What Causes Back Pain?

5 min read

Go see a doctor if you’ve had a traumatic event like a fall and to rule out more serious forms of back pain like tumors, cardiac conditions, and disease. Very intense pain, constant pain that doesn’t change based on the day or what you do, loss of bladder or bowel control, and fever or unexplained weight loss are signs of more serious causes of pain. Here are qualified clinicians that can help you diagnose your back pain.

This article is for the person who has visited their doctor and followed their advice but still has chronic back pain. If you want help on your journey, book a consultation to work with me directly.

1. Common Causes of Back Pain

These are common causes of back pain that you can easily identify with the tests below.

Flexion intolerance

Rounding forward and then pulling down on your seat causes pain.

Man sitting on stool, shirtless, slouching forward. Text reads "Round forward" and "Pull down." Indoor setting with tiled floor.

Extension intolerance

Arching back and then pulling down on your seat causes pain.

Man in shorts sits on a stool, arching back with hands gripping the seat. Text: "Arch back," "Pull down." Glass window backdrop.

Load intolerance

Raising a light weight (10-15lb) to shoulder height in front of you causes pain.

Man in black workout attire in brick-walled gym. He performs a kettlebell exercise with text "Brace Core" and "Hold." Arrows indicate motion.

Sciatica

Diagram of a herniated disk affecting the sciatic nerve. Shows spine, areas of pain in red, and labels like vertebrae and normal disk.

Perform the slump test by rounding your spine as you flex your toes up towards your shins, and if this nerve stretch causes pain it indicates sciatica.

Man sitting on a stool performing a slump test, with arrows indicating movement. Background shows glass doors and greenery. Text reads "Slump Test".

Piriformis syndrome

Illustration of pelvis anatomy showing sciatic nerve and piriformis muscle. Includes labeled close-up circle highlighting nerve under muscle.

Piriformis syndrome can be caused by a tight or loose piriformis. Perform the FABER test by lying on your back and crossing your ankle over your opposite leg and dropping your knee to the ground without letting your opposite hip rise. Take a picture from the front and perform both sides to see if your painful side is tighter or looser than the other side.

Person lying on a wooden floor, performing FABER test. Knee bent outward, foot on opposite thigh. Text: "FABER Test," "Compare sides."

If your piriformis is tight, the painful side will be tighter, and your foot tends to turn out while standing

Two images display bare feet on tiled flooring. The left shows feet with green and red arrows; the right shows a standing person with arrows.

If your piriformis is long, the painful side will be looser, and your knees tend to collapse inward during squatting or single leg exercise.

Man demonstrating squats; correct form: knees over toes, incorrect form: knees cave. Brick wall background with text labels.

2. Poor Posture

Try this yourself. Place one hand on your low back and the other at the back of your neck and then round forward. You’ll feel these muscles activate. Now, lean back until you feel these muscles relax.

It’s often overlooked, but if your back pain builds throughout the day, poor posture habits are a likely cause. Better posture balances bones, while worse posture uses muscles and ligaments to hold you up. Good posture requires less effort than slouching and is more comfortable.

Biggest Mistake: Overcorrecting posture and using too much muscular force to hold you up. Forcing your shoulders back and your neck tucked leads to fatigue and worse posture after just a few minutes.

Three side-by-side images of a man showing different postures: rounded, neutral, and arched. Background: brick wall, windows.

Quick Fix: Be as tall as you can be and keep your nose below your ears. Imagine a string pulling you up from the crown of your head. Avoid overarching by keeping your ribs down. Sit on your hip bones, not your tailbone.

Two side-by-side images of a man's head posture against a brick wall. Left has "Tight neck" with a red X, right has "Nose below ears" with a green check.

Two drawings of stacked cubes: one collapsing under a downward arrow, the other stable under an upward arrow with a hook. Monochrome.

Diagram of four skeletons showing different postures with curved lines, arrows, and highlighted muscles in red. Illustrates movement and alignment.

Illustration of two pelvic sitting positions. Left shows slouched posture, right shows balanced posture over ischial prominences. Text below.

3. Poor Movement Patterns

If you hit your fist against a wall once you might be fine, but if you do it 1,000 times in a row your hand will be damaged. All tissues in your body have a maximum capacity that they can handle, and if you surpass that you experience pain. It’s the same with the low back.

Cycle diagram on a blue background showing low back issues: Hypermobile, Overuse, Stiff, and Stretch. Arrows connect each stage.

Repetitively using the low back excessively leads to microdamage. Bending over once by rounding the back is not a problem, but if this becomes the primary way you move, chronic back pain is much more likely.

Silhouette of a person bending forward, illustrating spinal compression. Text explains effects on spinal discs. Simple, educational graphic.

Biggest Mistake: Focusing too much on strengthening or stretching the low back. People with bad backs generally use their backs more and their hips less (McGill 2017, Ultimate Back Fitness and Performance, pp. 50).

Drawing of a person in various stretch poses, with text advising to stop these stretches to reduce pain sensitivity. Black and white sketch.

Quick fix: Maintain a neutral spine and improve coordination by moving primarily at the hips. When bending over, focus on tilting the hips forward until you feel a stretch in the back of your legs. Perform a hip airplane to work hip mobility and control by balancing on one leg as you rotate at the hips.

Man demonstrating pelvic tilt positions: incorrect posterior tilt on left, correct anterior tilt on right. Brick wall background.

Illustration of a skeleton bending, showing correct posture. Text advises to keep spine elongated during movement. Neutral background.

Person in black performs a "Hip Airplane" exercise in front of a brick wall. Sequential poses show dynamic balance with arrows indicating movement.

4. Muscle Imbalances

In 1979 Dr. Vladimir Janda identified human patterns called crossed syndromes where sedentary living causes certain muscles to become habitually weak while others become tight.

Side view of a muscular human body with labeled areas of muscle imbalance: tight (hypertonic) and weak (inhibited) muscles marked by lines.

Many people have back pain because of tight hips, weak glutes (reciprocal inhibition), and overactive hamstrings (synergistic dominance). If you go to the gym and stretch muscles that are already loose or tighten up muscles that are already tight, you’ll make your pain worse.

Biggest Mistake: Performing bench press, bicep curls, squats, crunches, and excessive isolation exercises.

Quick Fix: Train in a more athletic or functional way by using single leg and arm exercises that require balance and full body coordination.

5. Trigger Points

Trigger points are areas of muscular tension caused by poor posture and movement habits that can directly cause back pain. If a muscle is tender to the touch, it’s a sign of trigger points.

Diagram of muscle anatomy showing a human back with zoomed-in view of healthy muscle fibers, trigger points, and overstretched fibers.

Self-myofascial release (SMR) involves using your hands or a tool to release trigger points by relaxing the muscles. Start close to your center and with a softer tool like a tennis ball and progress away from your center and to a harder tool like a lacrosse ball.

Biggest Mistake: Foam rolling too intensely can actually make the problem worse causing you to tighten up further. Stay away from any painful spots that are above a 7/10 intensity, and make sure you’re not holding your breath.

Quick Fix: Grab a tennis ball, and lie on the ground looking for tight areas of your feet, glutes, quadriceps. Breathe deeply and let the tension melt away. Perform regular, daily treatments until the pain is less than a 3 out of 10.

Socked foot on a green ball with a gray mat background, suggesting a massage or exercise setting. Neutral tones and relaxed mood.

Man in a gym uses a foam roller on his glutes. Brick wall background. Text reads "Glute Max & Piriformis." Calm and focused mood.

Man in black workout gear using a foam roller on one leg in a brick-walled gym. Text reads "Quadriceps one leg." Focused mood.

6. Stress

Two cavemen with spears encounter a growling lion. One flees in fear, while the other faces the lion. Rocky terrain with sparse grass.

Stress isn’t just in your head—it can settle into your back, too. When you’re tense, your muscles tighten up, your breathing gets shallow, and your posture slumps. Over time, this creates a perfect storm for back pain.

Diagram showing neural response pathway: stimulus (muscle flexing) to eye (receptor), neurons to brain (CNS) saying "LET'S FUCKING GO!!", and muscle response.

Emotions like anger or depression can take form in the body as muscular tension. If you suffer from stress or excessive muscular tension throughout the day, practice deep breathing, mindfulness, and myofascial release to relax your muscles and nervous system. The alexander technique can be helpful for improving awareness of the different parts of your body.

Biggest Mistake: Training too intensely and not prioritizing sleep.

Quick Fix: Take 5 minutes for a stress reset. Sit quietly, breathe deeply with your diaphragm, and let your shoulders drop. Your back will thank you.

Ready to Ditch Back Pain for Good?

Back pain doesn’t have to run your life. By understanding these common causes of back pain you’ve already taken the first step toward feeling better. As a back pain fitness coach, I’m here to help you dig deeper with personalized tools like posture analysis, movement analysis, muscle testing, and trigger point testing.

Once you've identified the cause of your back pain, you're 90% of the way to having a pain-free back! Want more tips or a custom plan to kick back pain to the curb? Head over to whatiswrongwithmyback.com for free resources and to learn how we can work together. Let’s get you moving, standing, and living pain-free—because you deserve it!

Smiling man in green shirt with arms crossed. Blue gradient background, back pain symbol, and "TP FIT" text. Confident and calm mood.