What causes back pain?

Rick Olderman
Physical Therapy Specialist

Most chronic back pain is due to a few problems: 1. The shape of our spine, 2. How we use our spine, and 3. The forces pulling our spine into one direction or another. 

How the shape of the spine relates to back pain
The spine has curves and these curves serve a function which is to allow the spine to bend and twist without straining tissues.

Not everyone’s curves are the same though. Some people have more or less curve than others. These changes are then reflected in how we move our backs. How we bend or twist can cause back pain. To fix back pain, you must be aware of these issues as well as the forces tugging on your spine.

Forces acting on our spine
One of the primary systems creating back pain involves the legs and pelvis. The pelvis is the foundation upon which the spine rests. The way the pelvis rests and moves therefore affects how the spine rests and moves. 

For instance, if the pelvis is tilted too far forward, then the spine must adjust by increasing its lumbar curve. This increase creates stress to the tissues of the spine including disks, ligaments, bony articulations, and tendons because it changes how the spine moves.

The opposite can also occur when the pelvis is tilted too far backward, reducing the lumbar curve and stressing the tissues of the spine in the opposite fashion.

The orientation of the pelvis while standing also affects spinal movement. This issue biases the spine to either flex too much or too little during bending or lifting activities, stressing tissues. Over time, vulnerabilities are established in these tissues which, when exposed to repeated stresses, cause pain or disk deformities--such as disk bulges or herniations.

Eric Olsen
Fitness Specialist

Our present epidemic of back pain is really the result of our sedentary habits; the typical back pain sufferer is usually a somewhat overweight, out-of-shape, middle-aged man (or a woman, although guys are more likely to suffer low-back pain) with a bit of a paunch who suddenly decides to do something physically demanding, such as agreeing to help his brother-in-law move a refrigerator one weekend. Because our typical back pain sufferer is out of shape, the muscles of his lower back and abdomen, which help support the spine and protect it from injury, are weak and more prone to injury, thus he ends up pulling a muscle or even tearing an intervertebral disk (tough cushioning pads between the vertebrae).

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Debra Fulghum Bruce PhD
Healthcare Specialist

The most common source of back pain is from the muscles, tendons, and ligaments around the lower spine, but pain can affect any part of the back or neck. It is extremely common to have osteoarthritis (wear-and-tear arthritis) in the spine that shows up on x-rays. Back pain can also occur after injuries, with fibromyalgia syndrome, and even after a fracture in one of the bones of the spine (most commonly from osteoporosis). If your back pain lasts more than a few weeks, it is important that you check with your doctor to be sure no other medical problems are causing the pain.

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Some conditions that may cause low back pain, include the following:

  • Sciatica
  • Arthritis
  • Osteoporosis
  • Bulging disc
  • Infection
  • Injury

The conditions above can be a result of muscle imbalances. Muscle imbalances can be caused by repetitive motion. Muscle imbalances cause us to have bad posture. The bad posture leads to bad movement patterns. This will put stress on our ligaments, tendons and joints, leading to an injury. When an injury happens our body lacks proper range of motion, becomes inflamed and may lead to more serious conditions mentioned above.


  • Exercise
  • Proper lifting mechanics
  • Maintain a healthy weight
  • Good posture
Joanne Duncan-Carnesciali, CPT, NASM Elite Trainer
Physical Medicine & Rehabilitation Specialist

Low back pain (LBP) is a multi-dimensional experience. It has sensory, emotional, cognitive and behavioral components.

Risk factors associated with LBP include age, gender, height and body build, spinal abnormalities and previous history with low back problems. Too, a strong indicator of LBP is poor general health.

Physical factors such as lifting heavy objects, forceful movements and awkward positions can put individuals at risk for developing low back pain.

The cause of back pain for some can be related to soft tissue problems, strains and sprains for example or can be a fracture, spinal stenosis, nerve root compression or visceral pathologies.

It's hard to pinpoint a specific cause for back pain without a comprehensive diagnosis from a qualified professional. In the fitness world, we see a variety of issues starting with poor posture or inefficient gate mechanics. Other potential causes for back pain could be lack of stability/mobility in the small muscles that stabilize the core.

The lack of "core strength" can be a result of being overweight, ineffective workout programs or sitting for long periods of time.

My suggestion—change your working environment (get up and move around), think about losing a few pounds and find a fitness professional that can build a program specific to your needs.

Brian Yee
Physical Medicine & Rehabilitation Specialist

There are multiple sources of back pain. Most people assume it comes from degeneration of the spine or a herniated disc. However, there are many other structures around the spine that can generate or cause low back pain. This could include myofascial trigger points in muscles arond the trunk such as the multifidus or quadratus lumborum. Pain fibers have even been found in the thoracolumbar fascia, which is the fasical layer that wraps around your back. Fascia can help provide stability to the spine, but weakens in prolonged slouching/sitting postures that slowly stretch the fascia out. Back pain can also be due to poor stability in the trunk that cause increase compression or friction to the spine. This is commonly seen in overly flexible people such as gymnasts and dancers.

Sacroiliac joint / pelvis pain should also be considered as a source of low back pain.

You should also consider how the rest of the body works and how it affects your back. In clinic, we always assess patients walking mechanics because the way you walk affects the way your back works. Even a simple ankle sprain when you were younger, can alter the way your leg works, and over time puts more stress to your back. There is a high correlation of hip dysfunction with associated low back pain.

Back pain can also be a symptom from another referred source such as internal organ irritation—commonly kidney dysfunction presents itself as back pain. You should consult a physician to rule that out. Even food intolerances/allergies or vitamin/hormonal deficiencies can cause low back pain.

As you have read, there can be many reasons why back pain occurs. Be sure to find a practitioner that can thoroughly examine / rule out various possibilities, and then can either provide the proper care or refer you to another practitioner that is qualified.

There can be some serious health issues that cause back pain, so check with your physician to rule those out.

In the people that I see musculoskeletal issues are the most common cause for back pain. So sit up tall and take a deep breathe. Sitting and poor posture are two major contributors to back pain. Research has shown that the longer we sit at a computer the more we trend to slump forward.

  • Over 80 percent of people in the United States will experience low back pain at some point in their life.
  • The good news about low back pain? Fifty percent will go away on it's own. The bad news? Fifty percent will reoccur.
  • It is an epidemic that costs nearly $26,000,000,000 billion (yes with a "B") a year in treatment and lost wages.
  • Low back injuries account for more than 60 percent of work related injuries.
  • Low back injuries lead to 39 million lost days of work per year.

Human beings were not designed to sit in an office. Low back pain is more common among societies that are technologically based, i.e. it's members sit most of the day. In fact males who sit more than 4 hours per day in a vehicle (like police officers and professional drivers) are at a greater than 300% risk for a disc injury in their low back than those who do not do so.

Can lifting something heavy with poor form cause an injury? Or a motor vehicle accident or sports injury? Of course, but most of the patients I see have pain from poor posture and repetitive movements. Movements that cause compression, bending and twisting forces increase pressure on the discs in between our vertebrae. Crunches done without development of the smaller muscles around the spine are a too blame as well.

Limitations in ankle movement and hip rotation can contribute to low back pain as well so remember to look at the big picture. Our bodies are like one giant, interconnected series of links or one long chain. In fact it is often referred to as the kinetic (movement) chain. If there is dysfunction in any link throughout the chain, it can cause symptoms (like pain) anywhere throughout.

So move your body, stretch, practice core stability exercises, lay off the crunches, sit tall and take a break from your computer screen once an hour. Your back will be glad you did.

Dr. Matthew F. McCarty, MD

Back pain most often is caused from muscle spasm. In addition an underlying source can come from different structures. Degenerative disc disease, herniated lumbar disc leading to spinal cord or nerve root compression, pain coming from the disc itself and infection can all be causes. Facet joint pain caused by underlying osteoarthritis of the spine or spondylosis as well as arthritis involving the sacroiliac joint with surrounding painful ligaments can be sources. Back or flank pain can also come from a distended or inflamed kidney. Other signs of urinary tract infection could accompany this condition.

Back pain can be caused by a multitude of different things. In the fitness world, we often see muscle imbalances that ultimately end up causing back pain. For instance, if the psoas, one of your hip flexors, is chronically shortened, then it could cause back pain. This, because it actually attaches to the lumbar spine. The tightness causes un-natural pulling on the spine, and in turn, causes back pain. A similar mechanism for back pain, although not directly attaching to the spine, is having tight hamstrings.

You can stretch the psoas and hamstrings by watching and following the videos below.

A variety of conditions can cause back pain:

  • Strains
  • Sprains
  • Spinal or pelvic misalignment
  • Herniated or degenerative disc disease
  • Spinal arthritis
  • Spinal stenosis
  • Fractures
  • Scoliosis/kyphosis

Less commonly: Infections, inflammatory conditions, or medical conditions of the abdominal or pelvic organs

Back pain can have a variety of causes, and the specific cause in each case is often not determined. The most common explanation is a strain in the muscles and ligaments, often from lifting. Lifting can also result in back pain via a slipped disk. Back pain can come from spinal problems like cancer, infection, curvature, fractures, or stenosis (narrowing). Other causes include kidney problems, fibromyalgia, aortic aneurism, twisted testicle, and pregnancy.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

The price we pay for having the ability to walk upright is that much of that pressure and shock absorption that used to be distributed among our limbs when we walked on all fours is now transferred to our lower backs. But since we're sort of content with our two-legged mode of transportation (and willing to trade off wear and tear on our knuckles for an erect spine), we have to train our lower backs to deal with it.

Of the numerous risk factors for back pain (including smoking, your job, age, and certain diseases like arthritis), omental obesity (obesity around your abdominal tissues and organs) and core muscle weakness are the biggest. With obesity, it just makes anatomical sense: The bigger your belly, the more likely it is that your center of gravity is pulled forward, putting excess strain on your back. The solution's simple (at least in principle): Drop the weight, and you'll ease the tension.

On rare occasions, back pain is associated with tumors and infection, so it is wise—especially with back pain that doesn't go away after a few weeks of trying recommended drugs and diet treatments—to have doctors do a complete diagnosis to see if they can indeed pinpoint an atypical cause.

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Injury to a muscle or a ligament in the back is the most common reason people experience back pain. When you strain a muscle or ligament, you may feel pain immediately, or days later.

But an underlying health condition, such as arthritis, could be to blame, too. Osteoarthritis is the most common form of the disease. Ruptured or herniated disks in the spine—which become increasingly likely with age—can pinch nerves and cause pain, too.

Other medical problems that may lead to back pain include:

  • Osteoporosis
  • Fibromyalgia
  • Scoliosis
  • Spinal stenosis
  • Degenerative disk disease
  • Endometriosis
  • Infections (such as osteomyelitis or meningitis)

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Dr. Eugene Goldberg, DC
Chiropractic Medicine Specialist

Back pain is usually caused by a "pinched nerve," or by pain in the muscle. If one of the 24 movable vertebrae in the back or neck is misaligned, this can cause pain due to spinal cord pressure. A soft tissue injury (sprain/strain) can cause back pain. Also a protruding or bulging disc can cause lower back pain. A lot of people have Sacro-Iliac problems which can also cause lower back pain.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.