Experts reveal unexpected causes of back pain
Physiotherapists and osteopaths say daily activity, posture, stress and fear can all play a part, and sometimes the cause lies outside the back.
Key points
- Lower back pain ranks first among global causes of disability, the World Health Organization says
- Both too much activity and too much sitting can trigger back pain, experts say
- Stress can cause muscle tension and make minor strains more painful
- Scan changes often reflect normal ageing and do not always match the pain felt
- Back pain with no mechanical cause can sometimes be linked to endometriosis
Back pain is more common and more complicated than many people realise, according to clinicians quoted by The Guardian. The World Health Organization ranks lower spine pain first among global causes of disability. Its estimates suggest the number of cases could pass 800 million by 2050, driven largely by growing and ageing populations.
The Guardian spoke to several experts who say the causes are often unexpected. Many of them point to everyday habits rather than a single injury. Waking with a sore back does not usually mean the mattress is to blame.
Doing too much, or too little
Hannah Whitcombe, an osteopath and naturopath, said many people fail to consider what they did the previous day. A day of unusual exertion can leave the muscles and joints aching the next morning. A largely inactive day can have the same effect.
Physiotherapist Antony Bush, author of The Back Fix, said office workers can sit for around 12 hours a day once work, travel and evening television are counted. He said this is roughly double the amount linked to back pain in research. At the other extreme, repetitive loading, seen in rowers or gymnasts, can also overwhelm the back.
Posture and lifting myths
Many people were taught to sit up straight, but experts say that advice has limits. Anisha Joshi, a London-based osteopath, still warns against a heavy slouch. She said a very upright, fixed posture can strain certain muscles, especially after hours in one position without a break.
Bush also argues that lifting with a rounded back is not as dangerous as often claimed. Studies comparing several lifting styles have not shown that any single method protects against back pain. Experts suggest that lifting sensibly and building strength may matter more than holding one correct posture.
Stress, scans and fear
Emma Hayward, a Kent-based osteopath, said prolonged stress can be a physical trigger for back pain. She said stress can tighten the connective tissue of the back over time, so even minor strains may set off a flare. She added that she rarely sees low back pain without a significant stressor in the same period.
Scans can also be misleading. Bush said MRI findings often do not match the pain people feel, since disc bulges and joint wear can appear in people without pain. Neil O’Connell, a physiotherapist who helped write a 2016 NICE guideline on lower back pain, compared scan changes to wrinkles. International guidelines advise against routine imaging for back pain.
Fear can also play a role. Mindy Cairns, a musculoskeletal physiotherapist, said children who hear parents complain of back pain may learn to fear every twinge. Osteopath Alison Durant said understanding pain differently can help reduce the nervous system’s protective response.
When back pain has another cause
Cairns said some patients have back pain that does not look mechanical. In these cases, an underlying problem such as endometriosis may be responsible. Endometriosis, a condition where tissue resembling the womb lining grows in other parts of the body, most often affects the pelvis and abdomen. Pressure on nerve roots there can mimic lower back pain.
Cairns said the condition is common but can be misdiagnosed. She said that if she is not almost certain of a mechanical cause, she refers patients for further investigation. She is working with Endometriosis UK on a nationwide survey into back pain linked to the condition.
Frequently asked questions
What is the main cause of back pain?
The experts quoted by The Guardian say there is rarely one cause. Activity levels, posture, stress and sometimes an underlying condition can all contribute.
Do I need an MRI scan for back pain?
Guidelines in several countries advise against routine imaging for back pain. Scan findings often do not match the level of pain a person feels.
Can stress cause back pain?
Osteopath Emma Hayward says prolonged stress can contribute to back pain by tightening connective tissue. She said it can make minor strains more likely to trigger a painful episode.
Sources
- The Guardian: Experts on why your back hurts – and what to do about it
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