used to create movement variety, not to replace one fixed posture with another fixed posture.

Breaks Are Part of Ergonomics

Breaks are not separate from ergonomics. They are one of the most important parts of it.

The Cochrane review found very low-quality evidence that supplementary breaks may reduce discomfort in the neck, right shoulder or upper arm, and right forearm, wrist, or hand among data entry workers (Hoe et al., 2018). Although the quality of evidence was low, the finding makes practical sense. Muscles and joints often tolerate work better when sustained loading is interrupted.

Even a well-designed workstation cannot remove all strain if someone sits and types for hours without interruption. The body needs changes in position. Muscles need recovery. Joints need movement. Eyes need breaks from the screen.

A useful strategy is to take short movement breaks throughout the day. This does not need to be complicated. Stand up, walk briefly, roll the shoulders, gently move the neck, open the chest, stretch the hips, or take a few slow breaths away from the screen.

Microbreaks are especially helpful because they interrupt the buildup of strain before it becomes noticeable. A one- or two-minute break every 20 to 30 minutes can sometimes be more useful than one long break after several hours of discomfort.

Ergonomic Training Alone May Not Be Enough

Many workplaces offer ergonomic training, but education alone does not always change outcomes. The Cochrane review found low- to very low-quality evidence that ergonomic training may or may not prevent work-related musculoskeletal disorders of the upper limb or neck among office workers (Hoe et al., 2018).

This is important because people often know what they “should” do but still struggle to apply it. They may know their screen should be higher, but they do not have a monitor stand. They may know they should take breaks, but their workload does not allow it. They may know they should avoid reaching for the mouse, but their keyboard is too wide. They may know they should exercise, but pain makes them hesitant.

Training is most useful when it is practical, individualized, and paired with real changes to the workstation and work routine.

The Problem With Repetition

Ergonomics is not only about posture. It is also about repetition and workload.

The NIOSH report found that hours of keying per week were associated with both hand and arm symptoms and hand and arm disorders (Gerr, 2001). This means that the amount of typing matters. Even with a good setup, long periods of repeated keying can still increase strain.

This is important for people who type, code, document, chart, schedule patients, write reports, process claims, or answer emails for many hours per day. The more repetitive the task, the more important breaks, variation, and recovery become.

Reducing unnecessary repetition can help. This may include using keyboard shortcuts, speech-to-text tools, templates, alternating tasks, taking microbreaks, and avoiding long uninterrupted blocks of typing when possible.

Your Chair Matters, But It Is Not the Whole Solution

A good chair can help support the spine, hips, and pelvis. Adjustable seat height, lumbar support, a stable base, and comfortable seat depth can make sitting easier.

However, the NIOSH report found that simply having an easily adjustable chair was not necessarily associated with better measured postures among computer users (Gerr, 2001). This does not mean adjustable chairs are useless. It means that providing equipment alone is not enough if people do not know how to use it, do not adjust it, or continue working in the same habits.

This is a common real-world issue. Many people have expensive office chairs but never change the settings. Others sit at a desk that is too high, so even a good chair cannot fully solve the problem. Some people have a chair that fits well but still sit for hours without moving.

A chair is a tool. It helps, but it does not replace movement, breaks, and a properly arranged workstation.

Documents, Phones, and Small Habits That Matter

People often focus on the chair and monitor but ignore documents, phones, notebooks, and secondary screens. These smaller details can matter.

The NIOSH report found that participants using a document holder had different head and gaze positions than those who did not use one. A document holder can reduce repeated looking down or rotating the neck when copying from papers (Gerr, 2001).

The report also found that using a telephone shoulder rest was associated with increased risk of neck and shoulder symptoms and disorders (Gerr, 2001). This makes sense because holding a phone between the ear and shoulder can place the neck in a side-bent, compressed position. For anyone who spends significant time on the phone, a headset or speaker option is usually better.

These details may seem small, but ergonomics is often about small repeated exposures. A few minutes of awkward neck position may not matter. Doing it repeatedly every day can become a problem.

Ergonomics for Working From Home

Working from home has made ergonomics even more important. Many people work at kitchen tables, couches, beds, or small temporary desks. These setups may be fine for occasional use, but they are usually not ideal for full workdays.

The biggest work-from-home problem is laptop posture. When a laptop sits flat on a table, the screen is usually too low. This encourages forward head posture, rounded shoulders, and upper back strain. If the laptop is raised to eye level, the keyboard becomes too high. This is why an external keyboard and mouse are so helpful.

A simple home setup can include a laptop stand, separate keyboard, separate mouse, supportive chair, and screen positioned directly in front of you. You do not need a perfect office to make meaningful improvements. Even small changes can reduce daily strain.

Ergonomics Is About Reducing Load, Not Blaming Posture

It is important not to turn ergonomics into fear. People should not feel that every posture is dangerous or that their spine is fragile. The body is strong and adaptable. Pain is usually influenced by many factors, including sleep, stress, workload, strength, activity, recovery, and overall health.

Ergonomics is not about blaming people for how they sit. It is about making the environment easier on the body.

A better setup reduces unnecessary load. Better habits reduce repetition. Movement breaks reduce static strain. Exercise builds capacity. Together, these changes can help people feel and function better.

How Chiropractic Care May Help

At The Muscle and Joint Clinic, we often see patients with neck pain, upper back stiffness, low back pain, shoulder tension, headaches, wrist discomfort, and posture-related symptoms that may be connected to desk work, laptop use, computer work, studying, or working from home.

Chiropractic care begins with a proper assessment. We look at the patient’s symptoms, work habits, posture, spinal and joint mobility, muscle tension, movement patterns, and any signs that may require referral or further investigation.

For many patients, discomfort is related to mechanical factors such as joint restriction, muscle tension, reduced mobility, prolonged sitting, repetitive strain, weakness, or poor movement habits. Care may include chiropractic treatment, soft tissue therapy, mobility work, strengthening exercises, ergonomic advice, posture education, and strategies to reduce strain during work.

The goal is not simply to tell people to “sit up straight.” The goal is to help patients move better, feel better, understand what may be contributing to their symptoms, and build habits that support long-term musculoskeletal health.

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Practical Ergonomic Tips

• Start with your screen. Place your main monitor directly in front of you and close to eye level. Avoid looking down at a laptop for long periods.

• Keep your keyboard and mouse close. Your elbows should stay near your body and your shoulders should feel relaxed.

• Avoid reaching for the mouse. If your mouse is far away, bring it closer. If your keyboard is very wide, consider whether it is forcing the mouse too far to the side.

• Support your lower back. Sit back into the chair and use lumbar support if helpful.

• Keep your feet supported. If your feet do not comfortably reach the floor, use a footrest.

• Avoid holding the phone between your ear and shoulder. Use a headset, earbuds, or speaker option when possible.

• Take regular breaks. Stand, walk, stretch, and change position often.

• Use a laptop stand for longer sessions. Pair it with an external keyboard and mouse.

• Do not chase perfect posture. Focus on comfort, support, and movement variety.

The Bottom Line

Ergonomics matters because many people spend hours each day at computers, laptops, and phones. Small workstation problems repeated over time can contribute to neck pain, shoulder tension, back pain, wrist discomfort, and fatigue.

The evidence shows that computer workstation design is complex, and guidelines are not always consistent (Woo et al., 2016). Research on computer users also shows that many people work in non-neutral postures, and that factors such as keyboard position, mouse use, telephone habits, and hours of keying can influence musculoskeletal symptoms and disorders (Gerr, 2001).

At the same time, high-quality evidence for many ergonomic interventions remains limited or mixed. A Cochrane review found that some interventions, such as arm supports combined with alternative mouse designs and supplementary breaks, may help in certain situations, but many interventions do not have strong evidence as standalone solutions (Hoe et al., 2018).

The solution is not one perfect posture, one perfect chair, or one perfect desk. The solution is a better setup, less unnecessary strain, regular movement, appropriate breaks, and enough strength and mobility to tolerate the demands of the workday.

Your workstation should fit your body and your work. Your body should not have to constantly adapt to a poorly designed workstation.

Disclaimer

This article is for general educational and informational purposes only and is not intended to replace individualized medical advice, diagnosis, or treatment. Ergonomic recommendations should be adapted to the individual, the work environment, and any existing health concerns.

If you have severe, worsening, persistent, recurrent, or unusual pain, numbness, weakness, radiating symptoms, or symptoms affecting your ability to work or function, please seek assessment from a qualified health professional.

References

Gerr, F. (2001). Musculoskeletal disorders among VDT operators: Final report (NIOSH R01-OH03160). Rollins School of Public Health, Department of Environmental and Occupational Health, Emory University.

Hoe, V. C. W., Urquhart, D. M., Kelsall, H. L., Zamri, E. N., & Sim, M. R. (2018). Ergonomic interventions for preventing work-related musculoskeletal disorders of the upper limb and neck among office workers. Cochrane Database of Systematic Reviews, 2018(10), CD008570. https://doi.org/10.1002/14651858.CD008570.pub3

Woo, E. H. C., White, P., & Lai, C. W. K. (2016). Ergonomics standards and guidelines for computer workstation design and the impact on users’ health: A review. Ergonomics, 59(3), 464–475. https://doi.org/10.1080/00140139.2015.1076528

Back pain is often thought of as an adult problem, but children and teenagers can experience it too. In fact, research over the last several years has shown that spinal pain in young people is much more common than many parents realize. Neck pain, mid-back pain, and low back pain can appear during the school years, sometimes after sports, sometimes after prolonged sitting, and sometimes after long periods of phone, computer, or tablet use.

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For many children, back pain is mild and temporary. It may come and go, settle with rest, or improve once they start moving again. For others, it can become more persistent and begin to interfere with school, sleep, sports, physical education, mood, and daily activity. This is why back pain in children should not automatically be dismissed as “just growing pains,” especially when it becomes recurrent or starts limiting normal life.

A growing body of evidence suggests that pediatric back pain is influenced by many factors. These can include age, sex, physical activity level, body composition, posture, screen time, smartphone use, computer use, school habits, sports participation, and prolonged sitting (Azevedo et al., 2023; Joergensen et al., 2021; Minghelli, 2020). The relationship is not always simple, and these studies do not prove that screens alone cause back pain. However, they do show that modern childhood habits may play an important role.

Back Pain in Young People Is Common

Several studies have reported high rates of back pain in children and adolescents. In a Portuguese study of 304 students aged 10 to 17, lifetime prevalence was 51% for neck pain and 65.1% for low back pain. Over a 12-month period, 39.8% reported neck pain and 47% reported low back pain (Minghelli, 2020).

A larger cross-sectional study from northern Portugal included 1,463 students aged 9 to 19. In that study, approximately half of the children and adolescents reported experiencing back pain at least once in their lifetime. The most commonly reported regions were the lumbar spine and thoracic spine, and most pain was described as mild or moderate in intensity (Azevedo et al., 2023).

These findings are important because they show that back pain is not rare in young people. Many children and teenagers experience spinal pain at some point, and the risk appears to increase with age. Azevedo and colleagues found that age was a factor associated with back pain, and Minghelli found that older adolescents between 15 and 17 years old had a higher probability of low back pain compared with younger students between 10 and 14 years old (Azevedo et al., 2023; Minghelli, 2020).

This may reflect the reality of adolescence. Older students often have longer school days, more homework, more time spent sitting, more time on phones and computers, heavier academic demands, and sometimes more intense sports or exercise schedules. Growth and puberty may also change the way the spine, muscles, and joints respond to load.

Smartphones, Computers, and Back Pain

One of the strongest themes across these studies is the relationship between screen-based habits and spinal pain. In Minghelli’s study, adolescents who used a mobile phone for more than 10 hours per week had 2.48 times higher probability of neck pain and 2.39 times higher probability of low back pain compared with those who used a mobile phone for 10 hours per week or less (Minghelli, 2020).

Azevedo and colleagues also found that prolonged smartphone and computer use were associated with a higher relative risk of back pain in children and adolescents. Their study specifically identified prolonged smartphone use and computer use as risk factors, along with age, female sex, percentage body fat, hyperkyphosis, and lateral global spine tilt to the left side (Azevedo et al., 2023).

This does not mean every child who uses a phone or computer will develop back pain. The issue is more likely the combination of time, posture, repetition, and lack of movement variety. When children look down at a phone, sit curled over a laptop, or stay in one position for long periods, the neck, shoulders, mid-back, low back, and hips can become tired or irritated.

The problem is rarely one single screen session. It is the repeated pattern across the day. A child may look down at a phone before school, sit at a desk during class, use a laptop for homework, watch videos after school, game in the evening, and then look at a phone again before bed. Over time, these habits can add up.

Screen Time and Spinal Pain in Pre-Adolescents

A large Danish study published in BMC Musculoskeletal Disorders looked at 45,555 pre-adolescents from the Danish National Birth Cohort. These children were around 11 to 12 years old. The researchers examined screen time, physical activity, and spinal pain involving the neck, mid-back, and low back (Joergensen et al., 2021).

The study found a stepwise association between screen time and spinal pain. Compared with children who spent less than two hours per day in front of screens, children who spent six or more hours per day in front of screens had a substantially higher likelihood of severe spinal pain. For girls, six or more hours of daily screen time was associated with a relative risk ratio of 2.49 for severe spinal pain. For boys, it was associated with a relative risk ratio of 1.95 (Joergensen et al., 2021).

This is an important finding because it suggests a dose-response pattern. As screen time increased, the likelihood of spinal pain also increased. The association was stronger for severe pain than for moderate pain among children with the highest screen exposure (Joergensen et al., 2021).

However, it is important to be careful with how we interpret this. The Danish study was cross-sectional, which means it can show an association but cannot prove cause and effect. It is possible that high screen time contributes to spinal pain, but it is also possible that children with pain become less active and spend more time on screens. The authors themselves noted that future prospective studies are needed to better understand causality (Joergensen et al., 2021).

For parents, the practical takeaway is still useful: long, uninterrupted screen time is worth addressing when a child has neck or back pain.

Posture Matters, But Movement Matters More

Posture is often blamed for back pain, but the message needs to be balanced. Children do not need to sit perfectly straight all day, and it is not realistic to expect them to hold one “perfect” posture for hours. The spine is made to move.

That said, posture can still matter when certain positions are held for long periods. Minghelli found that students who sat with the spine in a poor position had 3.24 times greater odds of low back pain (Minghelli, 2020). Azevedo and colleagues also found that hyperkyphosis was associated with increased risk of back pain, and lateral global spine tilt to the left side was also associated with higher risk, although the number of students with this tilt was relatively small (Azevedo et al., 2023).

Hyperkyphosis refers to an increased rounding of the upper back. In children who spend long periods sitting, looking down, or using devices, this rounded posture may become more common. But posture should not be treated as a moral failure or something children should feel anxious about. A more helpful message is that the body likes variety. Sitting upright, leaning back, standing, stretching, walking, and changing position throughout the day are all useful.

Instead of constantly telling a child to “sit up straight,” it may be more effective to say, “Let’s change position,” “Take a quick movement break,” or “Bring the screen up a little higher.”

Physical Activity Can Be Protective

Physical activity is one of the most important factors to consider. Azevedo and colleagues found that practicing physical activity or sports regularly had a protective effect against back pain (Azevedo et al., 2023). Joergensen and colleagues found that physically inactive pre-adolescents were more likely to report severe spinal pain compared with moderately active children (Joergensen et al., 2021).

This makes sense clinically. Children who move regularly tend to develop better strength, endurance, coordination, balance, and confidence in their bodies. Regular movement may also help counterbalance long periods of sitting and screen use.

However, more is not always better. Azevedo and colleagues found that while sport and physical activity were generally protective, performing physical exercise for two to three hours per day increased the risk of back pain compared with zero to one hour per day (Azevedo et al., 2023). Joergensen and colleagues also discussed the possibility of a U-shaped relationship, where inactivity may increase risk, but very high levels of intense activity may also contribute to pain in some children (Joergensen et al., 2021).

This is an important point for parents of both inactive children and highly active young athletes. A child who does very little physical activity may need encouragement to move more. A child training intensely every day may need better load management, rest, recovery, strength work, and attention to technique.

The Surprising Finding About Video Games

One interesting finding from Azevedo’s study was that video game use appeared to have a protective effect. Specifically, video game use for two to three hours per day was associated with a reduced risk of back pain, although this result was based on a relatively small number of students (Azevedo et al., 2023).

This finding should be interpreted carefully. It does not mean children should be encouraged to play unlimited video games to prevent back pain. The authors noted the finding, but because the number of students in that category was small, it should not be overgeneralized.

One possible explanation is that video game use may involve more varied postures or more active engagement compared with passive screen use. Some gaming may also involve movement-based consoles or more frequent position changes. But for most families, the safest interpretation is still moderation. The goal is not to replace one type of screen time with another. The goal is to balance screen time with movement, sleep, outdoor activity, school demands, and family routines.

Body Composition and Back Pain

Azevedo and colleagues found that percentage body fat was associated with a higher risk of back pain in children and adolescents (Azevedo et al., 2023). Interestingly, body mass index was not the key factor in their analysis, but percentage body fat was.

This distinction matters. BMI is a broad measure and does not always tell the full story about body composition, strength, or fitness. Percentage body fat may better reflect some of the mechanical and metabolic factors that can influence musculoskeletal pain.

That said, this topic should be approached carefully with children. The goal should never be to shame a child about weight or appearance. The healthier and more useful focus is on building strength, improving fitness, increasing daily movement, improving sleep, eating well, and supporting overall health.

Why Back Pain in Children Should Not Be Ignored

Most pediatric back pain is not dangerous, but it can still affect a child’s quality of life. Azevedo and colleagues found that 20.8% of students who reported back pain also reported functional limitation related to that pain (Azevedo et al., 2023). This means that for some children, back pain is not just a minor complaint. It can interfere with normal activities.

Pain can also change behaviour. A child may stop participating in gym class, avoid sports, sit out at recess, become less active, or spend more time resting. Over time, this can lead to weakness, stiffness, reduced confidence, and more sensitivity to movement.

This is why early assessment and education can be helpful. The goal is not to medicalize every ache and pain. The goal is to identify children who need support and to help them return to healthy movement before pain becomes a recurring pattern.

When Parents Should Seek Assessment

Parents should consider having their child assessed if back pain is persistent, worsening, recurrent, interfering with school or sports, affecting sleep, or causing the child to avoid normal activities. Assessment is also important if pain follows a significant fall, collision, or injury.

Parents should seek medical attention more urgently if back pain is associated with fever, unexplained weight loss, night sweats, constant night pain, progressive worsening, numbness, weakness, changes in walking, bowel or bladder changes, unexplained fatigue, or pain in a very young child.

In many cases, the pain is mechanical and manageable with conservative care. But a proper assessment helps determine whether further medical investigation is needed.

How Chiropractic Care Can Help

At The Muscle and Joint Clinic, we often see children and teenagers who complain of back pain, neck pain, posture-related discomfort, sports-related soreness, or pain that seems to come on after long periods of sitting, studying, gaming, or using a phone or computer.

Chiropractic care begins with a proper assessment. Before recommending treatment, we take time to understand the child’s symptoms, how long the pain has been present, what activities make it better or worse, whether it affects school, sports, sleep, or daily life, and whether there are any signs that require medical referral. This is especially important in children because back pain can have many possible causes, and care should always be based on the child’s specific presentation.

For many children and adolescents, back pain is mechanical in nature. This means it may be related to muscle tension, joint restriction, posture habits, prolonged sitting, screen use, backpack strain, sports overload, reduced mobility, weakness, or poor movement control. In these cases, chiropractic care may help by improving spinal and joint mobility, reducing muscle tension, supporting better movement patterns, and helping the child return to activity safely.

Treatment may include gentle chiropractic care, soft tissue therapy, mobility exercises, strengthening exercises, posture education, ergonomic advice, backpack guidance, and recommendations around screen habits and movement breaks. The goal is not simply to tell a child to “sit up straight.” The goal is to help them move better, feel better, understand their body, and develop habits that support long-term spinal health.

We also focus on education for both parents and children. Many families feel worried when a child has back pain, but most cases are not serious and can improve with the right guidance. We help families understand what may be contributing to the pain, what activities are safe, what changes may help, and when further medical evaluation or imaging may be needed.

If your child or teenager has been complaining of back pain, neck pain, posture-related discomfort, or pain with school, sports, or screen use, we offer free consultations at The Muscle and Joint Clinic. A consultation is an opportunity to discuss the concern, ask questions, and determine whether chiropractic care may be appropriate.

Practical Tips for Parents

A helpful first step is to look at the child’s daily routine. How much time are they spending sitting? How much time are they spending on a phone or computer? Are they physically active most days? Are they sleeping well? Are they carrying a heavy backpack? Are they avoiding sports or gym class because of pain?

Children should be encouraged to take regular movement breaks during homework, gaming, studying, and recreational screen use. Even a short break every 20 to 30 minutes can help reduce prolonged static loading.

Phones should be brought closer to eye level when possible, rather than always bending the neck down toward the lap. Laptops can be raised for longer work sessions, and an external keyboard or mouse can make the setup more comfortable.

Physical activity should be encouraged in a positive way. Children do not need to become elite athletes. They need regular opportunities to walk, run, play, strengthen, stretch, and move in different ways.

Parents should also avoid fear-based language. Telling a child that their spine is “bad” or that they are “damaging their back” can create unnecessary worry. A better message is that the body is strong, movement is healthy, and small habit changes can make a big difference.

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The Bottom Line

Back pain in children and adolescents is common. Research from Portugal and Denmark shows that spinal pain is associated with factors such as age, female sex, prolonged smartphone and computer use, high screen time, physical inactivity, posture, and body composition (Azevedo et al., 2023; Joergensen et al., 2021; Minghelli, 2020).

This does not mean screens are the only cause, and it does not mean children need to avoid technology completely. The more balanced message is that children need movement variety, regular physical activity, healthy screen habits, supportive school and homework setups, and early assessment when pain persists.

Most children with back pain do not have a serious condition, but their pain still deserves attention. With the right education, movement, and care, many children and teens can feel better, stay active, and build healthier habits for the future.

Disclaimer

This article is for general educational and informational purposes only and is not intended to replace individualized medical advice, diagnosis, or treatment. Back pain in children and adolescents can have many possible causes, and recommendations should always be based on a proper clinical assessment.

If your child has severe, worsening, persistent, recurrent, or unusual back pain, or if symptoms are associated with fever, unexplained weight loss, night pain, numbness, weakness, changes in walking, bowel or bladder changes, or a significant injury, please seek assessment from a qualified health professional.

A free consultation at The Muscle and Joint Clinic is an opportunity to discuss your child’s concern, ask questions, and determine whether a full assessment or referral may be appropriate. It does not replace a complete examination or medical evaluation when one is needed.

References

Azevedo, N., Ribeiro, J. C., & Machado, L. (2023). Back pain in children and adolescents: A cross-sectional study. European Spine Journal, 32, 3280–3289. https://doi.org/10.1007/s00586-023-07751-z

Joergensen, A. C., Strandberg-Larsen, K., Andersen, P. K., Hestbaek, L., & Andersen, A.-M. N. (2021). Spinal pain in pre-adolescence and the relation with screen time and physical activity behavior. BMC Musculoskeletal Disorders, 22, Article 393. https://doi.org/10.1186/s12891-021-04263-z

Minghelli, B. (2020). Musculoskeletal spine pain in adolescents: Epidemiology of non-specific neck and low back pain and risk factors. Journal of Orthopaedic Science, 25(5), 776–780. https://doi.org/10.1016/j.jos.2019.10.008

Pregnancy is one of the most significant physical changes a person can experience. As the body adapts to support a growing baby, nearly every part of the musculoskeletal system is affected in some way. The spine, pelvis, hips, ribs, abdominal wall, pelvic floor, muscles, ligaments, and joints all respond to changing weight distribution, hormonal changes, altered posture, and new daily demands.

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For many people, these changes are manageable. For others, they can contribute to low back pain, pelvic girdle pain, hip discomfort, rib pain, neck tension, headaches, difficulty sleeping, or trouble with everyday activities such as walking, climbing stairs, rolling in bed, sitting, standing, lifting, or caring for other children.

These symptoms are common, but they should not be dismissed as “just part of pregnancy.” Pregnancy-related low back pain and pelvic girdle pain can affect sleep, work, activity levels, mood, confidence with movement, and quality of life. Research has reported that low back pain, pelvic girdle pain, or a combination of both are frequently experienced during pregnancy, and some individuals continue to experience symptoms into the postpartum period (Weis et al., 2020; Weis et al., 2022).

Chiropractic care during pregnancy is not about “treating pregnancy.” Pregnancy is not a disease. Instead, chiropractic care focuses on the musculoskeletal system: the spine, pelvis, joints, muscles, nerves, movement patterns, and daily function. The goal is to help patients understand what is changing, manage discomfort where appropriate, move more comfortably, stay active when safe, and transition into postpartum recovery with more confidence.

The Canadian Chiropractic Association has highlighted several reasons why a pregnant person may consider chiropractic care, including education, pain relief, guidance around physical activity, postpartum support, and ergonomic advice for feeding and infant care (Canadian Chiropractic Association [CCA], 2026). These themes are also reflected in the best-practice recommendations for chiropractic care for pregnant and postpartum patients with low back pain, pelvic girdle pain, or combined pain (Weis et al., 2022).

Why Pregnancy Can Affect the Spine and Pelvis

During pregnancy, the body changes in ways that can affect posture, balance, and movement. As the uterus expands and abdominal weight increases, the body’s centre of gravity often shifts forward. To compensate, many people develop an increased curve in the lower back, known as lumbar lordosis. The pelvis may also tilt forward, changing the way force travels through the low back, sacroiliac joints, hips, pelvic floor, and surrounding muscles.

Hormonal changes also play a role. During pregnancy, ligament laxity increases. This is a normal adaptation that helps the body prepare for birth, but it may also reduce joint stability in some areas. When ligaments are more relaxed, muscles often have to work harder to provide support. This can contribute to fatigue, tightness, aching, or discomfort, especially in the low back, pelvis, hips, and abdominal wall.

These changes can also affect walking mechanics and balance. Some pregnant patients notice they walk differently, take shorter steps, feel less stable on stairs, or have discomfort when standing on one leg. Others may experience pain when rolling in bed, getting out of a chair, sitting for long periods, or lifting.

These symptoms do not always mean something serious is wrong, but they should be assessed properly. Best-practice recommendations emphasize that chiropractors should take a detailed history, complete an appropriate physical examination, screen for red flags, and adapt care to the patient’s stage of pregnancy or postpartum recovery (Weis et al., 2022).

Low Back Pain and Pelvic Girdle Pain Are Not the Same Thing

One of the most important points in the pregnancy-related pain literature is that low back pain and pelvic girdle pain are not always the same condition. They can overlap, but they often have different patterns, different aggravating factors, and different management needs.

Low back pain is generally described as pain in the lumbar region, between the lower ribs and the upper part of the pelvis. It may feel dull, achy, tight, or stiff. It may be aggravated by bending, prolonged sitting, prolonged standing, or certain spinal movements (Weis et al., 2022).

Pelvic girdle pain is different. It is often felt near the sacroiliac joints at the back of the pelvis, the pubic symphysis at the front of the pelvis, or both. It may refer into the buttock or posterior thigh. Pelvic girdle pain may be aggravated by walking, stairs, rolling in bed, getting in and out of a car, standing on one leg, or changing positions (Vleeming et al., 2008; Weis et al., 2022).

Some patients experience both low back pain and pelvic girdle pain at the same time. This is often called combined pain. Combined pain may be more disabling than low back pain or pelvic girdle pain alone, and patients with combined pain may require more careful assessment, education, and management (Weis et al., 2022).

This distinction matters because the most helpful plan depends on the source and pattern of symptoms. A patient with primarily lumbar pain may benefit from different exercises, manual therapy, and ergonomic strategies than a patient with pelvic girdle pain. A patient with combined pain may need an even more individualized approach.

Pain During Pregnancy Should Not Be Ignored

A common misconception is that back or pelvic pain during pregnancy is unavoidable and should simply be tolerated until delivery. While many pregnancy-related symptoms improve after birth, some patients continue to experience pain postpartum. The 2020 systematic review by Weis and colleagues noted that pregnancy-related low back pain or pelvic girdle pain can interfere with activities of daily living and may lead some patients to delay care because they believe the pain is a normal part of pregnancy (Weis et al., 2020).

This is important because delayed care may allow symptoms to become more persistent. Some patients continue to experience low back or pelvic symptoms months or even years postpartum, especially if they had significant symptoms during pregnancy or combined pain patterns (Weis et al., 2022).

Seeking care does not mean the pregnancy is abnormal. It means the patient is looking for support to move better, function better, and manage symptoms in a safe and appropriate way.

What Does the Research Say About Chiropractic Care During Pregnancy?

A 2020 systematic review examined chiropractic care options commonly used for pregnancy-related low back pain, pelvic girdle pain, or combination pain. The review included 50 articles from 18 systematic reviews, 30 randomized controlled trials, and 2 cohort studies (Weis et al., 2020).

The review found several interventions with favorable or potentially useful evidence. For pregnancy-related low back pain, electrotherapy and osteopathic manipulative therapy had moderate favorable evidence. Chiropractic care, exercise, and support devices had inconclusive but favorable evidence. (Weis et al., 2020). For pregnancy-related pelvic girdle pain, exercise had favorable evidence. (Weis et al., 2020).

For patients with low back pain or pelvic girdle pain, multimodal care, patient education, and physiotherapy had favorable evidence. Exercise had moderate evidence, with some positive findings (Weis et al., 2020).

The main takeaway is not that one single treatment is clearly superior for every pregnant patient. The better takeaway is that pregnancy-related back and pelvic pain should be assessed individually, and care is often best delivered as a combination of education, exercise, manual therapy where appropriate, ergonomic advice, support strategies, and collaboration with prenatal healthcare providers.

Why Multimodal Care Matters

In clinical practice, chiropractic care is rarely just one thing. It is usually multimodal, meaning it may include several components. This may involve patient education, advice on daily activities, spinal or pelvic joint mobilization, soft tissue therapy, exercise prescription, support belts, taping, pillow positioning, and home-care strategies.

This multimodal approach is important because pregnancy-related pain is often multifactorial. Pain may be influenced by posture, joint loading, muscle endurance, sleep position, activity level, pelvic stability, abdominal wall changes, work demands, and previous injury history. It would be unrealistic to expect one technique alone to solve every case.

The 2020 systematic review found favorable evidence for multimodal care in patients with low back pain or pelvic girdle pain during pregnancy (Weis et al., 2020). One randomized trial included in the review compared usual obstetric care with a multimodal program that included manual therapy, exercise, and education. The multimodal group had improvements in pain and disability compared with usual obstetric care alone when applied between 24 and 33 weeks of gestation (George et al., 2013, as cited in Weis et al., 2020).

This supports what many clinicians see in practice: patients often do best when care includes both symptom relief and active strategies to improve function.

Education Is a Key Part of Pregnancy Care

Education is one of the most valuable parts of chiropractic care during pregnancy. Many patients are unsure which symptoms are common, which symptoms require medical attention, and how to safely modify their daily activities.

A chiropractor can help explain how pregnancy-related physical changes may affect posture, joint loading, muscle function, movement patterns, and pain. Education may include advice about sleeping positions, pillow support, workstation setup, lifting mechanics, footwear, walking tolerance, exercise modifications, and pacing daily activities.

Best-practice recommendations emphasize that pregnant and postpartum patients should be encouraged to take an active role in their care. They should receive information about anatomy, biomechanics, controlled movement patterns, and strategies to continue daily activities as tolerated (Weis et al., 2022).

This matters because fear can lead to unnecessary inactivity. Some pregnant patients stop moving because they worry that exercise or daily activity will worsen their pain or harm the pregnancy. However, in the absence of contraindications, physical activity during pregnancy is recommended and is associated with several maternal and fetal health benefits (Mottola et al., 2018).

Physical Activity During Pregnancy: What the Canadian Guideline Recommends

The 2019 Canadian Guideline for Physical Activity Throughout Pregnancy recommends that all pregnant individuals without contraindications should be physically active throughout pregnancy (Mottola et al., 2018).

The guideline recommends accumulating at least 150 minutes of moderate-intensity physical activity per week. Moderate intensity means the activity noticeably increases heart rate while still allowing the person to talk. This is often described using the “talk test.” If a person can talk but not sing during the activity, they are likely exercising at a moderate intensity.

The guideline also recommends that activity be spread over at least three days per week, although being active every day is encouraged. It recommends a variety of aerobic and resistance training activities, and notes that yoga or gentle stretching may also be beneficial (Mottola et al., 2018).

This is important because many people assume pregnancy exercise should be limited to gentle stretching or occasional walking. While walking and stretching can be excellent, resistance training may also be appropriate when modified properly and when there are no contraindications. Combining aerobic and resistance training may provide greater benefits than aerobic activity alone (Mottola et al., 2018).

The Health Benefits of Prenatal Physical Activity

The Canadian guideline describes prenatal physical activity as a front-line therapy for reducing pregnancy complications and improving maternal physical and mental health (Mottola et al., 2018).

According to the guideline, prenatal physical activity is associated with decreased risk of preeclampsia, gestational hypertension, gestational diabetes, caesarean section, instrumental delivery, urinary incontinence, excessive gestational weight gain, and depression. It is also associated with improved blood glucose, decreased total gestational weight gain, reduced depressive symptom severity, and decreased severity of lumbopelvic pain (Mottola et al., 2018).

The guideline also addresses common safety concerns. In women without contraindications, physical activity during pregnancy was not associated with miscarriage, stillbirth, neonatal death, preterm birth, preterm or prelabour rupture of membranes, neonatal hypoglycemia, low birth weight, birth defects, induction of labour, or birth complications (Mottola et al., 2018).

This does not mean every activity is appropriate for every pregnant person. It means movement should be encouraged, modified when needed, and individualized based on symptoms, pregnancy stage, health history, and obstetric guidance.

Exercise and Pregnancy-Related Back or Pelvic Pain

Exercise can be an important part of managing pregnancy-related low back pain and pelvic girdle pain. The Canadian guideline reported that prenatal physical activity can reduce the severity of lumbopelvic pain (Mottola et al., 2018). Best-practice chiropractic recommendations also encourage pregnant patients with low back pain or pelvic girdle pain to remain active where possible, continue normal activities as tolerated, and follow an individualized exercise program (Weis et al., 2022).

The 2020 systematic review found that exercise had favorable evidence for pregnancy-related low back pain and pelvic girdle pain, although results varied depending on the type of pain, exercise program, study quality, and dosage (Weis et al., 2020).

This is why exercise should be individualized. A person with mild low back stiffness may tolerate general walking, mobility work, and strengthening quite well. A person with significant pelvic girdle pain may need more careful exercise selection because certain movements, such as wide stances, stairs, single-leg loading, or uneven walking, can aggravate symptoms.

For some patients, a supervised or guided program may be helpful. Exercises may include hip strengthening, glute activation, gentle core coordination, pelvic floor muscle training, breathing strategies, mobility exercises, and postural endurance work. The goal is not to overload the patient. The goal is to help them move with more confidence and less irritation.

Previously Inactive Patients Can Still Start

One of the most helpful parts of the Canadian guideline is that it does not only apply to people who were active before pregnancy. The guideline specifically states that previously inactive women without contraindications should also be physically active throughout pregnancy (Mottola et al., 2018).

This is important because some people believe pregnancy is not the time to start exercising. While pregnancy may not be the time to suddenly begin intense or unfamiliar training, it can be an appropriate time to gradually introduce safe physical activity.

Previously inactive patients may need to begin with lower intensity, shorter duration, and slower progression. This may include short walks, gentle mobility, breathing exercises, pelvic floor awareness, and basic strengthening. Over time, activity can be increased based on tolerance, symptoms, fatigue, and medical guidance.

The goal is not perfection. The goal is progress.

Pelvic Floor Muscle Training

The Canadian guideline recommends that pelvic floor muscle training, often called Kegel exercises, may be performed daily to reduce the risk of urinary incontinence. It also recommends instruction on proper technique to obtain optimal benefits (Mottola et al., 2018).

This is important because many people are told to “just do Kegels,” but not everyone performs them correctly, and not everyone needs the same pelvic floor strategy. Some patients may have pelvic floor weakness, while others may have overactivity, tension, pain, or poor coordination.

For chiropractic care, pelvic floor considerations are relevant because the pelvic floor is part of the broader lumbopelvic system. Low back pain, pelvic girdle pain, hip function, breathing mechanics, abdominal wall control, and pelvic floor coordination can all interact. Chiropractors can screen, educate, and refer to pelvic floor physiotherapy when appropriate.

Manual Therapy During Pregnancy

Manual therapy can be one part of care for pregnancy-related low back or pelvic pain. Depending on the patient, this may include spinal manipulation, mobilization, soft tissue therapy, gentle stretching, or other hands-on techniques.

Best-practice recommendations state that spinal manipulative therapy may be appropriate for some pregnant and postpartum patients with low back pain, pelvic girdle pain, or combined pain, while also emphasizing the need for modifications, informed consent, and attention to contraindications (Weis et al., 2022).

Care should be individualized. Some patients may benefit from gentle mobilization, soft tissue therapy, low-force approaches, or modified adjusting techniques. Others may respond better to exercise, education, support belts, or co-management with physiotherapy, pelvic floor physiotherapy, massage therapy, midwifery, or obstetric care.

The treatment should fit the patient, not the other way around.

Support Belts, Pillows, Taping, and Home Strategies

Many patients benefit from simple supportive strategies during pregnancy. Pillow support can help with sleep positioning. A pillow between the knees, under the abdomen, or supporting the back may reduce strain and improve comfort. Best-practice recommendations note that pregnant patients may consider pillow support under the abdomen, legs, or knees to help manage pregnancy-related back pain and sleep discomfort (Weis et al., 2022).

Support belts may provide short-term symptomatic relief for some patients with low back pain, pelvic girdle pain, or combined pain. The 2020 systematic review found that support devices had inconclusive evidence, but some studies showed favorable findings for pain relief or improved function with certain activities (Weis et al., 2020). Best-practice recommendations suggest that pelvic belts may be considered for short periods of symptomatic relief, especially when combined with education and exercise (Weis et al., 2022).

Taping may also be considered in some cases. However, clinicians should check for skin sensitivity or adhesive reactions. If irritation occurs, the tape should be removed and not reapplied (Weis et al., 2022).

These tools are not cures, but they can help patients function better while they continue working on movement, strength, and recovery.

Supine Exercise and Position Modifications

The Canadian guideline recommends that pregnant individuals who feel light-headed, nauseous, or unwell when exercising flat on their back should modify their position to avoid the supine position (Mottola et al., 2018).

Some pregnant patients feel uncomfortable lying flat on their back, especially later in pregnancy. They may experience dizziness, nausea, shortness of breath, or a feeling of pressure. In these cases, exercises can often be modified to side-lying, seated, standing, quadruped, or inclined positions.

This is also relevant during chiropractic treatment. Care should be modified for comfort and safety. Side-lying positions, pillows, pregnancy cushions, seated techniques, and lower-force approaches may all be used depending on the patient.

Safety: When Exercise Should Stop

The Canadian guideline provides clear reasons to stop physical activity and consult a healthcare provider. These include persistent excessive shortness of breath that does not resolve with rest, severe chest pain, regular and painful uterine contractions, vaginal bleeding, persistent loss of fluid from the vagina, and persistent dizziness or faintness that does not resolve with rest (Mottola et al., 2018).

These symptoms should not be ignored. They are not typical exercise discomforts and require medical guidance.

The guideline also lists absolute contraindications to exercise, including ruptured membranes, premature labour, unexplained persistent vaginal bleeding, placenta previa after 28 weeks, preeclampsia, incompetent cervix, intrauterine growth restriction, high-order multiple pregnancy, uncontrolled type 1 diabetes, uncontrolled hypertension, uncontrolled thyroid disease, and other serious cardiovascular, respiratory, or systemic disorders (Mottola et al., 2018).

Relative contraindications include recurrent pregnancy loss, gestational hypertension, history of spontaneous preterm birth, mild or moderate cardiovascular or respiratory disease, symptomatic anemia, malnutrition, eating disorder, twin pregnancy after 28 weeks, and other significant medical conditions (Mottola et al., 2018). Patients with relative contraindications should discuss physical activity with their obstetric care provider.

Chiropractic Care and Red Flags

Best-practice chiropractic recommendations also highlight the importance of red flag screening. Certain symptoms or conditions may require medical clearance, treatment modification, referral, or co-management.

Caution is recommended with vaginal bleeding without prior clearance, abdominopelvic cramping, ruptured membranes, premature labour, placenta previa with bleeding, placenta abruption, ectopic pregnancy concerns, bowel obstruction, pregnancy-induced hypertension, preeclampsia, eclampsia, recent pelvic trauma, known bleeding disorders, and other high-risk situations (Weis et al., 2022).

Blood pressure is particularly important. Hypertensive disorders of pregnancy can develop quickly and may also occur postpartum. Best-practice recommendations advise blood pressure monitoring during pregnancy and postpartum in appropriate circumstances, and immediate referral when concerning findings are present (Weis et al., 2022).

This reinforces an important point: chiropractic care during pregnancy should be careful, informed, and collaborative. It should support prenatal care, not replace it.

Diastasis Recti and Abdominal Wall Recovery

During pregnancy, the abdominal wall stretches as the uterus grows. Many patients develop some degree of increased separation between the rectus abdominis muscles, commonly referred to as diastasis recti. This occurs because the linea alba, the connective tissue between the abdominal muscles, stretches and thins.

Best-practice recommendations suggest that pregnant and postpartum patients should be checked for diastasis recti where appropriate (Weis et al., 2022). The Canadian physical activity guideline also notes that people with diastasis recti should seek physiotherapy advice and avoid abdominal strengthening exercises such as abdominal curls if those exercises worsen the condition (Mottola et al., 2018).

This does not mean the core should never be trained during or after pregnancy. It means the approach should be appropriate. Good rehabilitation should consider breathing, pressure management, abdominal wall tension, pelvic floor coordination, pain, symptoms, and function.

For many patients, diastasis recti improves naturally postpartum. For others, individualized rehabilitation may help restore confidence, strength, and trunk control. Co-management with pelvic floor physiotherapy may be helpful when there are pelvic floor symptoms, urinary leakage, pelvic heaviness, pain, or more complex postpartum concerns.

Chiropractic Support Into the Postpartum Period

The postpartum period brings a new set of physical demands. The body is recovering from pregnancy and birth while also adapting to feeding, carrying, lifting, bending, interrupted sleep, and repetitive infant care. Even when delivery goes well, the physical load of caring for a newborn can be significant.

Postpartum back pain, pelvic girdle pain, neck pain, shoulder tension, wrist discomfort, and hip pain are common complaints in clinical practice. Some symptoms are related to pregnancy-related changes that persist after birth. Others develop from new daily demands such as feeding positions, lifting the baby from a crib, carrying a car seat, holding the baby on one side, or prolonged sitting.

Best-practice recommendations include postpartum chiropractic care for low back pain, pelvic girdle pain, and combined pain, with appropriate assessment and management based on the patient’s presentation (Weis et al., 2022).

Postpartum pain should not be dismissed as something the patient simply has to tolerate. Some pain improves naturally, but persistent pain can affect mood, sleep, function, and confidence. Patients with pelvic girdle pain or combined pain during pregnancy may recover more slowly postpartum, and those with ongoing pain beyond three months may be at greater risk of prolonged symptoms (Weis et al., 2022).

Feeding Posture, Lifting, and Infant Care Ergonomics

After birth, many parents spend hours feeding, holding, rocking, carrying, and soothing their baby. These tasks are meaningful and necessary, but they can place repetitive stress on the neck, shoulders, upper back, low back, wrists, and hips.

Feeding posture is a common issue. Whether breast/chest feeding or bottle feeding, parents may sit with the head forward, shoulders rounded, upper back flexed, and arms unsupported for long periods. Over time, this can contribute to neck pain, upper back tension, headaches, shoulder discomfort, or wrist strain.

Chiropractors can help patients adjust feeding posture by encouraging better support. This may include bringing the baby toward the parent rather than the parent collapsing toward the baby, using pillows to support the arms, changing sides, keeping the feet supported, and taking brief posture breaks when possible.

Lifting and carrying strategies are also important. Parents may benefit from learning how to hinge at the hips, keep loads close, avoid twisting while lifting, alternate carrying sides, and reduce repetitive strain when lifting from cribs, car seats, or strollers.

Small changes can make a meaningful difference when repeated dozens of times per day.

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A Practical Example: Why Individualized Care Matters

Consider two pregnant patients with low back and pelvic discomfort.

The first patient is 24 weeks pregnant and has mild low back stiffness after sitting at work. Her pain improves with walking and gentle movement. She has no red flags and her pregnancy is uncomplicated. Her care plan may focus on education, workstation modifications, gentle mobility, walking breaks, low-force manual therapy if appropriate, and home exercises for hip and trunk support.

The second patient is 32 weeks pregnant and has sharp pelvic pain with rolling in bed, stairs, and standing on one leg. She feels unstable and avoids walking because of pain. Her assessment may suggest pelvic girdle pain rather than simple low back pain. Her plan may involve activity modification, pelvic support strategies, careful exercise selection, avoiding aggravating positions, manual therapy adapted to comfort, and possible co-management with pelvic floor physiotherapy or her prenatal provider if needed.

Both patients are pregnant. Both have back or pelvic pain. But their care plans should not be identical.

That is the value of assessment.

The Bottom Line

Pregnancy and postpartum recovery place new demands on the spine, pelvis, muscles, joints, abdominal wall, pelvic floor, and nervous system. Low back pain, pelvic girdle pain, and combined pain are common, but they should not be dismissed as something patients simply have to endure.

Chiropractic care during pregnancy and postpartum may help by providing education, assessment, manual therapy when appropriate, exercise guidance, ergonomic strategies, support devices when appropriate, and support for daily function. Best-practice recommendations emphasize informed consent, red flag screening, individualized care, modified treatment techniques, interprofessional collaboration, and active rehabilitation (Weis et al., 2022).

Physical activity is also a key part of pregnancy health. The 2019 Canadian Guideline for Physical Activity Throughout Pregnancy recommends at least 150 minutes of moderate-intensity physical activity per week for pregnant individuals without contraindications, accumulated over at least three days per week, with a combination of aerobic and resistance training encouraged (Mottola et al., 2018).

The goal is not only pain relief. The goal is to help patients move with more confidence, stay active safely, manage physical demands, and transition into postpartum recovery with support.

At The Muscle and Joint Clinic, we provide pregnancy and postpartum care that is individualized to the patient’s symptoms, stage of pregnancy or recovery, health history, comfort level, and goals. Whether someone is dealing with low back pain, pelvic girdle pain, hip discomfort, posture changes, feeding-related neck pain, or return-to-exercise questions, an appropriate assessment can help determine the safest and most effective plan.

Pregnancy changes the body. Care should change with it.

Disclaimer

This article is for general educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Chiropractic care and exercise during pregnancy and postpartum should be individualized based on health history, pregnancy stage, symptoms, risk factors, contraindications, and guidance from prenatal or postpartum healthcare providers. If you have vaginal bleeding, severe abdominal or pelvic pain, signs of preeclampsia, chest pain, shortness of breath, dizziness, trauma, high blood pressure, loss of fluid, painful contractions, or any pregnancy-related complication, seek medical care immediately. Always speak with a qualified healthcare provider before starting or changing an exercise or treatment plan during pregnancy or postpartum.

References

Canadian Chiropractic Association. (2026, April 29). Five reasons to see a chiropractor during pregnancy. Canadian Chiropractic Association.

George, J. W., Skaggs, C. D., Thompson, P. A., Nelson, D. M., Gavard, J. A., & Gross, G. A. (2013). A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy. American Journal of Obstetrics and Gynecology, 208(4), 295.e1–295.e7.

Mottola, M. F., Davenport, M. H., Ruchat, S.-M., Davies, G. A., Poitras, V. J., Gray, C. E., Jaramillo Garcia, A., Barrowman, N., Adamo, K. B., Duggan, M., Barakat, R., Chilibeck, P., Fleming, K., Forte, M., Korolnek, J., Nagpal, T., Slater, L. G., Stirling, D., & Zehr, L. (2018). 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine, 52(21), 1339–1346. https://doi.org/10.1136/bjsports-2018-100056

Vleeming, A., Albert, H. B., Ostgaard, H. C., Sturesson, B., & Stuge, B. (2008). European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal, 17(6), 794–819.

Weis, C. A., Pohlman, K. A., Barrett, J., Clinton, S., da Silva-Oolup, S., Draper, C., Lee, J., Kumar, R., O’Beirne, M., Stuber, K., & Hawk, C. (2022). Best-practice recommendations for chiropractic care for pregnant and postpartum patients: Results of a consensus process. Journal of Manipulative and Physiological Therapeutics, 45(7), 469–489. https://doi.org/10.1016/j.jmpt.2021.03.002

Weis, C. A., Pohlman, K. A., Draper, C., da Silva-Oolup, S., Stuber, K., & Hawk, C. (2020). Chiropractic care for adults with pregnancy-related low back, pelvic girdle pain, or combination pain: A systematic review. Journal of Manipulative and Physiological Therapeutics, 43(7), 714–731. https://doi.org/10.1016/j.jmpt.2020.05.005

Most people think about exercise in terms of what they should do. Should they walk, run, cycle, lift weights, stretch, or do rehabilitation exercises? Others focus on how much they should do. Should they aim for 20 minutes a day, 150 minutes per week, 10,000 steps, or three gym sessions?

These are important questions. The type, intensity, frequency, and consistency of exercise all matter. But research is increasingly asking another question that may be just as important: does the timing of exercise matter?

For many years, the simplest answer has been that the best time to exercise is the time you can actually do consistently. That remains true. A realistic routine that happens regularly is better than a perfect plan that never gets done. However, newer research suggests that the body may respond differently to exercise depending on the time of day, a person’s natural body clock, and their health goals.

This does not mean there is one perfect time for everyone to exercise. It does not mean morning workouts are automatically better. It also does not mean evening exercise is harmful. Instead, the research points toward a more personalized approach. Morning exercise may have certain benefits for sleep timing, fat metabolism, cholesterol, and triglycerides. Evening exercise may have certain benefits for vascular function and blood pressure. Chronotype, which refers to whether someone is naturally more of a morning person or evening person, may also influence how the body responds to exercise.

For patients, this is important because exercise is not just about discipline. It is about matching the right activity, intensity, timing, and recovery strategy to the person in front of us.

The Body Has a Clock

The human body follows internal 24-hour rhythms known as circadian rhythms. These rhythms help regulate sleep and wakefulness, alertness, body temperature, hormone release, digestion, blood sugar regulation, blood pressure, heart rate, and many other physiological functions.

This means the body is not exactly the same at every hour of the day. The way we move, digest food, regulate blood pressure, use energy, and prepare for sleep can vary depending on timing. Melatonin, for example, usually rises in the evening as the body prepares for sleep. Blood pressure and cardiovascular function also follow daily patterns, with certain cardiovascular events being more common at particular times of day (Shen et al., 2025).

Exercise is also a signal to the body clock. Light is the strongest signal for circadian rhythm, but physical activity, meal timing, sleep timing, and daily routines can also influence the body’s rhythm. This is why regular movement at a consistent time may help shape sleep-wake patterns and other health-related rhythms.

In real life, patients often notice this without using scientific language. Some people feel stiff and slow in the morning but much better after moving around for a few hours. Others feel energized early in the day and lose motivation by evening. Some sleep better when they exercise earlier. Others use evening exercise to unwind after work. These differences matter when designing an exercise plan.

What Is Chronotype?

Chronotype refers to a person’s natural tendency to feel more alert and active earlier or later in the day. Morning types often wake up earlier, feel more alert in the first half of the day, and prefer doing demanding tasks in the morning. Evening types often feel more alert later in the day and may find early mornings more difficult. Many people fall somewhere in the middle.

Chronotype is not simply a preference or a personality trait. It reflects how a person’s internal clock aligns with their daily schedule. Two people may complete the same workout at the same intensity, but their bodies may experience that workout differently depending on their chronotype.

This matters because many people are told that the “best” or most disciplined time to exercise is early in the morning. For some people, that works very well. They feel focused, energetic, and more consistent when they exercise before the day becomes busy. For others, early morning exercise feels unusually difficult. Their body feels stiff, their energy is low, their heart rate may climb faster, and they may struggle to stay consistent.

That does not mean they are lazy. It may mean that their exercise timing does not match their biology, their sleep schedule, or their recovery needs.

Study One: Exercise Timing, Chronotype, and Fuel Use

A 2025 study by Kang and colleagues examined how exercise timing and chronotype influence cardiorespiratory and metabolic responses during aerobic exercise. The study included 30 healthy young adults, including 15 men and 15 women. Participants were categorized as morning types, neither types, or evening types using the Morningness-Eveningness Questionnaire (Kang et al., 2025).

Each participant completed two treadmill exercise sessions. One session was performed in the morning before 9:00 AM, and the other was performed in the afternoon after 3:00 PM. Both sessions involved 30 minutes of aerobic exercise at approximately 75% of VO₂max. The researchers measured oxygen uptake, heart rate, respiratory exchange ratio, carbohydrate oxidation, and fat oxidation (Kang et al., 2025).

In simpler terms, the researchers wanted to know whether the body uses energy differently during morning versus afternoon exercise and whether a person’s chronotype changes the body’s response.

The study found no major difference in oxygen uptake or heart rate between morning and afternoon exercise overall. This suggests that, at least for submaximal aerobic exercise in healthy young adults, the basic cardiorespiratory demand of the workout may not change dramatically based on whether it is done in the morning or afternoon.

However, the study did find differences in fuel use. Morning exercise was associated with a lower respiratory exchange ratio and lower carbohydrate oxidation compared with afternoon exercise. Fat oxidation was also higher in the morning, although this was described as a trend rather than a statistically significant finding (Kang et al., 2025).

This suggests that morning aerobic exercise may encourage the body to rely slightly more on fat as a fuel source during the workout. This does not mean that morning exercise automatically causes fat loss. Fat loss is influenced by total weekly activity, diet, sleep, stress, muscle mass, hormones, and overall energy balance. Still, the finding is useful because it suggests that the body’s metabolism may respond differently depending on exercise timing.

Chronotype May Affect Heart Rate During Exercise

One of the most interesting findings from Kang et al. was that heart rate during exercise differed across chronotypes. Evening types had the highest exercising heart rates, neither types were in the middle, and morning types had the lowest heart rates. This occurred even though the groups were similar in aerobic fitness and other baseline characteristics (Kang et al., 2025).

This is clinically important because heart rate is one way the body shows how hard it is working. If an evening-type person has a higher heart rate response during exercise, especially when exercising at a time that does not match their natural rhythm, the same workout may feel more demanding.

This does not mean evening types should avoid morning exercise. It means exercise prescription should be individualized. If someone feels unusually strained during early morning exercise, it may be helpful to adjust the warm-up, lower the intensity, monitor heart rate, or consider a later exercise window.

This is especially relevant for patients recovering from pain or injury. A person with low back pain, knee arthritis, shoulder pain, tendon irritation, or general morning stiffness may not tolerate a demanding early morning workout. The exercise itself may be appropriate, but the timing and intensity may need to be adjusted.

Study Two: Morning Versus Evening Exercise Over 12 Weeks

A second important study was published in Scientific Reports by Shen and colleagues in 2025. This randomized controlled trial compared the effects of 12 weeks of morning versus evening aerobic exercise on sleep, lipid profiles, body composition, and vascular function (Shen et al., 2025).

The study included 58 sedentary young adult males between the ages of 18 and 28. Participants were divided into three groups: a morning exercise group that trained between 6:00 and 8:00 AM, an evening exercise group that trained between 6:00 and 8:00 PM, and a control group that did not exercise (Shen et al., 2025).

The exercise program lasted 12 weeks. Participants completed at least three sessions per week and accumulated at least 150 minutes of moderate-intensity aerobic exercise weekly. Activities included running, jumping rope, elliptical training, and cycling. Exercise intensity was monitored using heart rate, with a target intensity of 60% to 70% of heart rate reserve (Shen et al., 2025).

This study is helpful because it did not only look at one workout. It examined what happened after a structured training program. It also measured several outcomes that matter to patients, including sleep timing, melatonin rhythm, body fat, cholesterol, triglycerides, resting heart rate, blood pressure, and carotid artery blood flow.

Morning Exercise and Sleep Timing

Sleep was one of the major outcomes in the Shen et al. study. The researchers used the Munich ChronoType Questionnaire to assess sleep patterns and also measured dim light melatonin onset, known as DLMO. DLMO is a common biological marker used to estimate circadian timing because it reflects when melatonin begins to rise under dim light conditions (Shen et al., 2025).

After 12 weeks, both the morning and evening exercise groups showed reduced sleep latency. Sleep latency refers to how long it takes to fall asleep after going to bed. In other words, regular aerobic exercise helped participants fall asleep faster, regardless of whether they exercised in the morning or evening (Shen et al., 2025).

However, morning exercise had a more specific effect on sleep timing. The morning exercise group showed an advance in sleep onset, mid-sleep time, sleep end time, and DLMO. This means their sleep-wake rhythm shifted earlier. Their biological night appeared to begin earlier, and their sleep schedule moved earlier as well (Shen et al., 2025).

This may be relevant for people who struggle with late bedtimes, delayed sleep schedules, or difficulty waking in the morning. Morning exercise, especially when combined with morning light exposure, may help reinforce an earlier sleep-wake rhythm. It should not be viewed as a cure for insomnia or sleep disorders, but it may be a useful lifestyle strategy for certain patients.

This is also relevant in musculoskeletal care. Poor sleep can increase pain sensitivity, reduce recovery, affect mood, and make exercise harder to maintain. When patients are dealing with low back pain, neck pain, headaches, tendon pain, or arthritis, sleep quality often plays an important role in how well they recover.

Morning Exercise and Metabolic Health

The Shen et al. study also found that both morning and evening exercise reduced body fat after 12 weeks. However, the morning exercise group showed significant reductions earlier, with measurable changes as early as week four. Morning exercise was also associated with reductions in total cholesterol and triglycerides. The evening exercise group did not show the same lipid changes in this study (Shen et al., 2025).

This fits with the Kang et al. study, which found that morning aerobic exercise may shift fuel use toward greater fat oxidation during the exercise session (Kang et al., 2025). Taken together, these studies suggest that morning exercise may have particular benefits for fat metabolism and lipid regulation in some populations.

However, this should be interpreted carefully. Shen et al. studied young sedentary males with normal body mass index and without major cardiovascular or metabolic disease. The results may not apply the same way to older adults, women, people with diabetes, people with obesity, people with shift-work schedules, or people with cardiovascular disease.

The better takeaway is not that morning exercise is always superior for metabolism. The better takeaway is that exercise timing may influence metabolic outcomes, and the best timing may depend on the individual’s health status, sleep rhythm, goals, and ability to stay consistent.

Study Three: UK Biobank, Peak Activity Timing, and Cardiovascular Mortality

The third study adds a longer-term population-level perspective. Ma and colleagues examined the association between the time of day of peak physical activity and cardiovascular mortality using data from the UK Biobank (Ma et al., 2023).

This was not a short exercise trial. It was a large observational cohort study involving 94,489 adults with objectively measured physical activity. Participants wore accelerometers, which allowed researchers to examine when during the day their physical activity tended to peak. The researchers categorized peak physical activity timing into early morning, late morning, midday, and night. The midday group was used as the reference group (Ma et al., 2023).

During a median follow-up of 6.9 years, the researchers identified 629 cardiovascular deaths. Compared with the midday peak activity group, the early morning peak activity group had a higher hazard of cardiovascular mortality, and the night peak activity group also had a higher hazard. The late morning group did not show the same statistically significant increase compared with midday (Ma et al., 2023).

At first glance, this may sound surprising. Many people assume early morning activity is always healthier. However, the study is not saying that a morning walk is dangerous or that people should avoid moving early in the day. It is saying that, in this large population, having peak physical activity in the early morning or at night was associated with higher cardiovascular mortality compared with having peak activity around midday.

This is an association, not proof of cause and effect. Observational studies can show patterns, but they cannot prove that the timing itself caused the increased risk. People who are most active very early or late may differ in other ways. They may have different work schedules, sleep patterns, health conditions, stress levels, medication use, shift-work exposure, or lifestyle factors. Even with statistical adjustments, some residual confounding is always possible.

Still, the study is important because it supports the broader idea that timing may matter. The cardiovascular system follows circadian patterns, and physical activity performed at different times of day may interact with those patterns.

Chronotype Changed the Pattern in the UK Biobank Study

One of the most interesting parts of the Ma et al. study was the chronotype-stratified analysis. The researchers found that the increased cardiovascular mortality seen in the early morning peak activity group was mainly observed in evening-type participants. In contrast, the increased cardiovascular mortality seen in the night peak activity group was mainly observed in morning-type participants (Ma et al., 2023).

This suggests that mismatch may matter. An evening-type person whose peak activity occurs very early in the morning may be exercising at a time that is misaligned with their natural rhythm. Similarly, a morning-type person whose peak activity occurs at night may be active at a time that is misaligned with their body clock.

This does not prove that chronotype mismatch causes cardiovascular mortality. But it fits with the broader theme seen in other studies: the timing of exercise may not have the same effect for everyone.

For patients, this is a helpful concept. The goal is not to force everyone into the same exercise schedule. The goal is to find a routine that supports the person’s health, recovery, sleep, and consistency.

How Should We Interpret These Studies Together?

When we look at Kang et al., Shen et al., and Ma et al. together, a more complete picture begins to emerge.

Kang et al. showed that morning aerobic exercise may influence fuel use during a workout, with lower carbohydrate oxidation and a trend toward higher fat oxidation. The study also suggested that chronotype may influence heart rate responses during exercise (Kang et al., 2025).

Shen et al. showed that 12 weeks of aerobic exercise improved health in both morning and evening exercise groups. Morning exercise appeared more effective for advancing sleep timing, improving sleep rhythm, reducing body fat earlier, and lowering total cholesterol and triglycerides. Evening exercise appeared more effective for improving certain vascular function measures and systolic blood pressure (Shen et al., 2025).

Ma et al. showed that, in a large UK Biobank cohort, peak activity timing was associated with cardiovascular mortality, and that the relationship differed by chronotype. Early morning peak activity appeared more concerning in evening types, while night peak activity appeared more concerning in morning types (Ma et al., 2023).

Together, these studies do not give us one universal answer. Instead, they suggest that exercise timing may be outcome-specific and person-specific.

If the goal is sleep timing, morning exercise may be useful. If the goal is lipid regulation or body fat reduction, morning exercise may have advantages in some populations. If the goal is vascular function or blood pressure regulation, evening exercise may have advantages in some populations. If the person is clearly a morning type or evening type, matching exercise timing to chronotype may improve tolerance and possibly health response.

What This Means for the Average Patient

For most people, the first priority is simply to move more. Exercise has well-established benefits for cardiovascular health, metabolic health, mental health, musculoskeletal health, pain management, strength, mobility, and quality of life. A person who walks consistently in the evening is likely doing far more for their health than someone who plans to exercise every morning but rarely follows through.

However, once a person is ready to build a routine, timing can be used strategically.

Morning exercise may be helpful for people who want to create a consistent routine before the day gets busy. It may also be helpful for people who want to shift their sleep schedule earlier or improve morning alertness. Based on the research above, morning aerobic exercise may also be useful for people focused on body composition or certain lipid markers, although this should not be overstated.

Evening exercise may be helpful for people who feel stronger, looser, and more coordinated later in the day. It may be a better fit for those who feel too stiff in the morning or who struggle to exercise before work or school. Evening exercise may also have benefits for vascular function and systolic blood pressure, based on the Shen et al. findings.

Midday or late morning exercise may be a useful option for many people as well. The Ma et al. UK Biobank study used midday as the reference group and found that early morning and night peak activity were associated with higher cardiovascular mortality compared with midday (Ma et al., 2023). This does not mean midday is automatically the safest or best time for everyone, but it does suggest that moderate timing may be worth considering, especially for people who feel poorly exercising at the extremes of the day.

What About People With Pain or Stiffness?

Exercise timing is especially important for people with musculoskeletal pain. Many painful conditions fluctuate throughout the day. A person with osteoarthritis may feel stiff in the morning and better after gentle movement. A person with low back pain may feel worse after prolonged sitting and better after walking. A person with tendon pain may tolerate loading exercises better at certain times of day. A person with neck pain or headaches may notice symptoms change depending on sleep, posture, stress, and work schedule.

This is why rehabilitation should be individualized. The same exercise can feel very different depending on when it is performed. A strengthening exercise that feels too difficult at 6:30 AM may feel much more manageable at 4:00 PM. A mobility routine may be useful in the morning, while more demanding strengthening may be better later in the day.

At The Muscle and Joint Clinic, we often encourage patients to think of exercise timing as part of the prescription. The exercise itself matters, but so does the dosage, intensity, warm-up, recovery period, and time of day.

For a patient with morning low back stiffness, it may be better to start with gentle walking, breathing, and mobility in the morning, then complete strengthening exercises later in the day. For a patient with knee arthritis, a morning mobility routine may help reduce stiffness, while strength work may be better tolerated once the body has warmed up. For a patient with tendon pain, loading exercises may need to be scheduled when symptoms are calm and recovery time is available afterward.

The goal is not just to exercise. The goal is to exercise in a way the body can adapt to.

The Problem With “One-Size-Fits-All” Exercise Advice

The biggest mistake in exercise advice is assuming that everyone should follow the same routine. Some people do very well with early morning exercise. Others do not. Some people sleep perfectly after evening exercise. Others feel wired and have trouble falling asleep. Some people feel strongest later in the day. Others lose motivation if they wait too long.

Research on exercise timing supports what clinicians often see in practice: the best plan is the one that matches the person.

This matters because guilt and shame are common barriers to exercise. People may think they are failing because they cannot wake up at 5:00 AM to train. But if they are naturally an evening type, sleep poorly, feel stiff in the morning, or have pain that improves later in the day, an early morning workout may not be the best starting point.

A better approach is to ask: When does your body feel most ready to move? When are you most consistent? When does exercise improve your energy instead of draining it? When does it support your sleep instead of disrupting it? When do your symptoms tolerate it best?

Those answers are often more useful than generic advice.

Practical Guidance: How to Choose Your Exercise Time

If your goal is consistency, choose the time you are most likely to follow through. For many people, this is the most important factor. Consistency drives long-term benefits.

If your goal is improving sleep timing, morning exercise may be helpful, especially when combined with morning light exposure and a regular wake time. This may be particularly useful for people who tend to fall asleep too late or struggle to shift their sleep schedule earlier.

If your goal is body composition or lipid health, morning aerobic exercise may have advantages in some people, based on the findings from Kang et al. and Shen et al. However, nutrition, total weekly exercise volume, resistance training, sleep, and stress management remain essential.

If your goal is blood pressure or vascular function, evening aerobic exercise may have potential advantages, based on the Shen et al. study. This should be individualized, especially for people with cardiovascular conditions or those taking blood pressure medication.

If you are a morning type, you may tolerate earlier activity better. If you are an evening type, you may tolerate later activity better. If your schedule forces you to exercise at a time that does not match your chronotype, adjust the intensity and warm-up accordingly.

If you have pain or stiffness, do not judge your body based only on the first few minutes of movement. Many people need a gradual warm-up. Start gently, increase slowly, and pay attention to whether symptoms improve, stay stable, or worsen.

What These Studies Do Not Prove

It is important to be balanced. Kang et al. studied only 30 healthy young adults, and the morning-type and evening-type groups were small. Shen et al. studied 58 sedentary young adult males and did not include women, older adults, shift workers, or people with major cardiovascular or metabolic disease. Ma et al. was a large observational study, but observational research cannot prove cause and effect.

This means we should not overstate the findings. The evidence does not prove that one exercise time is best for everyone. It does not prove that morning exercise is always better for metabolism or that evening exercise is always better for blood pressure. It also does not prove that early morning or night exercise directly causes cardiovascular mortality.

What the evidence does suggest is that timing may matter, chronotype may matter, and personalization may improve exercise tolerance and health outcomes.

The Bottom Line

The best time to exercise is still the time you can do consistently, safely, and sustainably.

But timing may matter more than we used to think.

Morning exercise may help shift the sleep-wake cycle earlier, improve sleep timing, support fat metabolism, and improve certain lipid markers in some people. Evening exercise may improve vascular function and systolic blood pressure in some people. Large observational data suggest that peak activity timing may be associated with cardiovascular mortality, and that mismatch between activity timing and chronotype may be important.

The key message is not that everyone should exercise at the same time. The key message is that exercise should be personalized.

If morning exercise helps you stay consistent and feel better, it may be a great choice. If evening exercise helps you move better, train harder, and stick with the routine, that may be the better option. If you are recovering from pain or injury, the right time may be the time your body tolerates movement best. If you have cardiovascular risk factors, the plan should be gradual, appropriate, and discussed with a healthcare professional when needed.

At The Muscle and Joint Clinic, we help patients build exercise and rehabilitation plans that fit their body, their schedule, their goals, and their recovery. Whether the goal is to reduce pain, improve mobility, build strength, return to sport, or improve overall health, the right plan should work with your body, not against it.

Disclaimer: This article is for general educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. The research discussed in this article should be interpreted in context, as exercise timing may affect individuals differently depending on age, health history, fitness level, sleep schedule, chronotype, medications, symptoms, and personal goals. If you have chest pain, dizziness, unexplained shortness of breath, high blood pressure, diabetes, cardiovascular disease, or any other medical condition, please speak with a qualified healthcare provider before starting or changing an exercise program. If you are recovering from an injury or experiencing pain with exercise, an individualized assessment can help determine what type, intensity, and timing of exercise is most appropriate for you.

References

Kang, J., Ratamess, N. A., Faigenbaum, A. D., Bush, J. A., Fardman, B., Vargas, A., Andriopoulos, T., Melao, J., O’Connell, E., Duff, A., Cmielewski, A., DeSalvo, J., Johnson, A., & Watts, M. (2025). Unlocking the body’s clock: The role of exercise timing and chronotype in cardiometabolic responses. Journal of Strength and Conditioning Research, 39(6), 634–641.

Ma, T., Jennings, L., Sirard, J. R., Xie, Y. J., & Lee, C. D. (2023). Association of the time of day of peak physical activity with cardiovascular mortality: Findings from the UK Biobank study. Chronobiology International, 40(3), 324–334. doi:10.1080/07420528.2023.2170240

Shen, B., Zheng, H., Liu, H., Chen, L., & Yang, G. (2025). Differential benefits of 12-week morning vs. evening aerobic exercise on sleep and cardiometabolic health: A randomized controlled trial. Scientific Reports, 15, 18298. doi:10.1038/s41598-025-02659-8

Vitale, J. A., & Weydahl, A. (2017). Chronotype, physical activity, and sport performance: A systematic review. Sports Medicine, 47, 1859–1868.

World Health Organization. (2020). WHO guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451–1462.

Low back pain is often thought of as a daytime problem. It can make it harder to walk, stand, bend, lift, garden, shop, exercise, or enjoy time with family. But for many adults, especially those over the age of 60, low back pain does not stop when the day ends. It can also affect sleep. A person may have trouble getting comfortable in bed, wake up when turning over, feel stiff in the morning, or notice that poor sleep makes their pain feel worse the next day.

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A recent systematic review published in Chiropractic & Manual Therapies looked specifically at the relationship between low back pain and sleep quality in adults aged 60 years and older. The review, by Rahbar and colleagues, examined whether low back pain is associated with poorer sleep quality in older adults. This is an important topic because both low back pain and sleep difficulties become more common and more impactful with age (Rahbar et al., 2026).

The authors searched several major health databases, including MEDLINE, Embase, CINAHL, and PsycINFO, from their beginning dates through December 2025. They identified 2,394 articles, removed duplicates, screened 2,237 citations, reviewed 191 full-text studies, and ultimately included five low-to-moderate risk of bias studies in their evidence synthesis. These included three cross-sectional studies and two cohort studies. Although the studies used different definitions of low back pain and different ways of measuring sleep quality, the overall finding was consistent: chronic low back pain was positively associated with poorer sleep quality in adults aged 60 and older (Rahbar et al., 2026).

This does not mean that low back pain always causes poor sleep. It also does not mean that poor sleep always causes low back pain. The relationship is likely more complex than that. Pain can make it difficult to fall asleep, stay asleep, or find a comfortable position. Poor sleep can also make the nervous system more sensitive, reduce recovery, affect mood, lower energy, and make pain feel more intense the next day. Over time, this can create a cycle where pain disrupts sleep, and poor sleep makes pain harder to manage.

For older adults, this cycle can be especially frustrating. A poor night of sleep can make the back feel stiffer in the morning. Morning stiffness may make it harder to start moving. Less movement during the day can lead to more stiffness, reduced strength, reduced balance, and less confidence with activity. This can gradually affect walking, exercise, household tasks, hobbies, travel, and independence.

The review by Rahbar and colleagues is clinically important because it focuses on adults aged 60 and older. This age group is often affected differently by low back pain compared with younger adults. Older adults may be dealing with age-related spinal changes, arthritis, spinal stenosis, disc degeneration, reduced muscle strength, balance changes, medical conditions, medication use, or lower activity levels. Sleep may also change with age. Some changes in sleep duration and sleep maintenance can occur naturally, but significant declines in sleep quality can still affect health, function, and quality of life (Rahbar et al., 2026).

In the studies included in the review, sleep quality was measured in different ways. Some studies used self-reported sleep questions, while others used tools such as the Pittsburgh Sleep Quality Index. Sleep quality can include several different features, including how long it takes to fall asleep, how long someone sleeps, how often they wake during the night, how refreshed they feel in the morning, and how much sleep affects daytime function. This is important because a person may be “in bed” for eight hours but still feel poorly rested if they wake frequently or cannot get comfortable.

One of the interesting findings from the review was that the association between chronic low back pain and poor sleep quality was generally small. This matters. It means low back pain is likely one factor among many that can influence sleep. Sleep can also be affected by stress, anxiety, depression, medications, caffeine, alcohol, sleep apnea, restless legs, urinary frequency, medical conditions, reduced activity, and irregular routines. For that reason, it is important not to oversimplify the issue. Back pain may be part of the sleep problem, but it may not be the only reason a person is sleeping poorly.

At the same time, even a small association can matter in real life. For a person already struggling with mobility, balance, fatigue, or chronic pain, poor sleep can make daily life feel much harder. A patient may say, “My back is not terrible, but I wake up exhausted,” or “I can manage during the day, but I cannot get comfortable at night.” These are important clinical clues. They tell us that the goal of care should not only be reducing pain on a pain scale. The goal should also include improving function, confidence, movement tolerance, and quality of life.

At The Muscle and Joint Clinic, we often see this pattern in patients with low back pain. Some patients feel worse first thing in the morning. Others feel relatively comfortable during the day but struggle when lying down. Some wake when rolling over in bed. Others report that they sleep better after they have been more active, stretched gently, or received treatment. Some patients with spinal stenosis feel better sleeping slightly flexed or on their side, while others with disc-related pain may prefer different positions. There is no single sleeping position that works for everyone, which is why assessment matters.

A proper assessment of low back pain should include more than simply asking where the pain is. It should include questions about sleep, morning stiffness, walking tolerance, sitting tolerance, standing tolerance, leg symptoms, numbness or tingling, balance, strength, activity level, and medical history. It is also important to ask whether symptoms are changing, whether pain wakes the person at night, whether there has been unexplained weight loss, fever, trauma, cancer history, bowel or bladder changes, or progressive neurological symptoms. These details help determine whether conservative care is appropriate or whether medical referral is needed.

When conservative care is appropriate, chiropractic and manual therapy care may help by addressing some of the physical factors that contribute to discomfort. This may include improving spinal and hip mobility, reducing muscle tension, addressing joint stiffness, improving movement patterns, and helping patients gradually return to activity. Treatment may include gentle spinal mobilization or manipulation when appropriate, soft tissue therapy, assisted stretching, exercise therapy, education, posture advice, and strategies to reduce flare-ups. For older adults, the plan should be individualized and adapted to the person’s comfort, health status, goals, and tolerance.

Exercise is also an important part of managing persistent low back pain. For many older adults, the goal is not aggressive exercise. The goal is safe, consistent movement that improves confidence and function. This may include walking, gentle mobility exercises, hip strengthening, core endurance work, balance training, and gradual conditioning. When people move better during the day, they may also feel less stiff at night and in the morning. However, exercise needs to be prescribed carefully. Too much too soon can flare symptoms, while too little movement can lead to deconditioning.

Sleep positioning can also be worth discussing. Some patients feel more comfortable lying on their side with a pillow between the knees. Others prefer lying on their back with a pillow under the knees. Some patients benefit from adjusting pillow height, mattress support, or how they get in and out of bed. These changes do not “cure” low back pain, but they can reduce strain and help the body settle more comfortably at night.

It is also important to recognize when sleep concerns need medical attention. If a patient has loud snoring, pauses in breathing, morning headaches, severe daytime sleepiness, restless legs, significant insomnia, medication concerns, mood changes, or ongoing sleep disruption that does not improve, they should speak with their family doctor or appropriate healthcare provider. Low back pain may be part of the sleep problem, but sleep disorders and medical conditions should not be missed.

The study by Rahbar and colleagues also reminds clinicians to be humble about the evidence. The authors noted that more high-quality studies are needed. Many existing studies use different definitions of low back pain and different measures of sleep quality. Most rely heavily on self-reported sleep measures. Cross-sectional studies can show an association, but they cannot prove cause and effect. Even the better-quality studies suggest that the relationship between low back pain and sleep quality is real, but generally small and influenced by many other factors (Rahbar et al., 2026).

For patients, the practical message is simple: if you are over 60 and struggling with low back pain, your sleep matters. If your sleep is poor, your back pain may feel harder to manage. If your back pain is persistent, it may be one of the reasons you are not sleeping well. Either way, it is worth discussing both issues during your assessment.

Low back pain care should not only focus on the spine as a structure. It should focus on the person. That means understanding how pain affects walking, sleep, mood, confidence, independence, and daily life. For some patients, the first goal may be sleeping more comfortably. For others, it may be walking farther, standing longer, returning to exercise, or feeling less stiff in the morning. These goals are connected.

At The Muscle and Joint Clinic, our approach is to assess the full picture. We look at spinal movement, hip mobility, muscle function, posture, walking tolerance, strength, flexibility, and symptom patterns. We also ask how pain is affecting sleep and daily function. From there, we create a treatment plan that may include hands-on care, exercise, education, and practical strategies to help patients move with more confidence.

Chronic low back pain and poor sleep often travel together in older adults. The relationship may not be simple, and it may not be the same for every person, but it is important. Better care starts by asking better questions. If back pain is affecting your sleep, or poor sleep is making your pain harder to manage, it may be time to have a proper assessment.

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References

Rahbar, P., Wong, J. J., DeSouza, A., Papaconstantinou, E., Wang, D., Hogg-Johnson, S., & Côté, P. (2026). The association between low back pain and sleep quality in adults 60 years and older: A systematic review. Chiropractic & Manual Therapies. Advance online publication. https://doi.org/10.1186/s12998-026-00656-w

Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R. J., Underwood, M., & Lancet Low Back Pain Series Working Group. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356–2367.

Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O’Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., Ware, J. C., & Adams Hillard, P. J. (2015). National Sleep Foundation’s sleep time duration recommendations: Methodology and results summary. Sleep Health, 1(1), 40–43.

Morelhão, P. K., Gobbi, C., Christofaro, D. G. D., Damato, T. M., Grande, G. D., Frange, C., Andersen, M. L., Tufik, S., & others. (2021). Bidirectional association between sleep quality and low back pain in older adults: A longitudinal observational study. Archives of Physical Medicine and Rehabilitation.

Rahbar, P., Wong, J. J., Wang, D., Papaconstantinou, E., Hogg-Johnson, S., & Côté, P. (2025). The association between chronic back problems and poor sleep quality among Ontarian adults aged 60 years and older: A cross-sectional study analyzing the Canadian Community Health Survey 2015–2016. Canadian Journal of Public Health.

Van Looveren, E., Bilterys, T., Munneke, W., Cagnie, B., Ickmans, K., Mairesse, O., & others. (2021). The association between sleep and chronic spinal pain: A systematic review from the last decade. Journal of Clinical Medicine.