13 Reasons for Chronic Back Pain – So Much Pain 

There are several reasons for chronic back pain. This type of pain is usually age-related but can also result from an injury. It often results from a combination of factors.

Chronic back pain is defined as any back pain that last up to three months or longer. The pain may occur at short or longer intervals with some respite in-between.

This article evaluates 13 contributing factors and these symptoms of chronic back pain. They fall under 4 categories – Biological causes, spine and disc related, bone and joint related, trauma or injury, lifestyle factors, and psychological factors.

Reasons for Chronic Back Pain – Biological Causes

Muscle or Ligament Strain

Overuse or improper use of the muscles and ligaments in the back can lead to strain, which may cause chronic pain. Poor posture, lifting heavy objects, or sudden awkward movements can contribute to this.

Muscle or ligament strain refers to the stretching or tearing of muscles or ligaments, commonly caused by overuse, improper lifting, or sudden movements. Symptoms include localized pain, stiffness, swelling, and muscle spasms in the affected area.

The pain may worsen with movement or activity and improve with rest. Commonly affected areas include the lower back, neck, and shoulders.

Inflammatory Conditions

Inflammatory conditions affecting the spine, such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS), can be reasons for chronic back pain and other symptoms.

Rheumatoid arthritis is an autoimmune disorder causing inflammation in the joints, including those in the spine. Symptoms of chronic back pain in this condition include joint pain, swelling, stiffness, and fatigue.

Ankylosing spondylitis primarily targets the spine’s vertebrae, causing inflammation and eventual fusion. Its symptoms include back pain, morning stiffness, and reduced spinal flexibility. In both conditions, inflammation can lead to irreversible joint damage.

Muscle Imbalances

Muscle imbalances refer to disparities in strength, flexibility, or function between opposing muscle groups or between muscles that work together to perform a specific movement. These imbalances can occur throughout the body, including the muscles that support the spine.

Muscle imbalance induced causes include prolonged periods of poor posture, such as sitting at a desk for extended hours, lack of physical activity or sedentary behavior can lead to weakened muscles.

This typically occurs in the core and back, and if engaging in repetitive activities that predominantly use one side of the body, such as carrying heavy bags on one shoulder.

Imbalances in the muscles surrounding the core, including the abdominal and lower back muscles, can affect spinal stability as certain muscles may be overworked while others remain underutilized.

Muscular imbalances in the pelvic region may contribute to posture issues, affecting the alignment of the spine. Imbalances may result in decreased flexibility and range of motion in the spine, making movements less fluid thereby increasing the risk of strain and injury.

Spine and Disc Related Reasons for Chronic Back Pain

Nerve Compression

Conditions such as sciatica, where the sciatic nerve is compressed, can cause chronic pain that radiates from the lower back down the leg.

Nerve compression occurs when a nerve is compressed or pinched, leading to a range of symptoms. Common reasons for nerve compression induced chronic back pain include herniated discs, spinal stenosis, or conditions like carpal tunnel syndrome.

Symptoms depend on the location and severity of the compression. They often include pain, tingling, numbness, and weakness in the affected area.

For example, compression in the spine may result in sciatica, with pain radiating down the leg. In the wrist, nerve compression may cause hand and finger numbness. Diagnosis involves clinical evaluation and imaging studies.

Herniated Discs

Discs act as cushions between the vertebrae in the spine. A herniated or bulging disc can press on nerves, causing back pain. This condition is more common in the lower back.

A herniated disc, also known as a slipped or ruptured disc, occurs when the soft inner core of an intervertebral disc protrudes through its outer shell. This can result in compression of nearby nerves, causing various symptoms.

Common symptoms include localized back or neck pain, numbness, tingling, and muscle weakness in the affected area. If the herniation is in the lower back, it may cause sciatica, with pain radiating down the leg. In the neck, it can lead to pain radiating into the arm.

Degenerative Disc Disease

As people age, the intervertebral discs can lose fluid and flexibility, leading to degeneration and chronic pain.

Degenerative Disc Disease (DDD) is a condition where the intervertebral discs in the spine break down over time.

These discs act as shock absorbers between the vertebrae. The discs lose hydration, flexibility, and height, leading to pain and reduced mobility.

Symptoms may include chronic low back pain, pain that radiates down the legs, numbness, and tingling. Aside from aging, factors such as genetics, and wear and tear contribute to DDD.

Spinal Stenosis

This occurs when the spaces within the spine narrow, putting pressure on the spinal cord and nerves.

Spinal stenosis is a condition where the spaces within the spine narrow, putting pressure on the spinal cord and nerves, narrowing the spinal canal and may lead to nerve pain. This narrowing can occur in the spinal canal or in the openings where spinal nerves exit the spine.

Spinal stenosis is often associated with aging, as the ligaments that support the spine can thicken and bone spurs may develop. It can also result from conditions like osteoarthritis, herniated discs, or tumors.

The associated symptoms of chronic back pain resulting from spinal stenosis can include back pain, numbness, tingling, and weakness in the legs. In severe cases, it can lead to difficulty walking and problems with bowel or bladder function.

Chronic Back Pain Causes – Scoliosis in Adolescents

Scoliosis is a medical condition characterized by an abnormal sideways curvature of the spine which can cause chronic back pain, especially if the curve is severe. The spine may take on an “S” or “C” shape, impacting posture and overall spinal alignment.

Symptoms of scoliosis can include uneven shoulder or hip levels, a visibly curved spine, and, in severe cases, back pain or respiratory issues due to compression of the chest cavity. Scoliosis often develops during adolescence, and early detection is key for effective management.

Reasons for Chronic Back Pain – Bone and Joint Related


This is a degenerative joint disease that affects the cartilage, which is the protective tissue covering the ends of bones in a joint. It is the most common form of arthritis.

Over time, the cartilage in joints undergoes wear and tear, leading to a breakdown. As a result, bones can rub against each other, causing pain, swelling, and stiffness.

Osteoarthritis can affect the joints in the spine, including the facet joints that connect the vertebrae. As the cartilage in these joints breaks down, it can result in pain, inflammation, and reduced flexibility in the spine.

Common symptoms include localized pain in the affected joints, stiffness, decreased range of motion, and sometimes the formation of bone spurs.


Osteoporosis is a bone disease characterized by the gradual loss of bone density and strength, leading to weakening and susceptibility to fractures. It often occurs as a result of aging, hormonal changes, or deficiencies in calcium and vitamin D.

The disease typically progresses silently without noticeable symptoms until a fracture occurs, most commonly in the spine, hips, or wrists.

Fractures from osteoporosis can result from minor stresses or falls. Individuals may experience a reduction in height, a stooped posture (kyphosis), and back pain due to vertebral compression fractures.

Trauma or Injury

Trauma or a past injury to the spine can result from accidents such as falls, car collisions, or sports injuries. Symptoms of chronic back pain vary depending on the severity and location of the trauma.

Common indications include immediate and intense back or neck pain, limited range of motion, muscle spasms, numbness, tingling, or weakness.

Severe injuries may lead to fractures, dislocations, or damage to the spinal cord, potentially causing paralysis.

Lifestyle Factor Reasons for Chronic Back Pain

Sedentary lifestyles, obesity, and smoking can contribute to chronic back pain.

Lifestyle factors can contribute to chronic back pain. Sedentary lifestyle behaviors, such as prolonged sitting, can weaken muscles and contribute to poor posture, leading to discomfort.

Obesity places extra stress on the spine, increasing the risk of back pain and conditions like osteoarthritis, while smoking is linked to reduced blood flow to spinal discs, impairing their ability to heal.

Lack of regular exercise can contribute to muscle imbalances and overall deconditioning while high-stress levels and poor sleep quality may also exacerbate back pain.

Standing for long hours, especially in jobs that require prolonged periods of standing without adequate breaks, can contribute to chronic back pain. The strain on the muscles, ligaments, and joints in the lower back can lead to discomfort and fatigue.

Factors such as poor posture, improper ergonomics, and lack of movement while standing can exacerbate these issues.

Standing for extended periods may result in muscle imbalances, increased pressure on the spinal discs, and reduced blood circulation, all of which can contribute to chronic back pain.

Furthermore, individuals with existing back conditions or those predisposed to musculoskeletal issues may be more susceptible to the negative effects of prolonged standing.

Psychological Factors

Conditions like stress, anxiety, and depression can exacerbate and contribute to physical discomfort as psychological factors can significantly influence chronic back pain.

Emotional distress may heighten the perception of pain and hinder the recovery process.

Symptoms of chronic back pain influenced by psychological factors can include increased pain intensity, reduced tolerance, and difficulty coping with daily activities. Conversely, chronic pain can also contribute to psychological distress, creating a cycle of pain and emotional issues.

Conclusion – Reasons for Chronic Back Pain

Having exhausted this list of chronic back pain causes, it may sometimes still be impossible to determine the cause of the pain.

As always, your best bet with chronic back pain is to discuss with your healthcare professional to identify the specific cause and develop an appropriate treatment plan.

Treatment may involve a combination of medications, physical therapy, lifestyle changes, and, in some cases, surgical intervention as a last resort.

Related Articles


John Hopkins Medicine (2023) 7 Ways to Treat Chronic Back Pain Without Surgery https://www.hopkinsmedicine.org/health/conditions-and-diseases/back-pain/7-ways-to-treat-chronic-back-pain-without-surgery

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