What are the causes of back pain? Surprising Triggers, From Stress to Sitting Upright – and What You Can Do About It | Life and style

Wlike washing the terrace with a jet, the straw that broke the camel’s back – and yours? It’s a possibility, but experts say the real causes of back pain might surprise you — and it’s a more serious problem than most people could imagine. The World Health Organization (WHO) reports that lower back pain is the leading cause of disability worldwide, with cases expected to reach more than 800 million by 2050, largely as the population grows and ages. Here, clinicians reveal some of the unexpected causes and how to avoid them.

You are too active (or too sedentary)

“It’s actually very common to wake up with back pain without having suffered an injury,” explains osteopath and naturopath Hannah Whitcombe. But in most cases, the hardness or softness of your mattress will not be the issue.

“People often forget what they did the day before. A particularly active day can cause muscle and joint pain the next morning, but the opposite can also be true: sitting at a desk or simply being less active,” she says. “So if you wake up with a sore back, don’t just look at the eight hours you spent in bed, think about the previous 16.”

Mindy Cairns, musculoskeletal physiotherapist and clinical researcher, sees a seasonal trend. “During the summer, patients say, ‘My back is much worse,’ and I say, ‘Well, what did you do?’ » Some will have spent fifteen days in four different hotels with four different beds. Others, she says, “remember that they washed the deck for five hours the other day and didn’t infer that that might be the cause of a flare-up.”

Both extremes – too active or too sedentary – can cause back pain. Antony Bush, physiotherapist and author of The Back Fix, says office workers can sit for 12 hours a day once work, travel and evening Netflix are taken into account, “double what we know gives people back pain”. At the opposite extreme, repetitive loads, relevant for rowers or gymnasts, can be too heavy on the back. In Bush’s experience, half of all cases of back pain have multiple causes, which suggests it’s better to look at the whole situation rather than a single trigger.

You’re sitting too straight

If you were told to sit up straight as a child, this advice might not have been particularly helpful to you. Bush argues that a rigid but conventionally “good” posture can itself cause back pain, especially if it’s not your natural resting position. London osteopath Anisha Joshi, who counts Rita Ora and Nick Grimshaw among her clients, still warns against excessive slouching, but says “a very upright, fixed posture” can create tension in certain muscles, most commonly from sitting in the same position for hours without a break.

“Posture is generally most helpful when it’s relaxed and adaptable, rather than forced or held in a ‘correct’ position for hours,” says Joshi. A hunched back isn’t necessarily bad as long as your movements vary throughout the day.

Bush goes further, saying myths about posture extend to lifting. He says that lifting with a rounded back, rather than the typical backward-bent knees approach, is not as dangerous as it is made out to be. “Contrary to everything you’ve heard, it’s best to bend with your back rounded and your legs straight.” Although studies have found no evidence that a single lifting technique prevents back pain, it can be assumed that lifting wisely and building strength matters more than “correct” posture.

You are stressed

The pain is in the brain, but that doesn’t mean it’s imagined. In fact, stress – and particularly prolonged stress – can be a physical and emotional trigger for back pain, says Emma Hayward, an osteopath based in Kent. She explains that stress causes the connective tissue in the back to contract, which over time can become fibrotic, or “sticky and tied,” so the body moves less efficiently, and even minor strains can trigger an acute episode. “I very rarely see lower back pain in my clinic without the person having also experienced a significant stressor in life. Stress essentially increases the volume of pain,” she says.

Bush also believes that mindset plays an important role in managing chronic pain. “We can better determine who is going to have chronic pain with psychometric testing than with MRI,” he says. This allows for a more multifactorial assessment of the physical and mental well-being of its patients when treating back pain.

You rely on scans

An MRI may seem like a way to get answers, but in most cases the results don’t correspond to the degree of pain felt, Bush says. Disc bulges and joint wear and tear can all appear in people without any pain.

Bush describes a study in which two groups with back pain each underwent MRIs showing disc protrusions, tears, and facet wear, all of which are normal signs of aging for their age group. One group was told this was within the normal range. The other received no explanation. “Pain increased in the group of people who participated without any pats on the back,” Bush says, adding that their confidence and psychological and physical measures also decreased.

Neil O’Connell, a physiotherapist who helped develop the 2016 clinical guidelines on lower back pain for the National Institute for Health and Care Excellence (NICE), agrees that the changes seen on scans largely reflect the natural process of aging. “They look like wrinkles on the face,” he says. This is why international clinical guidelines state that imaging should not be routinely used for back pain.

Bush wants people with back pain to resist the “I’m broken” mindset. “Back pain is part of the hilly journey of a human being’s life and you cannot speed up the pace of recovery,” he says.

You learned to fear him

You can, to some extent, blame your parents for your back pain, says Cairns, and not just because of your genes. “If I gained a pound for every time one of my patients said, ‘Oh, my mom had a backache, my dad had a backache, my aunt had a backache,'” she says, although it’s rarely a family illness. Diseases like osteoporosis or rheumatoid arthritis can be hereditary, but simple mechanical lower back pain is often just “bad luck,” she adds, and will affect more than 80 percent of us.

Cairns thinks some pain could be attributed to hereditary fear: “As a child, if a parent says to you, ‘Oh, my back hurts again. Oh, my back, my back, my back,’ there’s a certain degree to which it’s a learned behavior, and you become afraid every time your back hurts.” It is not a rejection of pain, she emphasizes, but rather a “tightening” which is not a sign of damage.

The good news, says osteopath Alison Durant, is that “we are adaptable. By understanding pain and learning to see it differently, you can reduce the nervous system’s protective response and improve function and confidence in movement,” she says. Depending on the person, this may involve applying a protective device during painful or avoided movements, working with breathing, or discussing how to manage a painful flare-up with a clinician.

The cause is not your back at all

Back pain without an obvious cause may be symptomatic of another problem. Patients often present with back pain that doesn’t seem particularly mechanical, Cairns says, which may mean it’s an underlying problem such as endometriosis.

Endometriosis, in which tissue similar to the lining of the uterus grows elsewhere in the body, most commonly affects the pelvis and abdomen, where pressure on nerve roots can mimic lower back pain. “Endometriosis is very common, but it can often be misdiagnosed,” says Cairns. “It can also involve the gut and ligaments connecting the pelvis and spine, limiting movement and contributing to pain.”

On physical examination, this will not present as mechanical back pain. “That’s where my clinical suspicions come in,” says Cairns. If it is not 99% certain of a mechanical cause, it is referred for further investigation. “Together with Endometriosis UK, we are studying back pain associated with endometriosis as part of a national survey,” says Cairns, who hopes the work will lead to a better understanding of how these conditions interact.

You don’t know your own strength

All experts agree that the body is more resilient than we think. “You have to make sure that you’re not narrowing your life in the face of pain, but that you’re listening to it and investing in it a little bit,” Bush says.

Our skeletons are sturdy and built to accommodate the load we place on them. So if the deck needs washing again in two years and your back protests, don’t panic and try to keep moving.