Why Does My Back Pain Keep Coming Back? 7 Possible Reasons
f you've experienced back pain before, you may recognise the frustrating cycle:
Your back hurts โ it gradually improves โ you return to normal โ then the pain comes back.
It's understandable to wonder why this keeps happening.
The good news is that a recurrence of back pain does not necessarily mean that you have caused further damage to your spine.
Back pain is common, and some people experience repeated episodes.There isn't always one single explanation. A combination of physical activity, lifestyle, work demands, sleep, stress, confidence with movement and other individual factors may influence how symptoms behave.
So rather than asking:
โWhat's wrong with my back?โ
it can sometimes be more helpful to ask:
โWhat might be contributing to my symptoms, and what can I do to manage them?โ
Here are seven possible factors.
1. You stopped being active when your pain improved
When your back starts feeling better, it is natural to stop the exercises or activities you were doing during your recovery.However, maintaining regular physical activity can be an important part of managing back pain and maintaining your overall physical health.Exercise does not necessarily mean following a particular set of โback exercisesโ. Depending on your circumstances, activities such as walking, swimming, cycling, strengthening exercises, Pilates or other forms of physical activity may be suitable.
Current clinical guidance supports considering exercise as part of the management of low back pain, with the type of exercise adapted to the person's needs, preferences and capabilities.
The aim is to find an approach that you can maintain rather than something you do for a few weeks and then stop.
2. You increased your activity too quickly
Sometimes back pain returns after a sudden increase in physical activity.For example, you may feel better and then quickly return to:
heavy lifting
gardening
DIY
sport
long walks
physically demanding work activities around the home
A flare-up following an increase in activity does not automatically mean that you have caused an injury.Your current tolerance for an activity may simply not yet match the demands you are placing on your body.
Gradually increasing activity may give your body time to adapt.
Rather than doing very little and then suddenly doing a lot, try to build your activity up progressively.
The appropriate pace will vary from person to person.
3. You've become worried about moving your back
Back pain can understandably make people cautious.If a particular movement has previously caused pain, you may start avoiding it. You might stop bending, lifting, exercising or participating in activities because you are concerned about making your back worse.
Short-term modification of activities can sometimes be sensible during a painful episode.
However, continually avoiding normal movement may affect your confidence and ability to perform those activities.
This doesn't mean that you should ignore pain or force yourself through severe symptoms.Instead, where appropriate, rehabilitation can involve gradually rebuilding confidence and tolerance for movements and activities that are important to you.
CSP information on back pain recognises that factors including avoiding movement, fear of damage, stress and reduced physical activity can be associated with back pain.
For many people, gradually returning to normal movement and activity can be part of managing back pain and rebuilding confidence.
4. Your activity levels have changed
Your physical capacity can change over time.Perhaps you've:
changed jobs
started working from home
become less active
stopped exercising
had an illness or injury
taken on caring responsibilities
had less time for physical activity
As your activity levels change, activities that were previously easy may become more demanding.
This doesn't necessarily mean that your back is โweakโ or damaged.
It may simply mean that your body needs time to adapt to the demands being placed on it.
Regular movement and gradually increasing your physical capacity can form part of a longer-term approach to managing back pain.
5. Sleep and stress may be affecting how you experience pain
Back pain doesn't occur in isolation from the rest of your life.
Periods of poor sleep, stress, tiredness or low mood can sometimes make pain more difficult to manage.
This does not mean that your pain isn't real.Pain is real whether or not psychological or lifestyle factors are also involved.
However, pain can be influenced by a range of factors, and addressing sleep, stress, physical activity and general wellbeing may be useful alongside physical rehabilitation.
If you notice that your symptoms tend to become more troublesome during particularly stressful or exhausting periods, it may be worth considering the bigger picture rather than focusing solely on your back.
6. You're focusing on short-term relief rather than longer-term management
Treatments such as hands-on therapy may provide relief for some people.
However, if your symptoms repeatedly return, it may be useful to look beyond short-term symptom relief.Depending on your individual circumstances, longer-term management may involve:
gradually increasing physical activity
strengthening
improving confidence with movement
returning to activities that are important to you
temporarily modifying activities
addressing sleep
considering factors that may be affecting your recovery
developing strategies for managing future flare-ups
Current NICE guidance recommends that manual therapy, where appropriate, is used as part of a treatment package that includes exercise rather than as a standalone treatment.
This doesn't mean that hands-on treatment has no place.
It means that it can be considered as one component of a broader rehabilitation approach, where appropriate.
7. You may benefit from an individual assessment
There isn't one explanation for every person's back pain.Two people can experience similar symptoms but have very different circumstances, physical demands, concerns and goals.
An assessment by an appropriately qualified healthcare professional can help explore these factors and determine whether physiotherapy management is appropriate for you and whether there are any reasons for further investigation or referral.
It is also worth knowing that having back pain does not automatically mean that you need an MRI or X-ray.
Current NICE guidance does not recommend routine imaging for non-specific low back pain in a non-specialist setting. Imaging may be considered when there is a clinical reason to do so and when the result is likely to change management.
Your symptoms and clinical assessment are therefore important when deciding whether further investigation is appropriate.
What can you do if your back pain keeps coming back?
If you're experiencing repeated episodes, consider the bigger picture.Ask yourself:
Have I become less active?
Have I increased my activity suddenly?
Am I avoiding movements because I'm worried about causing damage?
Have my sleep or stress levels changed?Have I stopped activities that previously helped me stay active?
Am I relying mainly on short-term treatments?
Would an individual assessment help me understand my symptoms?
There may not be one simple answer.
Several factors can sometimes interact, and the most appropriate approach will depend on the individual.
The aim isn't necessarily to guarantee that you will never experience back pain again.
A more realistic goal may be to improve your physical capacity, confidence and understanding of your symptoms, so that you are better able to manage your back and respond to future flare-ups.
When should you seek professional advice?
Most episodes of back pain are not caused by a serious condition. However, some symptoms require medical assessment.
You should seek medical advice if:
your pain is progressively worsening
your symptoms are not improving as expected
you feel generally unwell alongside your back pain
you develop unexplained weight loss, fever or night sweats
you develop significant or progressive weakness
you develop difficulty walking
you have other symptoms that concern you
CSP patient information also advises seeking medical help when back pain is worsening rather than improving, when someone feels unwell with symptoms such as fever, night sweats or weight loss, or when there are changes such as weakness or difficulty walking.
Important: symptoms requiring urgent assessmentVery rarely, problems affecting the nerves at the bottom of the spine can require emergency assessment.
Seek urgent medical attention if you develop:
difficulty starting to pass urine or a significant change in urinary sensation
new numbness or altered sensation around the genitals, anus or area between the legs
new loss of bowel control or sensation
significant or progressive weakness affecting the legs
new sexual dysfunction associated with back or leg symptoms
These symptoms can be associated with cauda equina syndrome, a rare condition requiring urgent assessment.
If you are concerned about your symptoms or unsure what to do, seek appropriate medical advice rather than relying solely on information provided in this article.
Could physiotherapy help with your back pain ?
If your back pain keeps returning or is affecting your work, exercise, sleep or everyday activities, a physiotherapy assessment may help you better understand your symptoms and explore appropriate management options.
Book a physiotherapy assessment with Ellie Physiotherapy & Wellness to discuss your symptoms, concerns and goals.
Medical information and disclaimer
This article is provided for general educational and informational purposes only.
It is not intended to provide a diagnosis, individualised medical advice or a treatment plan, and it should not be used as a substitute for an assessment by an appropriately qualified healthcare professional.
Back pain can have different causes, and information that is appropriate for one person may not be appropriate for another. If you have concerns about your symptoms, or if your symptoms are persistent, worsening or associated with any of the warning signs described above, please seek appropriate medical advice.Clinical guidance and evidence can change over time.
Clinical guidance and information sources
This article has been informed by current evidence and professional guidance relating to the assessment and management of low back pain, including:National Institute for Health and Care Excellence (NICE) โ NG59: Low back pain and sciatica in over 16s: assessment and management
Chartered Society of Physiotherapy (CSP) โ patient information relating to back pain, physical activity and self-management.
NICE and CSP have not reviewed or endorsed this article or the services provided by Ellie Physiotherapy & Wellness.