Back pain is one of the most common complaints worldwide. It affects millions of people, disrupting daily life, work, and overall well-being – in fact up to 60% of people will experience back pain at some point in their life (1). But why does back pain happen? The causes are vast and complex, ranging from natural ageing and wear and tear to lifestyle choices and even unexplained factors. Some people suffer extreme discomfort, while others with visible spinal degeneration on MRI scans feel no pain at all.
Here at Sundial Clinics in Brighton we have treated thousands of people with back pain so we understand what causes it and how to solve it. Let’s explore the many reasons behind back pain.
1. Disc Damage – When the Cushioning Wears Thin
Spinal discs act as shock absorbers between vertebrae. They are soft, gel-filled structures designed to cushion movement and prevent bone-on-bone contact. But these discs can suffer damage due to injury, trauma or even spontaneous wear and tear. A herniated disc, for example, occurs when the soft inner gel pushes through the tough outer layer, irritating nearby nerves. This can cause severe pain, numbness or weakness, particularly if it presses on the sciatic nerve, leading to sciatica.(2)
The sciatic nerve, the largest nerve in the body, originates from the lower lumbar spine (L4-S3) and travels down through the buttocks and legs. When a herniated disc presses on one of the lumbar nerve roots forming the sciatic nerve, it can trigger sciatica—sharp, radiating pain that follows the nerve’s pathway. These irritated nerves send pain signals to the brain through a complex network of electrical impulses, processed by the spinal cord and interpreted in the brain’s sensory cortex.
This is why pain may be felt in areas far from the actual source of the problem, such as the legs or feet, even though the issue originates in the lower back. Read our blog on referred pain here.
2. Disc Degeneration – Ageing Takes Its Toll
Disc degeneration is a natural process. Over time, spinal discs lose water content, making them less flexible and more prone to cracks or tears. This is known as degenerative disc disease (DDD). Although it sounds alarming, it’s not always painful. Many people with DDD have no symptoms, while others experience chronic back pain, stiffness or discomfort. The severity depends on the extent of degeneration, inflammation and whether nerve roots are involved.
Interestingly, some individuals with significant disc degeneration experience no pain at all. This can be due to several factors. First, not all degeneration leads to nerve compression or inflammation, which are primary sources of pain. If the affected discs are not pressing on nearby nerve roots or triggering an inflammatory response, pain may not occur. Additionally, the body can adapt over time, with neighbouring structures compensating for the degenerated disc.
Pain perception also varies greatly among individuals, influenced by genetics, overall health and psychological factors. Some people have a higher pain threshold or more effective pain modulation mechanisms in the brain, meaning their nervous system does not interpret degeneration as a threat.
Finally, the brain’s ability to adapt to chronic changes plays a role—when degeneration occurs gradually, the nervous system may become desensitised to the structural changes, leading to little or no discomfort. Get some tips on how to avoid the effects of ageing on your back here.
3. Wear and Tear – The Cost of an Active Life
The spine undergoes constant stress. Every movement, every twist and turn contributes to microscopic damage. This damage primarily affects the intervertebral discs, facet joints and surrounding ligaments. Tiny tears can develop in the outer layer of the discs, leading to a gradual breakdown of their structure. The cartilage within the facet joints can wear down, resulting in bone-on-bone contact and the development of osteoarthritis. Additionally, ligaments that support the spine may weaken or stiffen over time, reducing flexibility and increasing the risk of injury.
Microscopic damage accumulates slowly, often without noticeable symptoms. However, over time, this wear and tear can lead to conditions like osteoarthritis, spinal stenosis (narrowing of the spinal canal) and facet joint syndrome. Some individuals remain pain-free despite this ongoing degeneration, while others develop chronic pain due to inflammation, stiffness and nerve irritation.
While microscopic damage is largely unavoidable due to normal movement and ageing, certain factors can accelerate it. Poor posture, repetitive strain, excessive weight and a sedentary lifestyle all contribute to increased stress on the spine. However, regular exercise, maintaining a healthy weight, and practising good posture can help slow the rate of degeneration and reduce the risk of developing painful conditions.
4. Ageing – An Inevitable Factor
Like grey hair and wrinkles, back pain often accompanies ageing. As muscles weaken, joints stiffen and discs lose hydration, the spine becomes less resilient. This natural decline is why older adults commonly experience morning stiffness, reduced flexibility and increased vulnerability to injuries. However, maintaining strength and mobility through exercise can slow down these effects. You could try a gentle workout guided by this exercise video
5. Posture and Habits – The Silent Aggravators
Poor posture can be a contributing cause of back pain. Sitting for prolonged periods, slouching or hunching over screens puts excessive strain on the spine. A forward head posture, common among smartphone users, leads to “tech neck,” which affects the entire spinal column. Other bad habits include:
- Sleeping in the wrong position – An unsupportive mattress or improper sleeping posture can contribute to chronic back pain. You can read our advice on managing back pain in bed here.
- Lack of movement – A sedentary lifestyle weakens core muscles, making the back more vulnerable to injury.
- Lifting incorrectly – Bending at the waist rather than the knees places immense pressure on the lower back, increasing injury risk.
6. Lifestyle Choices – Are You Hurting Your Back?
Several lifestyle factors contribute to back pain:
- Obesity – Excess weight increases the load on the spine, particularly the lower back, leading to increased pressure on the intervertebral discs and joints. This accelerates wear and tear, contributing to disc degeneration, joint inflammation, and conditions like osteoarthritis. Additionally, excess fat can trigger chronic inflammation, exacerbating pain and stiffness by increasing the production of inflammatory chemicals that heighten pain sensitivity and prolong tissue damage.
- Smoking – Nicotine constricts blood vessels, reducing oxygen and nutrient delivery to spinal discs and tissues. This impairs their ability to repair and regenerate, leading to faster degeneration, increased disc dehydration, and a higher risk of injury. Poor circulation also slows healing after spinal injuries or surgeries.
- Lack of exercise – Weak core muscles, including the abdominals and lower back muscles, fail to provide adequate support for the spine. This creates instability, forcing other structures like the discs and joints to compensate, which increases strain and risk of injury. Poor muscle endurance can also contribute to chronic lower back pain and postural issues.
- Poor diet – A deficiency in key nutrients weakens bones, making them more susceptible to fractures and degenerative conditions. Calcium and vitamin D are essential for bone density, with calcium found in dairy products, leafy greens, and fortified foods, while vitamin D is sourced from sunlight exposure, fatty fish, and fortified dairy or plant-based milks. Magnesium, found in nuts, seeds, whole grains, and dark leafy greens, helps with muscle and nerve function, supporting spinal health. Vitamin K, crucial for bone metabolism, is abundant in green vegetables like kale and spinach. Collagen, important for joint and disc integrity, is present in bone broth, lean meats and collagen supplements. Omega-3 fatty acids, which help reduce inflammation and alleviate some types of back pain, are rich in fatty fish like salmon, flaxseeds, chia seeds, and walnuts.
7. Work Conditions – The Daily Grind
Jobs play a significant role in back pain. People in physically demanding roles, such as construction workers or warehouse staff, are prone to repetitive strain and lifting injuries. Hairdressers have to maintain positions which stress the back for long periods. Conversely, desk workers often suffer from prolonged sitting, leading to poor posture, muscle imbalances and weakened core strength.
Office-related back pain can often be alleviated with ergonomic chairs, which provide lumbar support and promote proper spinal alignment, and standing desks, which allow users to alternate between sitting and standing to reduce prolonged pressure on the lower back. Additionally, scheduling regular movement breaks—ideally every 30 to 60 minutes—can help ease stiffness and prevent muscle fatigue.
Simple activities like stretching, walking around, rolling the shoulders, and gently rotating the neck can relieve tension in the back, neck, and shoulders, promoting better circulation and overall spinal health. Here are some simple exercises you can do at your desk.
8. Why Doesn’t It Always Hurt? The Mystery of Pain-Free Degeneration
One of the most puzzling aspects of back pain is that some people with severe spinal degeneration experience no pain at all, while others with minor changes suffer intensely. This inconsistency is due to several factors:
- Pain sensitivity varies – Some people have a higher pain threshold than others.
- Inflammation plays a role – Pain often arises when degeneration triggers an inflammatory response.
- Nerve involvement matters – If disc damage doesn’t press on nerves, it may go unnoticed.
- Brain perception – Chronic pain is influenced by psychological and neurological factors, meaning some individuals are more susceptible to pain than others.(3)
9. Prevention and Management – Taking Control
While some causes of back pain are unavoidable, many can be managed or prevented:
- Strengthen your core – The core is a group of muscles that includes the abdominals, obliques, lower back, and pelvic muscles. These muscles work together to stabilise the spine and maintain proper posture. When the core is weak, the spine lacks adequate support, increasing strain on the vertebrae and discs, which can lead to pain and injury. Strengthening the core involves exercises like planks, bridges, and controlled abdominal workouts that build endurance and stability, reducing the risk of back pain and improving overall spinal health.
- Move regularly – Avoid long periods of sitting or standing.
- Improve posture – Maintain proper alignment whether sitting, standing, or sleeping.
- Lift safely – Use proper technique to avoid injury. Always bend at the knees, not the waist, keeping your back straight and your core engaged. Hold the object close to your body to minimise strain, and lift using the strength of your legs rather than your back. Avoid twisting while lifting; instead, pivot your entire body to change direction. If the object is heavy, seek assistance or use mechanical aids to prevent excessive strain on the spine. Practising these techniques reduces the risk of muscle strain, herniated discs, and long-term spinal damage.
- Stay active – Low-impact activities like swimming and walking keep the spine flexible.
- Eat well – A balanced diet supports bone and muscle health.
- Manage stress – Tension and anxiety can lead to muscle tightness and pain. (4)
Back pain is a complex issue influenced by numerous factors. From disc degeneration and lifestyle choices to ageing and work habits, the reasons are vast. The good news? While we can’t stop ageing, we can make sensible choices to protect our backs. Regular movement, good posture and a healthy lifestyle go a long way in preventing and managing back pain. And remember – just because an MRI shows degeneration doesn’t always mean pain is inevitable. The human body is remarkably adaptable, and with the right approach, back pain doesn’t have to control your life.
Our chiropractors and physiotherapists are experts at solving back pain. If you have back problems, get in touch!