7 Sneaky Causes Of Back Pain

Following a day of helping your friend move to a second-floor apartment or going for a 3-mile hike, it’s completely normal to wake up with an ache in your back. That said, if you notice you’re experiencing back pain on a regular basis, there could be something more serious going on.

“Depending on what is injured, you can have muscle pain, bone pain and/or nerve pain,” said Dr. Santhosh A. Thomas, staff physician at Cleveland Clinic’s Center for Spine Health at the Richard E. Jacobs Health Center. He added that back pain can extend to the legs or butt, intensify with pressure, and even feel worse when you cough or sneeze.

About 65 million people in the United States report experiencing a recent episode of lower back pain, while 16 million people said they have chronic back pain. While herniated disks, spinal trauma, and pulled muscles are well-known causes of back injuries, there may not always be an obvious trigger for ongoing discomfort.

These are sneaky causes of back pain that experts say can fly under the radar:

Simply put, body mechanics describe how you twist, turn, lift, maintain posture, and move during daily life. “Things we have done a thousand times can all of a sudden become painful or can start the process. Even simple things like bending to tie your shoes or picking up something small from the ground,” Thomas said.

Adam Goode, professor in the department of orthopaedic surgery at the Duke University School of Medicine, further explained that he tends “to see more individuals having the abrupt onset of lower back pain early in the spring when the weather is nicer, and activities such as yard work, spring cleaning, or sports are beginning back up.”

Fortunately, experts agree that pain from activities such as these tend to quickly pass and become less of a trigger with improvement of poor posture and better lifting habits.

An underlying health disorder may present with back pain as a symptom. “Many of our internal organs have shared nerve pathways that also supply the skin, soft tissue, and muscles of the back. Therefore, conditions affecting these internal organs can cause ’referred back pain,’” explained Dr. Jay Karri, a physiatrist and interventional pain specialist at the University of Maryland Medical System and assistant professor at the University of Maryland School of Medicine.

According to Thomas, gastrointestinal issues, kidney stones, infections, pancreatitis, and ankylosing spondylitis (AS) are physical health disorders that commonly present with back pain as a symptom. Another one is endometriosis, a serious condition that affects an estimated 6.5 million people in the United States alone, yet remains dramatically underdiagnosed.

Much like underlying physical health disorders, mental health conditions may also be the root cause of discomfort.

“Recent research has strongly shown psychological conditions ranging from anxiety to depression to chronic stress can lead to back pain,” Karri said. “It’s not ‘all in your head.’ We have found in recent years that the same neural pathways responsible for … biochemical imbalances also propagate chronic pain conditions.”

Though rest is an important aspect of healing, an aching back may indicate a need to incorporate additional physical activity into your week. Karri explained that “while a tendency may be to limit movement during severe back pain, movement is generally helpful in most instances.”

“For athletes and weekend warriors, a sports-focused and more rigorous exercise program may prove more effective,” he added. “For older people or those with more limitations, tai chi or chair yoga, which are gentler programs, can be just as effective.”

Incorporating movement is crucial to keeping your back healthy, but beginning a new exercise routine at too high of an intensity can have an adverse effect.

“Pain or injury from an exercise often stems from doing too much too soon,” said Goode. “Some increase in symptoms may be normal when starting a new exercise program. Appropriate instruction on the types and the progression of exercise is important to decrease the risk of injury.”

If you notice you’re waking up after a night’s rest with a sore back, the way you’re curling up in bed may be to blame. Despite common misconceptions, there is no “best” or “one size fits all” sleep position: Basic anatomy and health conditions can impact what feels most comfortable to you.

For example, according to Karri, if you begin to develop lower back pain, a doctor may recommend “trialing new sleep behaviors, including changing your sleeping position, shifting your pillow placement, or even undertaking a nighttime stretching routine.”

Thomas said to “avoid smoking, as this is a known cause for back pain and disc deterioration.” In fact, research has overwhelmingly found that smoking cigarettes not only increases the risk of developing osteoporosis as you age, but damages the arteries in your back muscles and joints. Nicotine is also a vasoconstrictor, meaning it causes blood vessels to narrow ― in turn decreasing the amount of nutrients and oxygen the spine receives.

If you aren’t prepared to quit smoking, try reducing how much you smoke (anything is better than nothing!) and practice tobacco harm reduction, such as choosing modern smokeless tobacco products.

When you begin to notice back tenderness flaring up, promptly trying to pinpoint the trigger and address the pain is key. “Whether it’s a shower, a heating pad, or an ice pack, superficial heat or cold can prove extremely helpful in treating more superficial causes of back pain, including muscle and soft tissue pain,” Karri said.

However, experts agree that it may be time to speak with a doctor if a sore back begins to interfere with your daily activities and sleep, or if you experience serious symptoms like bladder issues, accompanying fevers and weakness.

In these situations, physical therapy, medication, cortisone injections, surgery or other medical interventions may be considered. “Ultimately, our spines are incredibly strong,” Goode said. “Staying active and continuing to build strength and endurance will lead to healthy, adaptable spines.”