The Real Cause of Your Back Pain Isn't What You Think

The real cause of your back pain 

Far from being a weak, delicate structure that needs to be protected, our spines are highly mobile and capable of carrying incredible loads. It’s the part of your body that’s most capable of bending, twisting and turning — and I’m sure I don’t need to tell you how much a bad back gets in the way of that.

You almost certainly either know someone who has suffered from the vague, inconvenient and very upsetting blight of the bad back, or have one yourself.

But if our backs are so strong and capable, why is back pain so common, and what can you do about it?

Use it or lose it

In daily life, our backs are rarely challenged. In fact, they’re more likely to be dangerously under-utilised.

Most people who have a typical office job aren’t lifting often, twisting often or bending often, leading to a lack of strength in the back muscles or imbalances, where muscles that should be long are tight and muscles that should be short are lax.

This is why so many acute back injuries are caused by mundane actions that we should be able to cope with, such as lifting luggage, twisting to get out the car or even just coughing or sneezing. If things like these are causing you pain, it means that your back muscles are so unconditioned that it only takes the slightest load to damage them.

The more that your back experiences pain, the more sensitive to pain it will be, as the neural paths to the affected area become more active. This is how slow, gradual deconditioning of the back muscles can lead to stubborn, chronic pain.

Worst of all, people often respond in the exact opposite to how they should.

Instead of interpreting their pain as a warning sign that they’re out of shape, they’ll instead avoid loading their backs even more. I encounter people with back pain who insist they could never do a deadlift because of their bad back, when such load-bearing exercises are exactly what they should be doing to give their spine the support that it needs.

This leads to the same dangerous cycle of pain, inactivity, weakness and further pain that’s at the heart of so many of the conditions that we treat, and how a small injury that could have been a moment for intervention can snowball into a chronic and difficult-to-treat condition.

Back pain is in the MRI of the beholder

Blame for back pain is also often wrongly placed. One of the reasons people become so stressed about back problems is the belief that it’s caused by structural damage of the spine itself.

What complicates this is that if you go looking for structural problems, you will find them. As David’s written about before, if you have no back pain at age 30, there’s still a 52% chance that MRI imaging will reveal disk degeneration. This goes up to 68% at 40, and 80% by 50. Remember, this is in people with no back pain!

However, when someone finds disc degeneration, they may think they’ve found the culprit, and either resign themselves to having a condition that’ll be with them for life or undergo expensive and invasive surgeries to address degeneration that likely wasn’t the cause of pain to begin with.

In my experience, only around a fifth of the back pain cases that I’ve treated have been solely caused by a structural problem in the spine itself. Most of the time, the outlook is far more optimistic than you may expect and you can be rid of back pain with simple exercises and lifestyle changes.

Even in cases where back pain is caused by injury to the intervertebral disc or facet joints, exercise is still the correct response because you want to build up a strong layer of supporting muscles around the injured structure to alleviate excess pressure on them so that they’re less aggravated and given more opportunities to heal.

Of course, these exercises should be carefully prescribed and guided, and we also need to rule out rare but more sinister pathologies during our first diagnosis – but either way, the important thing is that you get seen.

So if you want a definitive answer on what’s really to blame for your bad back from people who can put you on the best path to recovery, get in touch with us at

If you have any questions feel free to get in touch with me at or book an appointment by calling 0207 937 1628 .

Kam Physio BelgraviaKam Sowman  BSc (Physio) MCSP MHCP

Musculoskeletal and Sports Physiotherapist