10 Surprising Causes of Back Pain

5. You sit and sit some more

You’ve probably heard by now that lots of sitting can take a toll on your health. It’s also a lesser-known cause of back pain. “If you’re sitting for a period of time, your joints aren’t being used,” says Akhil Chhatre, M.D., director of spine rehabilitation and assistant professor in the departments of Physical Medicine and Rehabilitation and Neurosurgery at the Johns Hopkins University School of Medicine.

Immobility in that nerve-dense location can jump-start what’s known as the pain-spasm-pain cycle, in which a skeletal muscle spasm causes pain in your spine. That exacerbates the spasm, which, in turn, exacerbates the pain. “It doesn’t involve just your spine,” Chhatre says. “It can extend to your hips and sacroiliac joints.”

One study showed that people who sat for 75 percent of the workday reported more back and neck pain than those who sat less (25 to 75 percent of the time). And — not surprisingly — the pandemic made matters worse. A small population study out of Malta published in 2022 in Musculoskeletal Care suggests that the sedentary lifestyle enforced by the stay-at-home mandate and shift to remote working resulted in an increase in back pain. Part of the cause was inactivity, but the researchers say the lack of ergonomic furniture at home also could have played a role. Another possible reason: COVID-era weight gain.

Plenty of research shows that adults who clock long hours of sedentary time every day can counter the risks by increasing the amount of physical activity they do. To keep stiffness at bay, observe the 30-minute rule: Don’t let yourself idle in the same position for more than half an hour. You can even set an alert on your phone to remind you to get up and move around, walk or stretch a bit.

“Set a schedule where you dedicate time focused on stretching and core strengthening, totaling half an hour to an hour, six times a week,” Okubadejo says. “Instead of sitting down for four hours straight, cut that time in half. After two hours, get up for five minutes of stretching, then go back to what you were doing.”

6. Your legs don’t go toe-to-toe

About 1 in 3 of us have legs that aren’t exactly the same length, says Ryan Enke, M.D., a physical medicine and rehabilitation specialist in Rockford, Illinois. Often it’s something people are born with, although injuries or arthritis can cause one leg to become shorter.

A difference in leg length alters the normal biomechanics of walking or standing, Enke says. “That puts unequal stress or strain on one side of the body versus the other.”

The solution may be as simple as adding a lift into the shoe on the shorter side, but physical therapy can help, he notes.

7. You smoke cigarettes

Yet another reason to kick the habit: Smoking damages the spine, according to a Swedish study published in The Spine Journal. Not only does nicotine damage spinal tissue, it can also weaken bones and make back pain worse. The number one reason people who have had spinal fusion surgery — back surgery to connect two or more vertebrae in the spine — don’t heal is because of smoking, Okubadejo says. “A lot of insurance companies won’t approve back surgery for smokers for that reason.”

That’s not all. Research suggests that smoking affects the way the brain responds to back pain and makes people less resilient to it. As a result, suggests the findings of a study in the journal Human Brain Mapping, smokers are three times more likely than nonsmokers to develop chronic back pain. Over-the-counter pain meds, such as nonsteroidal anti-inflammatory drugs (NSAIDs), helped study participants manage the pain but didn’t change the brain’s response to it.

8. Your mattress is too old or too soft

That cushy mattress that makes it seem like you’re floating on a giant marshmallow may feel good when you slip into bed each night, but it’s not doing your back any favors. “If you use a plush mattress or an old mattress, the body tends to sink down, so there’s less support for the spine,” Okubadejo says. The best type of mattress for preventing back pain aside from a new one is one that’s at least medium-firm. A review of studies published in 2021 in the Journal of Orthopaedics and Traumatology suggests that sleeping on a medium-firm mattress not only improves sleep quality, it also reduces the risk of developing low back pain.

Kyle Hilton

9. Your shoes don’t have enough support

Anybody who wears high heels knows they can do a number on your back. Turns out, even sensible shoes can change your gait and lead to back pain if the soles are uneven, which happens when you’ve worn them too long. “Think about your shoes the way you think about your mattress,” Chhatre says. “We talk about the support you need while lying flat; you equally need support while being upright.”

Look for shoes with soles that provide medium firmness and proper arch support. If you wear soft-sole shoes, “you might feel like you’re absorbing some of the impact, but if they’re too soft, you’re introducing instability,” he says. “The nerve endings in your feet provide a sense of balance, but even your nerve endings aren’t going to know how to provide support in a too-soft shoe.”

10. Your stress is eating at you

Stress wreaks all kinds of havoc on the body. No surprise, it can also put the squeeze on the muscles around your spine. “People usually carry stress in the neck and shoulder area,” Chhatre notes. But stress can cause pain to travel farther down the back because of the inflammatory response it sets off.

Say, for instance, you have a torn disc but aren’t showing any symptoms. Chronic stress can provide the “on” switch for the release of inflammation-causing molecules throughout the body. Inflammation, in turn, “opens the floodgates for pain,” Chhatre says.

To fend off this kind of pain, moving is particularly important, Okubadejo says. “If you’re stressed, you may not be as active. If you’re less active, you may have pain, and if you have pain, you’re stressed out.” As far as which exercise is the best remedy, he says it’s all about the “release of endorphins,” whether you opt for a long walk, a short run or strength training. Stretching, he notes, can help take the edge off, too.

Editor’s Note: This story, originally published June 25, 2021, has been updated with additional information.​