10 Surprising Causes of Back Pain

Kaitlin Vogel
·10-min read

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.

It can affect your posture and ability to feel comfortable sitting at work, exercising and even sleeping. If you have chronic back pain, help is available. Knowing the cause of your back pain is an important first step.

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.

10 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 Dr. Dan Halfman, PT, DPT, BDN, CMPT, FAAOMPT, the clinic Manager at Aahletico. “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, making 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: These Are the 16 Best Lower Back Exercises, According to Fitness Pros

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 lower back, Dr. Halfman states.

3. Poor posture

Adopting a forward head and 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 activity, but many people don't realize how long they sit 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: If Weight Loss Is Your Goal, the Treadmill Is Your Best Friend—Here Are 10 Fat-Burning Workouts to Try

5. Maignes Syndrome / TLJ Syndrome

Maignes or TLJ syndrome occurs when the joints and tissues at the junction between the thoracic and lumbar spine have inflammatory chemicals building up around them after being 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, Dr. 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,” Dr. Daley says. “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," Dr. 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 to pain in 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 a weakness, Dr. Daley states. The issue here is that the solutions for each are opposite, so it 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 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.

8. Obesity

While you're certainly not defined by the number on the scale. However, one 2023 study found that obese people had higher odds of experiencing chronic lower back pain.

"Obesity is a major factor in causing acute and chronic back pain due to several factors, including the overload on the spinal column," says Dr. Medhat Mikhael, MD, a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center. "Weak abdominal and back muscles — the core — can lead to a major spine insult with a minor trauma or fall."

What to do about it:

Losing weight can nix this risk factor for low back pain by decreasing the demand on your spinal structures, says Dr. Landon Uetz, PT, DPT, a physical therapist at TeachMe.To.

Dr. Uetz suggests combining a nutritious diet with exercise guidelines from the American Heart Association, which are:

  • 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise weekly

  • At least two days of strength training per week

"You may also work to strengthen core and posterior chain musculature — low back, glutes and hamstring—to support the spine," Dr. Uetz says.

9. Pregnancy

Dr. Uetz says that the changes the body undergoes to support the pregnancy, including weight gain, make back pain more likely.

"With an increase in load, the spine may experience discomfort if it is not able to tolerate the additional weight," Dr. Uetz says.

Dr. Uetz says that other pregnancy-related factors contributing to back pain include:

  • Changes in walking mechanics

  • Different physical activities triggering weakness and deconditioning

  • Hormonal changes that can relax ligaments supporting the back, creating some instability and discomfort

What you can do about pregnancy-related back pain:

While moving may be the last thing you want to do when you're pregnant and in pain, Dr. Uetz says exercise is helpful.

"The muscles of the back and abdomen can help reduce the demand on back structures as pregnancy progresses," he says.

Some of Dr. Uetz's favorite exercises during pregnancy are:

  • Walking

  • Swimming

  • Posterior chain strength for the back, glutes and hamstrings (hip hinges, squats, bridges or hip thrusts)

  • Core stability, such as dead bugs

Related: 7 Workouts That Will Benefit Anyone With Bladder Issues, from Dead Bugs to Pilates

10. Exercise

Exercise is one Rx for back pain. However, it can also trigger it.

"Exercise is extremely important, particularly with a focus on core strengthening and stretching to offload the spine," Dr. Mikhael says. "However, overdoing it without clear supervision or advancing quickly without good muscle support can lead to major load on the spine without adequate foundation, which can cause major spine injury to the discs, ligaments and joints."

How to prevent back pain from exercise:

First, meet your body where it is today. Dr. Uetz says it's important to acknowledge your load (heaviness of a weight, number of reps and the duration of your workout) vs. your capacity (the amount your muscles, bones, tendons and ligaments can handle). This step alone will reduce your injury and pain risk.

Dr. Uetz says other steps to reduce back pain related to exercise include following other healthy lifestyle habits like sleep, nutrition and stress management. Proper warm-ups and cool-downs can also help get blood flowing and engage the muscles you are about to or just worked.

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Related: This Simple Exercise Eliminates 'Tech Neck' in Five Minutes a Day

Sources

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