The Best Cities to Have an Achy Back
Back pain is one of the most common health complaints in the United States, affecting people of all ages and lifestyles. For many, it’s not just an occasional inconvenience; it can influence how you work, exercise, and go about your daily routine. While personal habits play a significant role, your environment can also influence how manageable the discomfort feels.
Some cities offer easy access to skilled providers, walkable neighborhoods, and numerous opportunities for staying active, all of which can help manage back pain effectively. Others may present more challenges, with fewer resources and daily conditions that can exacerbate symptoms.
To see where life might be a little easier, or harder, on an achy back, we ranked the 100 largest U.S. cities by analyzing 11 factors tied to back health. The results highlight not only the best and worst places, but also what makes a city more supportive for those living with chronic discomfort.
Key Findings
- Madison, Wisconsin, ranks No. 1 overall for living with back pain, thanks to exceptionally high access to physical therapists (121 per 100,000 people) and fitness trainers (182 per 100,000 people), paired with short commute times (3.43%).
- Lakeland, Florida, ranks last, with low recreational access (70%), just six fitness centers per 100,000 residents, and fewer physical therapists than the national average.
- Omaha, Nebraska, not only has the most chiropractors per capita (34 per 100,000 people) but also the lowest inactivity rate in the country at just 12%.
- Four cities, Washington, D.C.; New York, New York; Philadelphia, Pennsylvania; and Boston, Massachusetts, earned perfect scores for access to exercise locations (100%), compared to a 92% national average.
What Could Make a City Easier on Your Back?
To find the cities where living with back pain might be more manageable, we examined a range of factors that influence both access to quality care and how everyday life impacts spinal health.
A higher number of chiropractors, physical therapists, massage therapists, and orthopedic or spine surgeons can mean better access to specialized treatment, especially when more of those providers have top-tier (4-star or higher) ratings. Access to skilled fitness professionals and well-equipped recreational facilities can also play a role in strengthening muscles and improving mobility, which are key to supporting a healthy back.
Lifestyle and environment matter, too. Highly walkable cities and those with plenty of exercise-friendly spaces may encourage more movement, while lower inactivity rates can help reduce stiffness and chronic pain. Shorter commute times could mean less time sitting in traffic, which is a known contributor to back discomfort.
By looking at these combined factors, we identified the U.S. cities where residents may have the best shot at managing back pain.
Which Cities are the Best for an Achy Back?
When it comes to managing back pain, certain cities stand out for their robust provider networks, numerous fitness opportunities, and daily conditions that help minimize strain. Others face greater challenges, with fewer resources and environmental factors that can make discomfort harder to manage.
Top-Ranked Cities Characteristics
Four of the five top-ranked cities — Madison, Milwaukee, Des Moines, and Sarasota — have well above-average numbers of both physical therapists and chiropractors, showing how provider density plays a pivotal role in creating a back-friendly environment.
Short commute times in places like Des Moines and Madison help residents spend less time sitting, while Milwaukee’s near-universal access to exercise locations (98%) gives locals plenty of opportunities to stay active.
Austin stands out not for chiropractors, but for its concentration of massage therapists and recreational facilities, with alternative care and lifestyle perks also playing a role in spinal health.
Lowest-Ranked Cities Characteristics
The lowest-ranked cities share a pattern of limited access to both professional care and supportive infrastructure. Lakeland ranks last in part due to its minimal recreational facilities and lower-than-average access to physical activity, while Winston-Salem struggles with both provider scarcity and low walkability.
In Augusta, Memphis, and El Paso, there’s a consistent shortage of high-quality chiropractic care, accompanied by a scarcity of massage therapists and fitness centers. These gaps mean residents may face more barriers to staying active and addressing chronic discomfort, making daily life more challenging for those with back pain.
The Five Top-Rated Cities
1. Madison, Wisconsin
- Score 79.3
- Physical therapists per capita: 121 per 100,000
- Fitness trainers per capita: 182 per 100,000
- Percent with commute over 30 minutes: 3.43%
2. Austin, Texas
- Score: 77.6
- Massage therapists per capita: 55 per 100,000
- Fitness and recreational sports centers per capita: 19 per 100,000
- Physical therapists per capita: 98 per 100,000
3.Sarasota, Florida
- Score: 76.7
- Chiropractors per capita: 29 per 100,000
- Percent of 4+-star chiropractors: 11%
- Massage therapists per capita: 45 per 100,000
4. Milwaukee, Wisconsin
- Score: 74.2
- Chiropractors per capita: 21 per 100,000
- Physical therapists per capita: 105 per 100,000
- Percentage of population with adequate access to locations for physical activity: 98%
5. Des Moines, Iowa
- Score: 72.9
- Chiropractors per capita: 24 per 100,000
- Physical therapists per capita: 111 per 100,000
- Percent with commute over 30 minutes: 3%
The Five Lowest-Rated Cities
1. Lakeland, Florida
- Score: 17.1
- Percentage of population with adequate access to locations for physical activity: 70%
- Fitness and recreational sports centers per capita: 6 per 100,000 Physical therapists per capita: 49 per 100,000
2. Winston-Salem, North Carolina
- Score: 26.4
- Chiropractors per capita: 4 per 100,000
- Percent of 4+-star physical therapists: 1%
- Walk Score: 22/100
3. Augusta, Georgia
- Score: 27.7
- Fitness trainers per capita: 41 per 100,000
- Fitness and recreational sports centers per capita: 8 per 100,000
- Physical therapists per capita: 49 per 100,000
4. Memphis, Tennessee
- Score: 28.2
- Chiropractors per capita: 5 per 100,000
- Massage therapists per capita: 16 per 100,000
- Fitness trainers per capita: 66 per 100,000
5. El Paso, Texas
- Score: 28.2
- Chiropractors per capita: 6 per 100,000
- Percent of 4+-star chiropractors: 3%
- Fitness trainers per capita: 53 per 100,000
Top-Performing Cities by Factor
While overall rankings highlight the best and worst cities for living with back pain, breaking down individual factors reveals where certain locations truly excel. For example, Omaha, Nebraska, leads the nation in chiropractors per capita with 34 per 100,000 residents — nearly triple the national average of 11.89 — and also claims the lowest inactivity rate at just 12%, well below the U.S. average of 24%. Quality is another important dimension, with Fresno, California, boasting the highest percentage of top-rated chiropractors at 11%, compared to the national average of 7%.
When it comes to physical therapy, Little Rock, Arkansas, stands out with a remarkable 151.81 physical therapists per 100,000 residents, nearly double the average of 80.19. Provo, Utah, leads in quality, with half of its physical therapists rated four stars or higher, a sharp contrast to the 9% national benchmark. Massage therapy is most accessible in Las Vegas, Nevada, where there are 77.2 practitioners per 100,000 people, more than double the national average of 29.7.
Fitness-related infrastructure plays a significant role in prevention and recovery. Salt Lake City, Utah, tops the list for fitness trainers with 188.4 per 100,000 residents, while Madison, Wisconsin, claims the most fitness centers at 23.3 per 100,000, far surpassing the national average of 13. Cities like Washington, D.C., New York, Philadelphia, and Boston earn perfect scores for access to exercise locations, compared to 92% nationwide. Meanwhile, Des Moines takes the lead for the fewest residents with commutes over 30 minutes, at just 3% versus the 7% national average.
Looking at walkability, Washington, D.C., ranks highest with a walk score of 98, nearly doubling the U.S. average of 51. This factor, paired with its perfect access-to-exercise score, underscores how daily movement opportunities can vary dramatically depending on where you live.
Full Ranking
Explore the full list of 100 U.S. cities to see how each ranks for living with back pain.
While no New Jersey cities made the top 100, due to lower populations, nearby New York and Philadelphia both performed strongly in certain back health factors, including perfect scores for access to exercise locations. These results provide a useful snapshot of resources and lifestyle conditions in areas near Felician University’s home state.
Closing Thoughts
Where you live can seriously affect your access to care, activity levels, and overall health management, all factors that nurses confront daily in their work with patients.
In Felician University’s Accelerated Bachelor of Science in Nursing (ABSN) program, we prepare future nurses to understand these challenges and respond with compassion, skill, and evidence-based care. With two program delivery options, a Hybrid program that combines online learning with hands-on, experiential learning, and an On-Ground program, our ABSN equips students to improve outcomes not only for individuals but also for entire communities.
If you’re ready to advance your nursing career, you can earn a Bachelor of Science in Nursing in as few as 16 months with Felician. We invite you to explore the ABSN program and see how we can help you achieve your goals.
Methodology
To identify the U.S. cities where it’s easiest or hardest to live with back pain, we analyzed the 100 largest cities by population. We evaluated 11 factors that reflect both the accessibility of quality back care and the impact of daily life on spinal health.
Our ranking considered two main categories:
- Access to care: The number of chiropractors, physical therapists, massage therapists, orthopedic and spine surgeons, and fitness professionals and facilities, as well as the share of chiropractors and physical therapists rated four stars or higher.
- Lifestyle factors: City walkability, access to exercise locations, physical inactivity rates, and average commute times.
Each factor was scored on a 0 to 100 scale, with metrics where lower values are better (such as inactivity and commute time) inverted accordingly. Factors were weighted based on their potential impact. Core provider counts received the highest weight. We then combined into a composite score and rescaled on a 0 to 100 scale. A score of 100 reflects the most favorable conditions for living with back pain.