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Anxiety and Low Back Pain

Anxiety is an emotion that all of us will experience at some point in our lives. The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.”

Anxiety and stress can actually be beneficial emotions as our bodies are designed to respond to stress and anxiety in order to protect us from real and perceived threats in our environment.

For our ancestors, the threats might have included food scarcity, droughts or a bear attack. In 2021 the threats might come in the form of overdue bills, natural disasters, unemployment, or a global pandemic.

Chronic stress and anxiety can lead to negative effects on your body, including exacerbating issues like low back pain.

How Does the Natural Stress Response Work?

So how exactly does the stress response work? Well, when we encounter a stressful and anxiety-provoking event, our hypothalamus (a part of the brain that controls functions like hormone release) triggers an alarm response in the body. One result of this response is the release of the hormones, adrenaline and cortisol, from your adrenal glands.

You might have heard of adrenaline - the fight or flight hormone. Some of the effects that adrenaline can have on your body include such things as causing your blood pressure to rise, increasing your heart rate, and giving your body a boost of energy that you might need if you were running away from a bear. Cortisol, the other main stress hormone, increases glucose (sugars) in your bloodstream and optimizes your brain’s use of it. It helps to increase substances that can repair tissue and it controls inflammation. Cortisol also helps to suppress functions that we don't need in an emergency situation, like the digestive system and the reproductive system - who needs to digest lunch when you’re about to be lunch (using the bear metaphor again)?

LivaFortis looks at how long term activation of the stress response system, and prolonged exposure to stress hormones like cortisol, can have damaging effects on the body.

Chronic Stress

Once the perceived threat has passed, the bear has gone, the bills are paid, or the natural disaster is over, it is time for everything to return to normal in our bodies. Our adrenaline and cortisol levels drop, our heart rate goes back to normal, our digestive system kicks in again and all is well. Except, when it doesn’t.

Yale Medicine defines chronic stress as “A consistent sense of feeling pressured and overwhelmed over a long period of time”. When we experience chronic stress or anxiety, our system stays activated and it doesn’t go back to normal. If the bills keep coming, or the pandemic isn’t over, our adrenaline and cortisol levels stay elevated and our heart rate remains high. We stay in fight or flight mode. The problem is that our bodies are not designed to maintain this state. Long term activation of the stress response system, and prolonged exposure to stress hormones like cortisol, can have damaging effects on the body.

Loss of muscle mass and muscle pain are some of the negative of chronic stress.

Negative Effects Of Chronic Stress

Some of the negative effects of chronic stress and high cortisol levels:

  1. Stress

  2. Anxiety

  3. Depression

  4. Muscle pain (including low back pain)

  5. Heart disease

  6. Sleep issues

  7. Digestive issues

  8. Weight gain

  9. Loss of muscle mass and increase in fat accumulation

  10. Memory and concentration problems

High cortisol levels can lead to persistent involuntary muscle tension - particularly in the neck, shoulders, and back.

So how does all of this affect low back pain?

When our cortisol levels are high for a prolonged period of time, it can lead to persistent involuntary muscle tension - particularly in the neck, shoulders, and back. It can also cause reduced blood flow and a buildup of lactic acid in the muscles. All of this leads to our muscles being less elastic, and more limited in terms of growth and movement, making us more prone to injury or pain.

Cortisol also breaks down molecules and muscle. When proteins are broken down into amino acids and sugar we start using our muscles for energy, and not in a good way. Cortisol can actually start breaking down our muscles. When cortisol starts to eat away at our muscles and joints, such as the sacroiliac joints (where our spine meets our pelvis) it can lead to instability in those joints. Cortisol can also affect our perceptions of pain, leading to increased pain sensations such as low back pain (see our blog ‘Can Stress Cause Pain?’.

Muscle weakness and fatigue are two of the possible symptoms of chronically elevated cortisol levels.

Signs and Symptoms Of High Cortisol

We can all generally tell when we have been stressed, but everyone responds to stress differently. So how can you tell if your stress is affecting your cortisol levels? There are some general signs and symptoms that you can look for. These include:

  • weight gain, mostly around the midsection and upper back

  • weight gain and rounding of the face

  • acne

  • thinning skin

  • easy bruising

  • flushed face

  • slowed healing

  • muscle weakness

  • severe fatigue

  • irritability

  • difficulty concentrating

  • high blood pressure

  • headache

Testing For High Cortisol

If you are experiencing any of the above symptoms and you suspect that you might have high cortisol levels, you should schedule an appointment with your healthcare provider. Your doctor can recommend certain tests to measure the amount of cortisol in your body. These tests include:

Urine and blood tests

These tests can measure the amount of cortisol in your blood or your urine. The blood test involves a sample drawn from your vein. The urine test measures 24 hour urinary free cortisol excretion and uses urine collected over a 24 hour period.

Cortisol Saliva Test

This is one of the most common cortisol tests used. A sample of saliva is collected and the amount of cortisol in the saliva is measured.

LivaFortis shares some healthy coping mechanisms that can help reduce stress and lower cortisol levels.

How To Manage Your Stress In A Healthy Way

Stress is part of our everyday lives. If there is one thing we have learned recently, it is to expect the unexpected. We can’t always change our situation, but we can find ways to cope with anxiety and stress in healthier ways. When we learn to identify the things that trigger our anxiety we can use healthy coping mechanisms to reduce that stress and anxiety. During these stressful periods it is important to take care of ourselves, both physically, and emotionally.

Effective Stress Management Techniques:

Here are some simple and effective stress management techniques:

  1. Yoga

  2. Meditation

  3. Deep breathing

  4. Making sure you get enough sleep (7-9 hours each night)

  5. Exercise (just make sure not to exercise too much as that can increase cortisol)

  6. Eating a healthy diet (some foods have been shown to reduce inflammation and therefore cortisol, while others can increase it).

  7. Biofeedback (Biofeedback gives you information about how your body reacts when you try to relax)

  8. Talk therapy (speaking with a professional counselor can help with feelings of anxiety, CBT therapy can also have significant benefits in managing stress)

  9. Volunteering (helping others can lead to improved feelings of wellbeing)

  10. Connecting with others (having a healthy support system can help with feelings of stress and can help you feel supported)


If you are feeling overwhelmed, or if your anxiety lasts for more than several weeks, it might be time to reach out to your healthcare provider. Your doctor can recommend therapy, medication, or other valuable tools to help you manage your anxiety.

We often look to things like injuries or other underlying health conditions as causes of our low back pain, but keeping cortisol in mind can help you be on the lookout for stressful situations that could contribute to a flare up. Using some of these techniques on a regular basis can help reduce your incidence of low back pain without having to turn to medication. Being proactive about your back pain is also a great idea if you have frequent bouts of pain. It is much easier to prevent low back pain than it is to treat it once it has happened. We hope you found this article helpful. Don’t forget to subscribe to our weekly blog for more updates on managing low back pain!

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