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Can Smoking Cause Back Pain?

Back pain is a common complaint affecting millions of adults throughout the UK, with 18.3% of the population of Wales reporting that they had suffered back pain at some stage (Prevalence Of Back Pain In The UK By Country). In chronic cases, back pain can significantly impact a sufferer’s quality of life.

While back pain is most often linked to factors such as age, lifestyle, and injury (Symptoms, Causes, Diagnosis, And Treatment), smoking is an unexpected (but significant) risk factor (Association Between Smoking And Back Pain).

In this article, we explore the relationship between smoking and back pain and explain how chiropractic treatment can help alleviate smoking-related back pain.

The Link Between Smoking And Back Pain

Smoking is known to negatively impact the musculoskeletal system in several ways. Most significantly, chemicals in tobacco smoke (including nicotine) restrict blood circulation, altering the body’s ability to absorb essential nutrients.

These smoking-related changes are known to specifically damage healthy spinal tissues. According to one study, the risk of chronic back pain is increased by around 30 percent by smoking (Smoking And Back Pain).

The adult spine is composed of 24 individual backbones (“vertebrae”) connected via ligaments and stabilised by spinal muscles (The Spine).

These vertebrae are separated by 23 intervertebral discs that act as shock absorbers (Spinal Discs). Under healthy conditions, the discs receive a rich supply of blood and nutrients.

By restricting blood circulation, smoking reduces the flow of nutrients to the ligaments, muscles, and discs that stabilise the vertebrae, ultimately damaging these tissues.

In addition to its role in non-specific back pain, smoking also plays a specific role in the development of degenerative disc disease, increases the risk of osteoporosis, and increases the severity of fibromyalgia.

Smoking Alters Blood Flow Causing Back Pain

Smoking impairs blood flow in several ways, and these harmful changes to the vascular system can contribute to back pain.

High Blood Pressure

Smoking is one of the highest risk factors for high blood pressure (“hypertension”), which weakens arteries and compromises normal blood circulation.

In the spinal region, the changes in circulation induced by high blood pressure can starve spinal tissues of the oxygen and nutrients that they need for health and repair. As a consequence, the risk of back pain is increased.

Atherosclerosis, or Narrowing of the Arteries

In patients with elevated cholesterol levels, cholesterol levels can be exacerbated by smoking, causing a build-up of fatty plaques in the arteries. This build-up of plaques is known as atherosclerosis, and the associated narrowing of the arteries restricts blood flow, limiting nutrient supply to tissues.

In the spinal area, restricted blood flow accelerates the degenerative processes that contribute to back pain. In particular, smoking contributes to degenerative disc disease, an important cause of back pain.

Smoking Weakens Spinal Health

In addition to affecting blood flow, smoking impairs the absorption and metabolism of various nutrients essential for spinal health. Moreover, smoking also lowers overall immunity, increases systemic inflammation, and directly damages multiple tissues.

Low Vitamin D

Vitamin D is crucial for calcium absorption, which is essential for bone health. However, smoking interferes with Vitamin D metabolism, lowering its levels in the body. The lower Vitamin D levels lead to lower calcium levels, ultimately weakening bone structure.

In the spinal region, chronic low Vitamin D levels weaken vertebrae and destabilise the spine.


Low calcium levels (often associated with low Vitamin D levels) lead to the development of osteoporosis. It follows that smoking is also a known risk factor for osteoporosis.

Osteoporosis is a bone disease associated with the gradual reduction of bone mineral density and bone mass. These changes cause a reduction in bone strength, which can itself cause chronic back pain. The risk of a bone fracture is also markedly increased in osteoporosis sufferers.

In extreme cases, smokers with osteoporosis may suffer a vertebral compression fracture. This can cause chronic pain, limit mobility, and potentially cause a disability.

Low Vitamin C

Vitamin C is vital for the synthesis of collagen, a primary component of cartilage, tendons, and other connective tissues. However, smoking reduces Vitamin C levels, impairing the body’s ability to repair and maintain healthy tissues.

In the spinal region, chronic low Vitamin C levels can contribute to back pain.

Impaired Immune Function

Smoking also impairs immune function and causes inflammation. An inflammation of the spine is associated with both Inflammatory back pain (IBP) and ankylosing spondylitis (AS).

IBP is a chronic pain condition stemming from a systemic inflammatory response. IBP is usually localised to the lower back and buttocks. This chronic inflammatory condition also causes unbalanced bone remodelling and bone loss.

AS is a chronic autoimmune disease caused by inflammation in the vertebrae, and it is associated with inflammatory spine pain. Smoking increases the risk of ankylosing spondylitis (AS), the risk of a worse disease course with AS, and an increase in associated mobility problems.

Degenerative Disc Disease

In smokers, the supply of blood, nutrients, and minerals to intervertebral discs is reduced, and they eventually become soft and weak. The toxic effects of smoking (especially nicotine) may also cause cell damage within discs.

In degenerative disc disease, the discs become too soft to act as cushions between the vertebrae (Spinal Disc Problems). This can result in improper alignment, pinched nerves, and herniated discs, all major causes of severe back pain.

In addition to damaging healthy discs, smoking is known to speed up the disintegration of already damaged discs.

Chiropractic Care Of Smoking-Related Back Pain

Chiropractic care provides a holistic approach to treating back pain caused by smoking. Chiropractors use multiple techniques to address the underlying structural and functional issues in the spinal region.

Typically, chiropractic care for smoking-related back pain may include:

Spinal Manipulation

Spinal Manipulation involves adjusting the spine to improve alignment and mobility. This technique can help alleviate pain in the spinal region.

Myofascial Release

Myofascial Release helps release tension in the myofascial tissues surrounding the spine. This technique can improve flexibility and reduce discomfort.

Holistic Care

In Chiropractic care, our focus is on holistic recovery. Chiropractors can provide advice on exercises that reduce back pain (Stretches For Lower Back Pain). Lifestyle advice can help you find the best way to quit smoking, and we can help you improve your diet to support spinal health.

Together, these chiropractic treatments reduce pain, enhance spinal function, and encourage the body’s natural healing processes.

While chiropractors cannot treat osteoporosis directly, they can use the above techniques to alleviate pain and discomfort.

Conclusion: Can Smoking Cause Back Pain?

There is plentiful evidence that smoking is a risk factor for developing back pain. Smoking significantly affects spinal health by impairing blood flow, lowering essential nutrient levels, and directly damaging spinal tissues.

If you suffer from back pain and smoke, consider consulting a healthcare provider. Chiropractic care, alongside smoking cessation, can significantly improve your quality of life by addressing both the symptoms and the causes of your back pain.

James Barber

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