Causes of back pain

Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and Physician
Next review due November 2023

Back pain is very common, especially lower back pain. Around six out of 10 people are affected by lower back pain during their lifetime. You can also get pain in your upper back, your neck, hips and shoulders, and pain that travels down your leg.

Back pain doesn’t normally have a serious cause. In most cases, the pain will improve within:

  • a few weeks if you’ve pulled or strained a muscle in your middle or upper back
  • four to six weeks if it’s your lower back that hurts (this is called acute lower back pain)

However, for some people, back pain can become chronic (long term) and continue for many months or even years.

Girl taking a photo

About your back

It can help to know more about how your back is constructed.

Your back has many connected parts, including bones, joints, muscles, ligaments, nerves and tendons. Your spine supports your back. It is made up of 24 separate bones called vertebrae, which are stacked on top of one another. Below these are the bones of your sacrum and coccyx, which are at the bottom of your spine.

Between the vertebrae are discs that act as shock absorbers and allow your spine to bend. Your spinal cord passes through the vertebrae. It carries nerve signals between your brain and the rest of your body. The spinal cord ends in your lower back as a bundle of nerves. This is called the cauda equina (Latin for horse’s tail, which it was thought to resemble).

An image showing the different parts of the spine

What is non-specific back pain?

Non-specific lower back pain is the most common type of back pain. This means your doctor or physiotherapist won’t be able to tell you exactly what’s causing the pain because it’s not caused by anything that will show on a scan. But it’s not usually due to a serious problem. Non-specific back pain is often caused by a pulled muscle or ligament in your back, but no one knows for sure. You can also get non-specific pain in your neck and upper back.

What activities or events might cause back pain?

There may have been an event or movement that started your back pain – for example, straining, twisting or lifting something heavy. Or your back pain may have come on gradually. In some people, it’s linked to repetitive tasks at work or sitting in one position for a long time. You use and move your back all the time, so there are lots of reasons why you might hurt it. Some of the reasons why you may get back pain include:

  • poor posture sitting at a desk
  • poor posture sitting on the sofa to work from a laptop
  • dragging a suitcase
  • gardening
  • doing household chores such as loading or unloading the washing machine or bending over the sink or ironing
  • playing with the kids or picking them up
  • pulling or straining a muscle while exercising
  • working long hours on your feet – for example, standing behind a bar for a long time
  • waking up with back pain which might be caused by an unsupportive mattress
  • being overweight

Specific causes of back pain

Sometimes, damage to parts of your spine can be the cause of back pain. This might be from a fall or an injury such as whiplash. Or it might be caused by a particular condition. We’ve described some of the main conditions causing back pain.

Arthritis (osteoarthritis)

There are different types of arthritis, but osteoarthritis (pronounced os-tee-oh-ar-thry-tis) is the most common form. It affects your joints, making them painful and stiff. In your back, it’s often the joints in your neck or the lower back that are affected. Osteoarthritis may also affect your knees and hips.

In osteoarthritis, the cartilage covering the ends of your bones becomes rougher and thinner. The bone underneath thickens and your joints can become inflamed. The whole joint may be affected including the surrounding tissues and ligaments. Fluid can build up inside the joint. These changes can cause pain and make it difficult to move as easily as you once could.

The pain is usually worse when you’re moving and using your joint. The stiffness can be worse after you’ve been resting – when you wake up, for example. If your osteoarthritis is severe, you might have symptoms all the time. Many patients say their pain is worse in damp or rainy weather. You might also feel or hear grinding or crunching when you move the affected joint.

Degenerative disc disease

Degenerative disc disease means that the discs located between the bones in your back (vertebrae) have become worn down or damaged. This is usually as a result of ageing or repeated injury.

As you get older, the discs between the bones in your spine don’t absorb shock as well as they did when you were younger. And daily activities can cause the discs to become damaged. If you injure your back, the discs can be swollen, sore and not as stable.

The symptoms of degenerative disc disease are wide ranging. The pain may be mild or it may be severe and difficult to ignore. You might find it gets worse when you lift things or twist or bend your body. The pain might ease when you change position or lie down. It usually gets worse when you move around and better when you rest, particularly when lying down. But in some people, it can be the opposite – easing when you move around and getting worse when you’ve been sitting or standing for a while.

Symptoms are usually felt in your neck or lower back. So, the pain can affect your neck and your arms or it might affect your lower back, buttocks and thighs. It can feel like numbness, tingling or weakness in your arms or legs (which might mean there is pressure on a nerve).


Osteoporosis (pronounced os-tee-oh-por-o-sis) is a condition where your bones become thinner or weaker. This increases the risk that any of your bones may fracture more easily. However, because your spine is always carrying weight when you are upright, the vertebrae can fracture at any time even without an injury. This is called a spinal compression fracture and can cause sudden and severe back pain. But this definitely doesn’t mean you should stop moving around. The best way to keep your vertebra strong is weight-bearing exercise. They become weaker and more prone to fracture if you are not active.

Sometimes, these spinal compression fractures don’t cause symptoms and are spotted on an X-ray or scan for something else. If you keep having spinal fractures, your spine can become curved, causing you to hunch forwards.

Spinal stenosis

Spinal stenosis (pronounced sten-oh-sis) is when your spinal canal narrows. Your spinal canal is the tunnel-like passage that your spinal cord passes through. If the canal becomes narrow, it can press on the nerves inside it and cause back pain. This mostly happens because of changes happening to the bones in your spine as you get older. Spinal stenosis can cause back pain and pain in your legs (sciatica, pronounced sy-at-i-ka). The pain is often brought on by walking, and eases when you stop or sit down.

Spinal stenosis can affect your neck and upper back, but it’s mainly the lower back that is affected. If you have spinal stenosis in your lower back for some time, your spinal cord may be compressed. This may cause you to lose feeling in your legs and lose control over your bladder and bowel.


Spondylolisthesis (pronounced spon-dih-loh-lis-thee-sis) is when a bone in your spine (a vertebra) slips slightly out of place. It usually happens in your lower back, but it can happen higher up. Spondylolisthesis might be caused by a fracture, an injury or as a result of the wear and tear that happens to your bones as you get older. Pain in your back might be mild or severe and you may also have pain or tingling down your leg (sciatica, pronounced sy-at-i-ka).


Scoliosis (pronounced skoh-lee-oh-sis) is a condition in which your spine curves in either a C or an S shape. It mostly happens in teenagers, but it can also develop in older people as a result of wear and tear. A symptom of scoliosis can be pain in your lower back that gets worse as the bend in your spine increases. This pain may spread down the legs in older people. You may notice you become increasingly tired and get backache after sitting or standing for a long time.

Ankylosing spondylitis

Ankylosing spondylitis (pronounced an-kih-loh-sing spon-dih-lye-tis) is a condition in which your immune system causes inflammation in the spinal joints and ligaments. It’s a type of arthritis which can be painful and cause difficulty in moving freely. You might wake up in the early hours with stiffness and pain. Exercise can help to ease pain.

Ankylosing spondylitis usually develops in the lower back. Symptoms can flare up and settle down over time, and pain can be mild or severe. You may have pain in your lower back, a developing curve in your spine, and pain in your buttocks. It can also affect other joints in your body such as your shoulders and hips.


There is a link between back pain and depression. Aches and pains such as back pain can be a physical symptom of depression. Furthermore, having depression can increase the risk of developing long-term (chronic) pain. Alternatively, back pain can lead to the development of depression.

You may find it helpful to look at our information on psychological support for back pain.


Fibromyalgia (pronounced fye-bro-my-al-ja) is a long-term (chronic) condition that causes pain in different parts in your body. You might have pain all over or it might be in different parts of your body at different times. Pain is often described as tenderness, stiffness and aching. Fibromyalgia pain is often felt in the muscles in your back leading to tender spots, called trigger spots. You may also feel it in your neck and shoulders. If you have fibromyalgia, you may also have other symptoms or conditions such as depression and anxiety, headaches and tiredness.

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  • Reviewed by Liz Woolf, Freelance Health Editor, November 2020
    Expert reviewer, Dr Sundeept Bhalara, Consultant Rheumatologist and Physician
    Next review due November 2023