5 Surprising Reasons You Might Be Suffering with Back Pain

Janet Tiberian Author
By Janet Tiberian, MA, MPH, CHES
February 28, 2022
Middle aged man sitting on the edge of his bed, gripping his lower back.

If you struggle with back pain, you know firsthand how it can diminish your quality of life. If you work, for example, there’s a pretty good chance it’s interfering with your job. Low back pain has been the leading cause of disability since 1990, according to the International Association for the Study of Pain. 

Many people with back pain are often diagnosed with one or more spinal conditions such as:

  • Herniated disc
  • Degenerative disc disease
  • Osteoarthritis, stenosis
  • Spondylolisthesis or osteoporosis

These conditions are serious, but in many cases, your primary care doctor, physical therapist or chiropractor can develop an effective treatment plan and educate you on how to minimize pain. 

“Orthopedic diagnoses generally involve an Xray and/or MRI,” says Bernard Kaminetsky, MD, medical director, MDVIP. “Imaging shows spinal alignment, bone fractures and soft tissue damage. Masses – particularly when using contrast -- also can appear, helping a doctor diagnose or rule out cancer.”    

But what if you’re suffering in pain, been examined by professionals -- even had imaging, but nothing appears wrong? The pain is real, so what do you do?  

“If you have back pain, make an appointment with your primary care doctor,” says Kaminetsky. “If you were hurt in a car crash, slip and fall or sports injury – your PCP will refer you to the appropriate specialist. But if you haven’t been injured, your PCP may begin probing other possible causes of pain such as fibromyalgia, anxiety/depression, core weakness, inflammation or poor sleep positions.”

1. Fibromyalgia

Fibromyalgia is a disorder that causes widespread musculoskeletal pain along with fatigue, poor quality sleep, memory loss and mood issues. Studies suggest fibromyalgia affects the way your brain and spinal cord process pain and non-pain signals, intensifying painful sensations. This causes back pain for many fibromyalgia patients. About two-thirds of people with chronic low back pain have fibromyalgia and as many as 49 percent of people with fibromyalgia have low back pain, according to Everyday Health

“Fibro patients with back pain are often encouraged to make lifestyle changes that help ease pain such as improving their diet, beginning an exercise program and/or losing weight,” says Kaminetsky. “Your PCP also may refer you to a physical therapist, pain management specialist, acupuncturist or even a mental health counselor if the pain seems exacerbated by anxiety or depression.”  

2.  Anxiety and Depression

It’s common for people with anxiety to have a higher risk of back pain and experience sharp, localized pain throughout the spine, after exertion and long periods of standing or sitting. Body aches like back pain may also indicate  depression. It’s possible depression can cause chemical changes in the brain that lead to pain. And pain is felt more intensely when depressed. Plus, depression often causes fatigue, a common barrier to exercising, which can lead to a weak core.   

“Stress can tighten muscles, depression can alter brain chemistry and anxiety can lead to persistent aches and pain,” says Kaminetsky. “Let your primary care doctor know if you are dealing with these issues. They may suggest engaging in mood boosting activities like walking, meditating and gardening, or recommend counseling to get to the root of the problem, ultimately easing pain.”  

3. Core Weakness

Your core muscles hold up your torso. The stronger they are, the easier it is for your spine and the muscles, ligaments and tendons that help stabilize it to align properly when sitting or standing. A weak core makes it challenging to maintain proper posture; poor posture raises the risk of stress on the discs and joints, muscle strains/sprains and back pain. 

“Pilates is the first method of exercise I recommend to my patients with weak core muscles and poor posture, but there are other options,” Kaminetsky says. “Just make sure you discuss exercise with your doctor before starting or changing a program. Your doctor may want to provide specific guidance to you based on conditions you have or medications you take.” 

4. Inflammation  

Sometimes, back pain is caused by chronic inflammation. Inflammatory back pain, or a spondyloarthropathy, stems from inflammation that affects joints and/or where ligaments and tendons attach to bones. Examples of spondyloarthropathies include:

  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Enteropathic arthritis (which is commonly associated with inflammatory bowel syndromes such as Crohn’s disease and ulcerative colitis).

Although these conditions predominately cause back pain, it can affect arms, legs, hands and feet. Pain associated with spondyloarthropathies seems to be triggered by and usually strongest after long periods of inactivity. That’s why so many people with spondyloarthropathies find mornings to be the most painful time of the day. 

“It’s very important to discuss pain with your PCP. If they feel it may be related to an inflammatory problem, they will probably refer you to a rheumatologist who may treat the condition with prescriptions for medication and exercise,” Kaminetsky says. “Tell-tale signs you may be dealing with inflammatory back pain, is if the pain began before you turned 35 years old and is not linked to an injury.”

5. Poor Sleeping Positions

Sleeping in a poor position can elicit back pain, especially if you’re holding your body in an unhealthy position for seven or eight hours. Unfortunately, it’s difficult to know what your position is while sleeping and how to control it. Learning to sleep in a neutral position can lower your risk for back and neck pain. 

This means you should be sleeping on your back. When you do, your spine is straight, and weight distributed evenly along the widest portions of your body. Sleeping on your stomach is probably the worst position for sleeping because it’s not possible to keep your neck properly aligned. If you sleep on your side, make sure you flip sides to keep the pressure on muscles and ligaments even. Muscle imbalances can cause pain. Also, while on your side, bend your knees and place a pillow between them to align the hips, spine and pelvis.  

If your spine is healthy and if your hips are wider than your waist, a softer mattress is more apt to keep your spine neutral; however, if your hips and waist are aligned, you’d be better off with a mattress with more support, according to Cleveland Clinic. If you have a spinal issue such as a herniated disc, talk to your health care provider as to which type of mattress and pillow bests suits your condition.

“There are so many reasons why you may be living with back pain. The best thing you can do, is talk about with your primary care physician so that they can guide you in the best course of action to get the pain under control,” Kaminetsky said.

If you don’t have a primary care physician, consider partnering with an MDVIP-affiliated physician. They have time to really work with you to develop a personalized wellness program that focuses on your individual needs. Find a physician near you and begin your partnership in health » 

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About the Author
Janet Tiberian Author
Janet Tiberian, MA, MPH, CHES

Janet Tiberian is MDVIP's health educator. She has more than 25 years experience in chronic disease prevention and therapeutic exercise.

View All Posts By Janet Tiberian, MA, MPH, CHES
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