Thyroid Strong

Hashimoto’s and back pain

by | Oct 12, 2022 | Symptoms

Many Hashimoto patients struggle with joint pain and back pain. The pain makes it difficult to think clearly, sleep well, and enjoy their lives to the fullest, which in turn makes it harder to manage Hashimoto’s well. Luckily there is a solution.

Once you understand the reasons for back pain in Hashimoto’s, you can eliminate the primary contributors and start living your life more vibrantly.  

Why does Hashimoto’s cause back pain?

Hashimoto’s can cause joint pain. While most people experience back pain at some point in their lives, Hashimoto’s can cause back pain or aggravate it for the following reasons: 

1) Inflammation 

The chronic inflammation present with Hashimoto’s can make your pain neurons more sensitive [1]. This can make you overall more sensitive to pain [2].  

2) Hypermobility

I’ve clinically observed that many women with autoimmunity also experience hypermobility in their joints  [3]. For example, their lower back tends to sway and extend too much (banana back) which can lead to compressed joints and facet pain. 

squat form

3) Movement dysfunctions

Many modern lifestyle habits, such as sitting, wearing tight shoes, and poor posture at a desk for hours every day can contribute a great deal to movement dysfunctions. These movement dysfunctions, combined with inflammation and hypermobility, can lead to chronic back pain and other types of joint pain.

For example, very few of these modern-day lifestyle habits require that you use your core, glutes, and back muscles. These are the muscles that stabilize your hips and back. 

As these muscles become weak, imbalances between different muscle groups cause strain on the muscles and the tendons, where the muscle attaches to bone. Deconditioned muscles can also develop trigger points (aka tight muscles that are stuck in a cycle of spasms) that can be very painful, as well as refer pain down the legs.

At the same time, the counteracting muscles, such as the psoas and other hip flexors, tighten up. Your psoas helps your hip flex, like when you’re sitting down. Since it connects the femur (upper leg) to your lumbar spine, it’s a common cause of low back pain when it’s tight. The psoas muscles can get tight from sitting regularly for extended periods. They then pull on the spine and cause deep aching back pain. The pain from this may be worse if other core muscles are also weak.

What makes Hashimoto’s back pain worse?

Anything that reinforces these patterns can make Hashimoto’s back pain worse, such as:  

  1. Repetitive movement exercises without strengthening the weak muscles. These include running and bicycling. You’ll be inclined to use your quads (the front of your legs) and hip flexors. They get relatively stronger while your glutes and core remain weak. 
  2. Shoes that lift your heels, even a little bit like sneakers, can tilt your pelvis forward.
  3. Crunches, leg raises, or any ab exercises that make you flex at the hip without a foundation of proper core strength. 
  4. A sedentary lifestyle or general lack of movement. 
  5. Poor posture and ergonomic setup

The back pain doesn’t mean you have to give up running, bicycling, and heels forever. You may need to stop these temporarily. Once you correct the dysfunctions that contribute to the back pain, you may be able to bring these back safely and pain-free.

How to fix back pain with Hashimoto’s

First and foremost, address the inflammation and work towards putting the Hashimoto’s into remission. One key piece of the puzzle is to exercise the right way like in Thyroid Strong. By building strength and muscles, you will reduce inflammation, stabilize your joints, and correct the movement dysfunctions that lead to back pain.

1. Work your core with functional movement and resistance training

Women with Hashimoto’s need to build strength, especially around their core. Stronger muscles help your joints to be more stable. A stronger core stabilizes your low back and pelvis. 

The core muscles include:

  • Front and side abdominal muscles (transverse abdominis, obliques, rectus abdominis)
  • Back muscles (erector spinae and multifidus)
  • Diaphragm
  • Pelvic floor muscles

The seven functional movements, including squatting, lunging, hinging, rotation, carrying, pulling, and pushing use these core muscles in one way or the other. 

The key is to do them correctly and avoid overdoing it. That means warming up, breathing, and bracing correctly. Then, don’t overdo it–you want to provide your body enough rest between sets and limit your workouts to 20 – 25 minutes. Lastly, I don’t advise pushing through pain. Instead, start small and gradually progress towards heavier or harder exercises when you feel ready. 

2. Warm up correctly

Before you work out, you want to activate your core and get your body and brain working in sync. The Thyroid Strong warmup mimics how we learned our movement patterns as babies. These include knees at 90 degrees, rolling, hands and knees rocking, tripod, squat and coming up to stand.

I recommend women with Hashimoto’s avoid foam rolling and stretching as these can make joint hypermobility worse. Instead, learn movements like babies to neurologically prime your body to lift. For example, we can improve flexibility with a 6-month supine belly breathing and using a half-kneeling tripod position to stand to open the hips.

Your muscles, tendons, ligaments, and connective tissue keep your spine stable. They also commonly contribute to chronic pain. Tendons and ligaments have a lot of nerve fibers at their attachments to bone. Weak tendons and ligaments allow joints to move more and strain the tissues, causing pain. These are known as tendinopathies and enthesopathies.

Connective tissue, or fascia, is extremely strong and is connected throughout your entire body. Fascial tension can pull on bones, and pinch nerves and blood vessels, which all create pain.

Usually, when one area is tight, it’s compensating for the lack of stability in another area, so building strength helps address the weakness that underlies the same mobility issues. This is another reason I don’t recommend foam rolling on the tight areas.

To learn more about proper warmups, check out this article on how to warm up before your workout with Hashimoto’s.

3. Stack and breathe correctly both during workouts and throughout the day

The wrong breathing can destabilize your spine and contribute to back pain. Regular 360 breathing practice on its own may help back pain by activating your core and supporting healthy posture. You want to breathe down and wide – front, sides, and back of the lower belly. This wakes up the nervous system, diaphragm, and surrounding muscles of the core. 

Also, many women with hypermobility have banana backs–their backs arch too far when they walk or perform functional movements, which can cause back pain. So, in Thyroid Strong, I teach the correct spine stacking. You want to make sure that your ribs are over your pelvic floor. It’s as if when someone looks to the side, your ears should line up over your shoulders and hips. This prevents injury and ensures you strengthen all the right muscles.

For more on the Thyroid Strong breathing method, read this article.

4. Improve your posture and ergonomics

Poor sitting posture is the recipe for back pain, especially if you have hypermobility, inflammation, and a weak core. Also, the longer you sit without moving around, the higher your risk of all-cause mortality is [4].

So, start by evaluating your office ergonomics and set it up so that you have proper ergonomics and posture. If you have a laptop, you may need to raise your screen to your eye level and get a separate keyboard. 

Then, set a timer to get up to move and stretch the tight muscles every hour on the hour.

Refer to my visual article about posture and ergonomics here

5. Check for ankylosing spondylitis and other structural causes of back pain

Having one autoimmune condition makes you susceptible to developing another. Ankylosing spondylitis (AS) is a painful autoimmune condition that leads to the vertebrae in the back fusing together. Hashimoto’s is associated with AS [5].

If your back pain is severe or isn’t improving as expected, see a physician to rule out AS and any other conditions that may be structural causes of your pain, like herniated discs or spondylolisthesis (slipping of vertebrae due to old fractures).


Many Thyroid Strong students had nagging back pain before they started. However, by taking the right actions, they eventually put the back pain behind them and now live pain-free. 

I developed Thyroid Strong precisely to help women with Hashimoto’s exercise the right way and correct movement dysfunctions from poor postures and the wrong ways to exercise. In Thyroid Strong, I provide:

  • A step-by-step guide to exercise how your body needs
  • A guide to correctly warming up and bracing your core correcting
  • A posture guide and checklist
  • Expert interviews to help you address all angles of Hashimoto’s


Know there’s a better way when it comes to back pain with Hashimoto’s.

In Good Health,

Dr Emily Kiberd


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Article References

1 Yi, J., Zheng, J.-Y., Zhang, W., Wang, S., Yang, Z.-F. and Dou, K.-F. (2014) Decreased pain threshold and enhanced synaptic transmission in the anterior cingulate cortex of experimental hypothyroidism mice. Mol. Pain 10, 38.

2 Pinho-Ribeiro, F. A., Verri, W. A., Jr and Chiu, I. M. (2017) Nociceptor Sensory Neuron-Immune Interactions in Pain and Inflammation. Trends Immunol. 38, 5–19.

3 Bilgic, A. O., Rapaport, S. and Lew, L. Q. Association between thyroid autoimmunity and joint hypermobility in children and adolescents.

4 van der Ploeg, H. P., Chey, T., Korda, R. J., Banks, E. and Bauman, A. (2012) Sitting time and all-cause mortality risk in 222 497 Australian adults. Arch. Intern. Med. 172, 494–500.

5 Emmungil, H., Erdogan, M., Kalfa, M., Karabulut, G., Kocanaogulları, H., Inal, V., Aksu, K., Oksel, F., Kabasakal, Y. and Keser, G. (2014) Autoimmune thyroid disease in ankylosing spondylitis. Clin. Rheumatol. 33, 955–961.

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