Back arthritis is most commonly treated with a combination of exercise, oral or topical pain relievers, and sometimes injections or procedures for persistent pain. The most effective approach depends on which type of arthritis is involved and how much it has progressed, but physical therapy and movement are the foundation for nearly every case.
What’s Happening in Your Spine
The most common form of back arthritis is osteoarthritis, a wear-and-tear condition where the cartilage cushioning the small joints along the back of your spine (called facet joints) gradually breaks down. As that cartilage thins, the bones experience more friction, which triggers inflammation and pain. Over time, the body may respond by growing bone spurs along the edges of these joints, making them larger and stiffer.
Disc degeneration often accelerates the process. As the rubbery discs between your vertebrae lose height, more mechanical load shifts onto the facet joints behind them. That extra pressure speeds up cartilage damage and can turn mild stiffness into chronic pain. The lower back is the most commonly affected area because it bears the most weight and absorbs the most movement.
Osteoarthritis isn’t the only culprit. Ankylosing spondylitis, an inflammatory condition, targets the vertebrae and the sacroiliac joints at the base of the spine. Psoriatic arthritis, rheumatoid arthritis, and arthritis linked to inflammatory bowel disease can also affect the back, though they’re less common. These inflammatory types involve the immune system attacking joint tissue rather than simple mechanical wear, and they often require different treatment strategies.
Exercise and Physical Therapy
Staying active is the single most important thing you can do for spinal arthritis, even when it feels counterintuitive. Movement keeps the muscles around your spine strong, maintains flexibility in stiff joints, and helps control inflammation over time. Inactivity, on the other hand, leads to muscle weakening that puts even more stress on arthritic joints.
Structured physical therapy delivers measurable results. In clinical trials, patients doing conventional physical therapy saw pain drop by roughly 2.6 points on a 10-point scale, while those performing targeted lumbar stabilization exercises (core-focused movements designed to support the lower spine) saw pain decrease by about 2.9 points. That difference matters: stabilization exercises specifically train the deep muscles that hold your vertebrae in alignment, reducing the grinding and shifting that causes flare-ups.
Adding hands-on manual therapy to an exercise program boosts results further. Studies have found that lumbar joint mobilization (a therapist gently moving your spinal joints through their range of motion) significantly reduces pain compared to exercise alone, while thoracic mobilization improves overall function and daily movement ability.
A practical routine for spinal arthritis typically includes three categories of exercise: core stabilization (planks, bird-dogs, pelvic tilts), flexibility work (gentle twisting stretches, cat-cow movements, hamstring stretches), and low-impact aerobic activity like walking, swimming, or cycling. Consistency matters more than intensity. Doing 20 to 30 minutes most days of the week produces better long-term results than occasional intense sessions.
Over-the-Counter Pain Relief
Oral anti-inflammatory medications like ibuprofen and naproxen reduce both pain and the inflammation driving it. They work well for flare-ups and can make it easier to stay active, which is ultimately what protects your spine. Acetaminophen helps with pain but doesn’t address inflammation, so it’s generally a second choice for arthritis specifically.
Topical pain relievers have one important limitation for back arthritis: depth of penetration. The spine sits deep beneath layers of muscle and tissue, making it harder for creams and patches to reach the affected joints compared to, say, a knee or finger. That said, topical options can still help with the muscular pain and tension that often accompanies spinal arthritis. Diclofenac gel or patches deliver anti-inflammatory medication through the skin. Lidocaine patches numb the area and can be worn for up to 12 hours a day. Capsaicin cream, derived from chili peppers, works by gradually desensitizing pain nerve endings with regular use. All of these are generally well tolerated, with skin irritation being the most common side effect.
Joint Injections
When exercise and medications aren’t enough, corticosteroid injections into or near the facet joints can provide targeted relief. A doctor uses imaging guidance to place anti-inflammatory medication directly at the source of pain. The results vary quite a bit from person to person. Studies report that 13 to 74 percent of patients achieve at least 50 percent pain reduction, with average improvement ranging from 23 to 67 percent for pain and 15 to 58 percent for physical function at one month or longer.
That wide range reflects the reality that injections work much better for some people than others. When they do work, the relief typically lasts weeks to a few months, not permanently. Many people use periodic injections alongside physical therapy to manage flare-ups while maintaining their exercise routine. The injections themselves take only a few minutes and most people return to normal activities within a day or two.
Radiofrequency Ablation
For people who respond well to diagnostic nerve blocks but find the relief from injections too short-lived, radiofrequency ablation offers a longer-lasting option. This procedure uses heat to disable the tiny nerves (medial branch nerves) that transmit pain signals from the facet joints to the brain. It doesn’t fix the arthritis itself, but it interrupts the pain pathway.
About half of patients who undergo the procedure experience 50 percent or greater pain relief lasting up to 12 months. Success rates are highest in the 6 to 12 month window after the procedure, dropping somewhat between 12 and 18 months as the nerves gradually regenerate. When pain returns, the procedure can be repeated. The recovery is minimal, with most people experiencing some soreness at the treatment site for a few days before noticing improvement.
Weight Management and Lifestyle Changes
Every extra pound of body weight multiplies the compressive force on your lower spine. Losing even a modest amount of weight, in the range of 10 to 15 pounds for someone who is overweight, can meaningfully reduce the mechanical load on arthritic facet joints and slow the rate of cartilage breakdown. Combined with exercise, weight loss is one of the few interventions that addresses both symptoms and the underlying progression of osteoarthritis.
Sleep position also matters. Sleeping on your side with a pillow between your knees, or on your back with a pillow under your knees, keeps the spine in a more neutral alignment overnight. Prolonged sitting compresses the lower spine, so breaking up long periods of sitting with short walks or standing stretches helps reduce stiffness throughout the day.
When Surgery Becomes an Option
Surgery is reserved for cases where arthritis causes nerve compression (leading to weakness, numbness, or radiating pain down the legs) or makes the spine structurally unstable. These are situations where too much abnormal motion between vertebrae, a consequence of severe joint degeneration, compromises the spine’s ability to support your body.
The two most common surgical approaches are decompression, where bone spurs or thickened tissue pressing on nerves are removed, and spinal fusion, where two or more vertebrae are permanently joined to eliminate painful motion at that segment. Fusion reduces flexibility at the treated level but can provide substantial pain relief when instability is the primary driver. Recovery from spinal fusion typically takes several months, with physical therapy playing a central role in rebuilding strength afterward. Most people with back arthritis never reach this point, but for those with progressive neurological symptoms or spine instability that hasn’t responded to other treatments, surgery can be a meaningful turning point.