7 Surprising Causes of Back Pain

What's causing your back pain, and what to do about it

Anyone who has had back pain knows how debilitating it can be. Whether it’s from an injury or a medical condition, back pain can affect people of any age. And it’s a very common health concern: Approximately 16 million adults suffer from chronic back pain.

While there are many obvious reasons for back pain, there are some that may surprise you. To learn more about causes and treatment, we spoke to physical therapists. Here's everything you need to know.

7 Surprising Causes of Back Pain 

1. Hip weakness

“Many people aren’t aware of the connection between weakness in your hips or pelvic muscles and back pain,” says Dan Halfman, PT, DPT, BDN, CMPT, FAAOMPT, and Clinic Manager at Athletico. “Poor hip girdle strength will result in poor control of the pelvis during walking and other everyday functional tasks. This can cause the pelvis to 'drop' on one side, resulting in excessive stress on the lumbar spine.”

How to keep your glutes strong:

Dr. Halfman recommends these two simple but effective exercises:

• Squats, which are a great way to strengthen multiple muscle groups, including the glutes. You can start with bodyweight squats and progressively add weight as you perfect your form by holding a single dumbbell or kettlebell. Make sure to avoid dropping your knees forward and keep your toes on the ground.

• Lateral band walking or sidestepping is another exercise that targets the glutes while working several other muscles. Place an exercise resistance band around your ankles and put your feet shoulder-width apart. Get into a small squat position and make sure your squat isn’t too deep. Keep your hips back without dropping your knees forward. Sidestep across the room to feel a glute burn.

Related: 40 Trainer-Approved Butt-Lifting Exercises to Help You Get Your Strongest Glutes Ever

2. Sleeping position

Would you stand with your back twisted for eight hours? Then you wouldn’t want to sleep in that position either.

When it comes to sleep, keeping your spine in a neutral position is the goal, Dr. Halfman explains. Keeping your neck and back in a neutral spine position reduces abnormal stress on your joints and muscles.

To improve your sleep position:

Try using a supportive pillow that keeps your neck in a neutral position. If you're a side sleeper, use a pillow between your legs—and make sure the pillow supports your knees and ankles, so it doesn't cause your hips to rotate and twist your low back, Dr. Halfman states.

3. Poor posture

Adopting a forward head, rounded shoulders posture places increased stress on the neck (cervical spine), mid-back (thoracic spine) and low back (lumbar spine), Dr. Halfman explains. This forward, rounded type of posture also forces muscles throughout the body to over-work and function in a way they are not necessarily designed to, which can cause pain.

How to improve your posture:

Focus on sitting or standing up tall and pinching your shoulder blades together, making sure to avoid shrugging your shoulders up towards your ears, Dr. Halfman recommends. Additionally, try incorporating lightweight, high-repetition strengthening exercises for your shoulder blade muscles, such as lateral raises, front raises and overhead presses.

4. Sitting

Sitting may seem like an obvious one, but many of us are still working from home and don't realize how long we're sitting every day.

Because our joints are avascular, they do not receive blood flow. Instead of blood, they get their nutrition from synovial fluid, Dr. Halfman states. Just like we need blood flow to keep our tissues happy, we need fluid in our joints to flow to keep them happy. Motion is our joints' heartbeat, and a lack of consistent motion can cause pain.

How to relieve pain caused by sitting:

The best thing you can do is to add more movement to your day. Standing up, stretching and walking around for just a few minutes every hour will keep your back from getting stiff and sore, Dr. Halfman explains.

You can also bounce on a Swiss ball/physical therapy exercise ball at your desk. Bouncing on one of these balls will load and unload your spine in a rhythmical way, similar to what happens when we walk, Dr. Halfman adds. This is a good way to give your spine the motion it craves without leaving your desk. You can also try an under-desk treadmill! 

Related: 10 Best Under-Desk Treadmills of 2022

5. Maignes Syndrome / TLJ Syndrome

Maignes or TLJ syndrome is when the joints and tissues at the junction between the thoracic spine and lumbar spine have inflammatory chemicals building up around them after getting overloaded past their capacity for one reason or another.

When there is dysfunction at this transitional joint, it can cause referred pain to the lower back, hip, abdominal, and/or groin/testicular/labia area, Megan Daley, PT, DPT, Cert Dn, CF-L1, explains. This is due to the nerve pathways from those joints—the brain sends "help me" signals not to the source itself, but along the nerve pathway, which leads to referred pain.

“The most common presentation I've seen in my practice is unilateral low back and testicular/labia pain, but any of the areas listed singular or in combination are possible. What I don't ever see is the person coming in complaining of pain around the thoracic or lumbar spine,” says Dr. Daley. “It's not until I assess those joints and it reproduces their familiar symptoms that there is any apparent issue there. Not objectively, at least.”

What you can do about it:

The best bet is to get assessed and treated by someone familiar with Maignes Syndrome.

“With proper assessment to confirm this as the issue, it'll only be a couple of sessions until you're better," Daley says. "To note, I've walked loved ones through how to assess this via telehealth before, but if you're also dealing with testicular pain, it's worth trying the treatments. Treatment includes manual techniques to ‘ungunk’ the area."

If you're dealing with pain in this area, be sure to talk to a physical therapist who can diagnose and help treat you.

6. Pelvic floor issues

The pelvic floor is a key supporter of the lower back. If the muscles are either too weak or too tight, then they aren't supporting the back as they should. A great example of this is with lifting anything.

We naturally brace—breathe in and tighten our abs around that brace—when we pick up anything heavy, whether that be a deadlift or a heavy gardening pot, Dr. Daley explains. That creates a pressure canister in our trunk that stabilizes the spine. The bottom of that pressure canister is the pelvic floor. So if that's unable to do its job, it can lead to back pain.

In addition, similar to other areas, you can have a pelvic floor issue that didn't directly cause a back issue, but instead, is just referring pain to the lower back.

What to do about pelvic floor issues: 

Seek out a pelvic floor physio to assess you. Just because you are postpartum does not mean the issue is weakness and not tightness. And just because you don't have kids doesn't automatically mean the issue isn't weakness, Dr. Daley states. The issue here is that the solution for each are completely opposite, so it really does behoove you to get assessed.

7. Stress

Our mental, emotional, spiritual and physical health are all intricately intertwined. If you have an issue that you ignore in one area, it will likely fester and grow and seep into other areas.

One common way that this plays out is someone not dealing with an emotional issue, like a family member they're upset with or a past trauma (big or seemingly little), that ends up being stored in the physical tissues, Dr. Daley explains, often manifesting as back pain.

What to do about it:

Take care of your mental, emotional and spiritual health, and stay as active as you are able to tolerate. Getting seven to nine hours of sleep a night, managing stress, eating whole foods and limiting sugar can really help as well, Dr. Daley says.

Conversely, taking care of other aspects of health improves our tissue's physical capacity and our nervous system's performance, which means less pain and sensitivity.

Next up: The 8 Best Workouts to Do If You Struggle With Back Pain—and the Ones You Should Avoid

Sources

• Georgetown University Health Policy Institute: “Chronic Back Pain”

• Dan Halfman, PT, DPT, BDN, CMPT, FAAOMPT and Clinic Manager at Athletico

• Megan Daley, PT, DPT, Cert DN, CF-L1