Dr. Stuart Weinstein says it's not uncommon to see a senior citizen in his exam room who has been suffering much too long with severe back pain.

"Sometimes seniors don't want to accept back pain just because they're just getting older," says Weinstein, a clinical professor at the University of Washington's Department of Rehabilitative Medicine.

Weinstein and other doctors, fitness instructors and physical therapists say back pain is not an inevitable symptom of aging. Rather, it's a sign of a physical problem with the back or spine that should be addressed before it worsens into a disability.

That pain can cause seniors to become more sedentary and even fearful of some of their favorite activities, such as golf, or even simply going out to lunch with friends.

"For any health issue, but particularly back problems, it's easy for seniors to fall into the trap of eliminating daily activities, even not leaving their house," Weinstein says.

Problems such as osteoarthritis, spinal stenosis and other degenerative back problems can worsen over time, leading some seniors to believe that as they age they are destined for an aching back.

They may even see it among their friends, since, according to a recent study, as many as 25 percent of people 65 and older complain of back pain. Weinstein believes the percentage of seniors with back problems is likely higher.

Anyone, of any age, should focus on back health to prevent back pain, and should use exercise to ensure they are strong and stable as they grow older, doctors and physical therapists say.

Exercises to improve back strength include movement in water, including walking in water, which gives a slight resistance yet is still low-impact.

Many yoga positions can be beneficial, too, but discuss any back problems with your instructor, because some yoga poses can aggravate the spine.

AILMENTS VARY

Common back problems include:

Osteoarthritis: The breakdown of cartilage between joints allows bones to move against each other. It can happen in many joints of the body, and can cause pain or weakness in the back, usually when a person stands, walks or bends. While osteoarthritis can worsen with age, it's not a disease that every person gets as they grow old.

Osteoporosis: Thinning bones is a serious condition that can cause painful fractures in the spine. Without fractures, osteoporosis is not usually painful, but it can lead to microfractures and a loss of height over time.

Scoliosis: Mostly diagnosed in women, the slight curvature of the spine might not cause problems when a woman is young, but the condition can worsen with age, causing strain on muscles, joints and ligaments in the upper and lower back and possibly lead to neurlogic symptoms.

Spinal stenosis: Spinal stenosis is caused by narrowing in the spinal nerve canal, which compresses nerves. It typically does not result in back pain, but symptoms include weak or painful legs. Stenosis can be helped with anti-inflammatory drugs, physical therapy, spinal injections and, in some cases, surgery.

Weinstein says each of those problems should be treated individually, and there are a variety of treatments, including medication, physical therapy and, sometimes, surgery.

Frequently, Weinstein prescribes a series of exercises to strengthen muscles to prevent problems from reoccurring, or to help loosen joints affected by osteoarthritis. He often encourages water-based exercises because they cause less stress on the spine.

Moderate or severe back pain, or persistent mild pain, should not be ignored or accepted, he says. Persistent back pain that cannot be traced to an injury can indicate other serious health problems, such as bone cancer or an aortic aneurism, particularly in seniors. So it's important to have back pain checked out by a doctor to eliminate such life-threatening issues before pursuing other treatments.

PHYSICAL THERAPY HELPFUL

After proper diagnosis, referral to a physical therapist is often in order, says Sidney Anderson, who specializes in the treatment of elders at her practice, Oasis Physical Therapy and Pilates, in Bellingham.

She says many people don't understand the proper postures, lifting and movement that promote a healthy back. Anderson says tight hip joints and leg muscles are often the cause of back pain because of the complex inner workings of muscles.

"What I see a lot of is people who are not aware of back care principles," she says.

Her work often requires exercise to strengthen weak muscles, so the patient can regain normal movement. Anderson includes the exercise regime Pilates in her practice, which she often integrates into her patients' treatments.

Anderson, who is a certified Pilates instructor, also teaches a class focused on balance at Bellingham Senior Activity Center each Wednesday and Friday.

She says a basis of good spinal health is extension and rotation of the spine, but that's something many people's daily lives no longer include.

"People are spending their days sitting in chairs and everything we do is in front of us," she says. "We do a lot of forward bending, but we don't turn or arch our backs very often."

Mike Locke, director of fitness and sports performance at Bellingham Athletic Club, says that while "core" work is the current buzzword in fitness, some clients mistake it for having six-pack abs. He says core muscles are actually an integrated system that extends from the mid-chest down to the quadriceps in the upper legs. All of the muscles should be fit to protect muscles, ligaments and joints in the back as people do daily tasks, exercise or participate in sports, he says.

Locke refers clients to the club's in-house physical therapist, as well as to Pilates, yoga and tai chi classes to help them strengthen and extend joints that can cause back pain. Locke also recommends myofascial release work, which releases the tissue that surrounds muscles so the muscles can stretch and relax without becoming strained.

Such exercise and treatment is important, no matter a person's age, Locke says. He's heard from people who stop to pick their keys off the floor and wind up frozen in agony.

That's not a normal part of getting older, he says, but is a normal part of not keeping fit.

"We don't wear out," Locke says, "we rust out."

WHEN TO SEE A DOCTOR ABOUT BACK PAIN

• Pain wakes you up from sleep.

• Pain can't be relieved by lying or sitting in a certain position.

• Pain is unrelenting or rapidly escalating.

• Legs are weak, in pain or numb.

• Chronic back pain persists on and off for two to three months.

Source: Dr. Stuart Weinstein, University of Washington

STRENGTHENING CORE MUSCLES

These two simple exercises can stabilize core muscles in the body to reduce compression in the vertebrae. However, people with back pain should consult a doctor or physical therapist before starting any new exercise regime, says Mike Locke, director of fitness and sports performance at Bellingham Athletic Club.

Standard plank: Hold your body in the "up" position of a push-up for up to one minute with your body in a straight incline. If you can't hold the position for long, start on your knees until you build up your strength. Locke says he sometimes starts people in a standing position, bracing themselves against a wall.

Superman: Lie flat on your stomach with your arms and legs extended. Lift our arms and legs outstretched, leaving only your lower belly on the floor (like Superman flying in the air). Hold for 30 seconds, release, and repeat several times. This exercise is recommended for people diagnosed with osteoarthritis in the spine or with spinal stenosis.

Ericka Pizzillo Cohen is an Ohio-based freelance writer and former reporter for The Bellingham Herald.