Back pain that has lasted longer than about three months is usually called chronic, or persistent, back pain. It is common, and it is one of the main reasons people come to see us. If you are reading this, the chances are you have already tried resting it, stretching it and waiting for it to pass, and you want to know why it is still there.
The answer is rarely a single cause. This article explains what tends to keep back pain going, the less common causes worth knowing about, and what the evidence says helps.
What chronic back pain usually is
For most people, persistent back pain is what clinicians call non-specific low back pain. That means the pain is real, but it cannot be traced to one damaged structure such as a single disc or joint. It also means it is very unlikely to be caused by anything serious.
This can be frustrating to hear if you were hoping a scan would show the answer. In practice, scans often show age-related changes, such as disc bulges and wear in the joints, in people with no pain at all, so a scan finding and a pain do not always match. A careful history and physical assessment usually tell us more.
Common reasons back pain persists
Several things tend to overlap. Most people recognise more than one of these.
- Doing less. When your back hurts it is natural to move less and avoid things. Over weeks and months the muscles that support the spine lose strength and stamina, and ordinary tasks begin to feel harder.
- Doing too much, too suddenly. A weekend of gardening, a new exercise class or a long drive can ask more of your back than it is currently used to, and it flares.
- Long periods in one position. Sitting is not harmful in itself, but hours without moving often leave a back stiff and sore. Changing position regularly matters more than holding a perfect posture. We wrote more about this in why your back hurts after sitting at a desk all day
- A sensitive system. After months of pain the nervous system can become more protective, so that movements which are safe still hurt. Poor sleep, stress and worry about the pain can all turn this up.
- An earlier injury. A strain or fall may have healed, while the stiffness, weakness and guarded movement that followed it remain.
Less common causes
A smaller number of people have a more specific reason for their pain. These include:
- An irritated nerve in the lower back, which can cause pain, tingling or numbness travelling down the leg. This is often called sciatica.
- Narrowing of the spinal canal (spinal stenosis), which tends to cause leg pain or heaviness when walking that eases when you sit or bend forward.
- Inflammatory conditions such as axial spondyloarthritis, where stiffness is typically worst in the morning, lasts more than half an hour and eases with movement.
- A fracture related to osteoporosis, particularly in later life.
Part of a first appointment is checking for signs of these, and referring you to your GP where further tests are needed.
Symptoms to have checked promptly
A few symptoms alongside back pain need urgent medical assessment because they can be signs of pressure on the nerves at the base of the spine (cauda equina syndrome): numbness around your genitals or bottom, new difficulty passing urine or controlling your bladder or bowels, or weakness in both legs. Back pain with a fever, unexplained weight loss, or after a significant fall or accident should also be checked. The NHS guidance on back pain explains what to do.
What helps
National guidance for persistent low back pain recommends staying active, exercise that suits you, and manual therapy alongside exercise rather than on its own. In practice that usually means:
- Understanding what is and is not going on, so that movement feels less threatening.
- A graded strengthening and mobility programme, built around what you need your back to do.
- Hands-on treatment, where appropriate, to ease pain and stiffness while you build up.
- A plan for flare-ups, because they are common and do not mean you are back at the start.
Progress with long-standing pain is often gradual, and most people find it comes from steadily doing more rather than from any single treatment.
How we can help
At The Health Hub, back pain is assessed and treated by our physiotherapists, chiropractors and osteopaths. We match you with the clinician whose skills best fit your problem, and if you are not sure who to see, our guide to the difference between a chiropractor, an osteopath and a physiotherapist may help. Your first appointment includes a full assessment, an explanation of what we have found and a plan you can start that day.
Written by Sam Pargeter, chiropractor and co-founder of The Health Hub.