For many expats in Spain, the link between stress and back pain is never explained — not by the GP, not by the physio, not by anyone. Yet in a significant number of chronic back pain cases we see at NordicFysio, unmanaged stress is either the primary cause or the main reason treatment isn’t holding.
You have done the physiotherapy. You have changed your mattress. You do your exercises most days. Yet your back pain keeps flaring — often for no obvious physical reason. If this sounds familiar, there is one factor that is almost always overlooked in back pain treatment, and it may be the most powerful of all: chronic stress.
This is not about dismissing your pain as “in your head.” Stress causes real, measurable physical changes in the body — and for people over 60 living with persistent back pain, understanding this connection is often the missing piece in a recovery plan that seems to be going nowhere.
How Stress Drives Back Pain for Expats in Spain
When you are under stress — whether from health worries, financial pressure, family concerns, or the low-grade anxiety that comes with years of chronic pain — your body releases cortisol and adrenaline. These hormones are helpful in a genuine emergency. But when they remain elevated for weeks or months, they cause a chain of physical changes that directly affect your spine:
- Muscle tension: Stress causes the muscles around the spine — particularly in the lower back, hips, and shoulders — to remain in a state of low-level contraction. Over time this creates stiffness, fatigue, and localised pain even without any structural cause.
- Central sensitisation: Prolonged stress sensitises the nervous system, lowering the threshold at which pain signals are triggered. This means that movements or pressures that would normally be painless begin to register as painful — not because the spine has changed, but because the alarm system has become overactive.
- Inflammation: Chronic stress elevates inflammatory markers throughout the body, including around the joints and soft tissues of the spine. For people already dealing with disc degeneration or facet joint problems, this inflammatory backdrop makes everything more painful and slower to heal.
- Poor sleep: Stress disrupts sleep, and poor sleep independently worsens pain perception. The two create a cycle that is very difficult to break without addressing both simultaneously.
What Most People — and Most Treatments — Get Wrong
The traditional approach to back pain is almost entirely physical: treat the disc, stretch the muscle, strengthen the core. And these interventions are important. But when stress is a major driver of the pain, physical treatment alone will only take you so far.
For expats in Spain, the connection between stress and back pain is especially common — relocation, language barriers, healthcare navigation, and chronic isolation all contribute to the kind of sustained low-grade stress that keeps the nervous system activated. Many patients we see at NordicFysio have had extensive physical treatment that produced limited or short-lived results — not because the treatment was wrong, but because the nervous system remained in a state of chronic stress throughout. The body simply could not heal efficiently under those conditions.
Equally, some patients try to manage stress alone — through relaxation, lifestyle changes, or counselling — and find their back pain does not improve as much as expected. This is because the physical components still need to be addressed. The relationship between stress and back pain is bidirectional: pain causes stress, and stress amplifies pain. Breaking the cycle requires working on both sides at once.
If your back pain keeps returning despite physical treatment, our guide on back pain in people over 60 covers the most common structural and lifestyle causes — many of which interact directly with stress.
What Actually Works
An effective approach to stress-related back pain integrates physical and nervous system treatment together. At NordicFysio, this means:
- Accurate diagnosis: Understanding what is structural (disc, joint, muscle) and what is sensitisation-driven — so treatment targets the right things
- Manual therapy and targeted exercise: To address the physical components and reduce the muscular tension that stress creates
- Pacing and load management: Teaching patients how to manage activity levels to avoid the boom-bust cycle that stress and pain together tend to create
- Education about the pain system: Understanding why you hurt — and why the alarm system becomes overactive — is itself one of the most evidence-backed interventions for chronic pain
- Sleep optimisation: Addressing the position, environment, and habits that affect sleep quality — covered in more detail in our post on the best sleeping positions for back pain and sciatica
This is not a quick fix. But for patients who have been stuck in a cycle of pain and partial recovery for months or years, this integrated approach consistently produces better results than treating the spine in isolation.
For reference, the NHS information on stress provides useful information on this condition and when to seek help.
What to Do Next
If you’re an expat in Spain and your back pain and stress levels seem closely linked — or if your pain fluctuates with your emotional state rather than with physical activity — this is exactly the pattern we look for. If your back pain feels disproportionate to what scans or previous diagnoses have found — or if it fluctuates strongly with your stress levels — it is worth speaking to a physiotherapy team who understands both the physical and neurological dimensions of chronic pain.
Our English and Swedish-speaking team at NordicFysio offers a free initial consultation at both clinics on the Costa Blanca:
- Punta Prima — +34 966 941 715
- Ciudad Quesada — +34 623 204 610
Book your free assessment — and let us help you understand what is really driving your pain, and build a plan that addresses all of it.