Persistent Back Pain? 5 Things You May Have Overlooked

by · April 26, 2013

DISCLAIMER: This article is not a substitute for professional medical, fitness, or dietary advice. Please consult with your healthcare provider before undertaking or modifying any healthcare intervention. Please read our disclaimer.


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By Chris Sovey, RN,BSN

In any given year, more than half of American adults experience back pain symptoms. (1) Some sources estimate that greater than 80% of adults will report back pain in their lifetime. The severity of the pain perception can range from slightly annoying to downright debilitating. In addition, back pain is one of the most common causes of days missed from work. Needless to say, it is costing our medical system a lot of money.

There are a lot of health professionals that view patients with chronic back pain as “just another back.” Unfortunately, this stigma often leads to poor treatment outcomes or unnecessary procedures. As I’ve stated many times, I am not here to provide medical advice. Your choices of care are between you and your provider. However, I will say that in my professional clinical experience as a nurse and Doctoral Physical Therapy student, I have observed countless patients who are not provided with conservative back pain management tools before opting for more invasive ones. There are cases of trauma and other situations where these choices will be necessary, but for the average Joe couch potato, there are much more cost-effective options.

If you’ve read what we’re about, you’d notice that we attempt to integrate the most conservative methods available, while still drawing from evidence-based literature. If you’re suffering from chronic or recurrent back pain, you may benefit from exploring the following common underlying contributors with your healthcare provider or licensed Physical Therapist. (It is worth noting that Physical Therapy is often considered to be one of the most effective methods for treating low back pain.) (2)

5 Commonly Overlooked Contributors To Back Pain

Flexibility / Range of Motion

It may be difficult to grasp, but your back pain may actually be caused by muscles that are not directly connected to your area of discomfort. The body is a marvelous machine when it is working correctly, as it is all beautifully connected to work in harmony. However, tight muscles in the hips or other areas of the musculature can pull on the alignment of the spine or your tailbone. This places additional stress on the back and may result in pain or degenerative conditions. Tight hamstrings or quads are some of the most common causes of back pain. (4) A tight piriformis is also a frequently tight muscle we observe in patients with back pain.

It is worth noting that poor flexibility can lead to all sorts of degenerative problems throughout the body. Since everything is connected, tight calf muscles can affect your walking pattern, thereby transferring forces up through the knees and into the back. This connection between the whole body is known as the kinetic chain. When it is in working order, it is a magnificent creation. When things become unbalanced, it can result in a lot of suffering. Maintaining range of motion through a properly prescribed stretch program or activities such as yoga are excellent options to maintain sufficient flexibility. Don’t think that just because you are active, that you are automatically flexible. Many athletes often neglect to stretch. As a result, they too suffer from these problems.


This relates to the kinetic chain that we just discussed. The majority of the population spends a great deal of their time sitting in front of a computer and / or at a desk. They are often consciously unaware of their posture, which tends to slump over time. With excessive sitting, shoulders tend to round forward, the neck juts forward into what is known as “forward head posture,” and additional stresses are placed onto the back.

To further compound this problem, most people who are spending this much time sitting, are less likely to maintain adequate strength of their postural muscles to maintain proper spinal alignment. A conscious awareness of poor posture is critical for spinal health. However, it is only the beginning. Proper strengthening of key muscles (deep cervical flexors, spinal extensors, and scapular stabilizers) are often necessary to re-establish proper posture.

Several muscles must often be stretched as well. Your case may be individual and it is necessary to establish an individual program with a Physical Therapist. Most clinicians refer to posture as a dynamic process. It is not necessarily that we must be constantly rigid, upright, with shoulders drawn down, back and externally rotated. It is stagnation that really kills. Our bodies are meant to move. If you must sit, keep changing positions. For most people, it is ok to slouch for short periods of time, just keep moving. Get up every 15 minutes if possible and stretch. Walk around a little. Sitting kills. I don’t mean that lightly. It really does.

Strength Imbalances

Most individuals with chronic back pain have some sort of strength imbalance. This will vary per person and requires an evaluation by a trained professional. Relating back to the kinetic chain, a muscle in one area may need to pick up the slack of a weaker muscle. As a result, unnecessary forces work their way up (or down) the chain, resulting in pain. A large number of individuals with chronic back pain show a smaller / weakened multifidus muscle in imaging studies. (5) The multifidus is a key spinal stabilizer muscle, and is frequently a contributor to low back pain.

Weak hip musculature may result in back pain as well. Several hip muscles connect near the low back, and can directly or indirectly cause stress to the low back.

Biomechanical Alignment

Our bodies undergo a lot of small, micro-stresses throughout the day. Due to this, and our sedentary lifestyle, our spine, hip bones, and tailbones can easily fall out of alignment. When this happens, forces are not distributed efficiently throughout the body. Every step we take may place undue stress on different areas of the spine. Unfortunately, due to the anatomy of the lower lumbar region, this is a focal region of pain for many individuals.

This is treatable through proper evaluation, hands-on therapy or manipulations, and proper stretching / strengthening. Therapists (or chiropractors) may use a variety of techniques to restore normal alignment of the spine and surrounding structures. You could exercise consistently for the rest of your life, but if your spine / pelvis is out of alignment it may cause chronic pain symptoms.

Psychological / Systemic Causes  

Back pain can sometimes be a troublesome problem to diagnose. A multitude of factors play a role in the perception of back pain. Not only does everyone perceive and process pain differently, but their intensity may be blunted or amplified based on previous life experiences. Any underlying depression, anxiety, or other mood disorders often significantly worsens the perception of back pain. Most individuals who are depressed or anxious experience an increased frequency of joint pain in general. (3)

In addition to psychological causes, systemic medical causes sometimes play a role. These can range from potentially serious to emergent conditions. Some examples include: Urinary tract infections, pregnancy, aortic aneurysm, and myocardial infarction. (6) It is never my intention to scare anyone with fear-based knowledge, but it is important to recognize these are possibilities. However, medical causes of back pain are far less common than the other factors mentioned above.

What Can I Do? What’s The Good News!!?!

The good news is that back pain is very treatable in most cases! First, it is critical to be assessed by a healthcare professional who is trained in orthopedics. Your general practitioner will likely refer you to a licensed Physical Therapist, who is knowledgeable in the body’s structures and musculoskeletal system. Therapists have a firm grasp assessing the underlying causes of back pain related to your muscles and joints. As I mentioned before, it is possible that your pain may be caused by other medical causes. This is something that your healthcare provider and Therapist will need to collaborate together in order to determine the root cause of your pain.

Other tips:

  • MOVE! Get up out of that chair every 15 minutes if possible. Take stretch breaks.
  • Walk and move naturally. Even if you don’t enjoy intense workouts, any form of movement is better than sitting.
  • Stretch regularly. Even if you have to physically write it into your schedule, stretching (in some form or another) is critical to preventing tight musculature.


(1) Back Pain Facts & Statistics:

(2) Physical therapy treatments for low back pain in children and adolescents: a meta-analysis:

(3) Chronic Pain:

(4) Risk Factors for the Development of Low Back Pain in Adolescence:

(5) Multifidus and Paraspinal Muscle Group Cross-Sectional Areas of Patients With Low Back Pain and Controls: A Systematic Review With a Focus on Blinding:

(6) Masquerade: Medical causes of back pain:

Images by: User:Mikael Häggström and Lparis22

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    Discussion1 Comment

    1. Sophia says:

      Hi this is Sophia, you are providing a good information about back pain and 5 things. these information help me lot in my life.

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