back pain

John Lyttle, MSK Physiotherapist

The truth about back pain

30 April 2024

Your back is a complex network of muscles, ligaments and nerves that surround the spinal column – 33 vertebrae, which are separated by soft discs and protect the spinal cord. With so many interconnected components, it’ll come as little surprise that our backs can run into difficulties from time to time.

In fact, it’s thought that around half of UK adults experience back pain each year.1 And, as it’s such an intricate and hard-working part of the body, there are many possible causes of back pain.

Let’s look at some of those potential causes, as well as treatment options and ways to help prevent it. We’ve also tackled seven of the most common back pain myths.

Possible causes of back pain

There are many possible causes of back pain, some more serious than others. In many cases, the cause may be unclear but the pain will resolve itself in time. Of course, there are also back pain issues that require medical attention, so it’s useful to know what kind of symptoms to look out for.

Some of the more common causes of back pain include:

  • Muscle or ligament strain – this is one of the most common causes of back pain. It may not always be obvious what has caused the strain. Sometimes it can be the result of sudden movement, overuse, bending, twisting or heavy lifting over a period of time. This kind of pain usually improves over time with self-care and is not usually a serious problem, but the pain can range from a dull ache to a severe stabbing sensation.
  • Disc bulge/ herniation - Most of us have disc bulges in our lower back, whether we are in pain or not. Discs are incredibly strong structures and, contrary to popular belief, cannot "slip." They have a large fluid content and this fluid moves to help with taking the weight of our body and allow for our everyday tasks. At times these discs can become sensitive, and this can lead to high levels of pain. If the nerves that sit near the discs are also affected by the sensitivity, they can send signals to the legs (in the lower back) or the arms (in the neck). The vast majority of times disc pain settles with advice and short-term activity modification but if issues persist, spread or get worse, speak to your GP.
  • Arthritisosteoarthritis is the most common form of arthritis, and the spine is one of the areas that’s most commonly affected.2 It happens over time as the cartilage between the vertebrae wears down, which can cause inflammation, grinding of bones and the formation of bony spurs called osteophytes. It will often be detected on imaging, and diagnosed alongside a person’s signs and symptoms, rather than imaging alone. Osteoarthritis can cause pain and stiffness, particularly in the lower back, and is more common in people after they’ve reached their mid-40s.3 Meanwhile, rheumatoid arthritis can also affect the spine by causing the immune system to attack tissue in the joints, causing pain and swelling.
  • Osteoporosis – this is a condition where we lose bone density – including the vertebrae – and as a result the bone is more at risk of fracture. It should be noted that osteoporosis itself isn’t painful. It’s usually only when a bone breaks or becomes fractured that people suffer pain as a result of osteoporosis.

>For more details about this condition, check out our guide to osteoporosis and bone health or our article on Understanding bone health.

Busting the myths

Back pain can be seriously misunderstood. Here are seven common myths, and the truth behind them.

1. Back pain is mainly caused by lifting heavy objects

While heavy lifting certainly can cause injury that leads to back pain, there are many other possible common causes. These include poor posture, a sedentary lifestyle, obesity, genetics and the conditions mentioned above.

2. Back pain indicates a more serious condition

Not necessarily. Back pain can be serious, but it’s usually caused by a strain or sprain. These issues should resolve themselves in time with the right combination of rest, light exercise and over-the-counter pain relief. More serious issues may require surgery, but this isn’t as common as strains and sprains.

3. Bedrest is the best thing for back pain

It depends on what the issue is but, while avoiding certain activities (particularly early on) may be necessary, bedrest should usually be avoided as much as possible. It’s important to keep active and not lie in bed for long periods of time as it rarely helps. In fact, bedrest can actually make the pain worse, and lead to a longer recovery period and / or absence from work.3

4. Exercise is a no-no

Again, this depends on what’s causing your pain, but as a general rule, gentle physical activity is often a yes-yes. Exercise and activity can help reduce back pain and prevent future issues so, even if you start off with very light movement and build up slowly, it’s usually better to move as much as you can.

5. Surgery is the best / only way to deal with chronic back pain

Certain conditions may require surgery, but it’s rare. In fact, most causes of back pain aren’t relieved by surgery at all and less than 1 in 100 people with low back pain have symptoms that need urgent medical attention.4

6. I need a firm mattress to avoid back pain

Just as back issues vary from person-to-person, so does the mattress you need.

7. If I sit still, I’ll avoid back pain

This is a simple, easy no. Poor posture and a sedentary lifestyle are actually major contributors to back pain.

How to avoid back pain

Back pain can be caused by many different issues. Around 80% of us will experience back pain during our lifetime,5 so it may not be possible to avoid it altogether.

But there are things we can do and lifestyle changes we can make to help minimise the risk of experiencing back pain.

Maintain a healthy weight - Excess bodyweight puts more stress on bones and joints, including the spine. Exercise, diet and lifestyle factors are all key. Visit our online content hub for more inspiration and information on Staying healthy.

Strengthen your core - Stronger core muscles (around your abdomen, sides and back) can help support your spine and prevent muscle injuries. Pilates and yoga are good things to try, as well as workouts that focus on the core muscles. Just be careful not to overdo it and cause a strain, instead think about gradually increasing these activities as your symptoms settle.

Consider your working environment - Good posture is key to avoiding back issues. If you spend a lot of time sitting at a desk for work, make sure you have a good, adjustable chair and that your screen is at the right height. This is particularly important if you work from home regularly. Sitting on a dining chair while hunching over a laptop is not good for your posture or overall health. You also need to make sure you don’t sit still for too long during the working day – get up and move around as often as you can.

Take care when lifting - Bend at the knees, keep your back straight and avoid awkward twists.

Sleep well - Your sleeping environment is also very important. Although firmer is not always better, a supportive mattress can really help, along with pillows that properly support your head and neck.

The main thing to remember is that movement and exercise are essential to looking after your back, as well as your overall health.


  1. Pain in the UK - Statista
  2. Arthritis - NHS
  3. 10 things you need to know about your back - Chartered Society of Physiotherapy
  4. Low back pain - NHS Guy’s and St Thomas’
  5. Acute Back Pain - British Association of Spine Surgeons (BASS)