Hundreds of Possibilities — But the Same Few Keep Coming Up
There are hundreds of things that can cause lower back pain. Hundreds. But the truth is, in clinic, the same few come up again and again. So rather than overwhelm you with a giant list, I’m going to give you the four most common causes of lower back pain I actually see — and, more importantly, how each one shows up in real life, so you can listen out for the one that sounds like you.
These four are pathology-based, which simply means they’re about the structures in your back. There’s a whole other side to this — the mechanical causes, the movement patterns and habits that drive pain — and that’s worth its own article. But these are the four big structural ones, and learning their patterns is genuinely useful.
One important note before we start: this is to help you understand what might be going on and spot your own pattern. It’s not a diagnosis. Backs are individual, and the only way to know for sure is to get assessed properly. Use this as a guide to point you in the right direction.
Cause 1 — A Disc Problem
The first, and one of the most common, is a disc problem — a disc bulge or herniation. Your discs are the cushions that sit between the bones of your spine, and when one bulges or herniates, it irritates the structures around it. That irritation is where the pain comes from.
But what really matters to you is how it shows up. With a disc, people really struggle with bending forwards. Putting your socks on in the morning becomes a real problem. Leaning over the sink, picking something up off the floor — that forward bend is the thing that flares it.
And there’s a classic one I hear all the time: pain when you roll over in bed. People tell me they dread turning over in the night because it catches them every time. So if bending forward and rolling over in bed are your worst movements, that points towards a disc.
Cause 2 — Facet Joint Degeneration
The second is facet joint degeneration. Don’t let the name put you off — the facet joints are simply the small joints at the back of your spine that let it move and bend. When those joints get a bit worn or irritated, they behave almost the opposite way to a disc.
So instead of bending forwards being the problem, it’s arching backwards and lying on your front that winds it up. And the really classic sign here is morning stiffness. You wake up stiff and achy, it takes a while to get going, it eases as you move through the day, and then it can creep back in.
So the typical facet joint picture is: stiff first thing, sore when you lean back or lie on your front, and loosening up once you get moving.
Cause 3 — Spinal Stenosis
The third is stenosis, which simply means a narrowing — in this case, a narrowing of the space where the nerves travel in your spine. This one has a really telling pattern, almost a giveaway.
People with stenosis tend to feel better sitting down and worse when they’re standing and walking. So it’s the opposite of what you might expect — being on your feet is what brings it on. They often get a lot of pain into the buttocks and legs, as well as the lower back, the longer they’re upright. And a classic tell is relief when they sit, or when they lean forwards onto something, like leaning on a shopping trolley.
So if standing and walking are your enemies and sitting brings relief, that points towards stenosis.
Cause 4 — A Stress Fracture
The fourth one is a bit different, because it affects a younger group, and it’s one we see a lot in clinic that often gets missed. This is a stress fracture in the spine, sometimes called a pars fracture.
We tend to see it in active teenagers and young adults — the ones playing a lot of sport, with lots of repetitive bending and arching. Fast bowlers in cricket, gymnasts, footballers, dancers. The pattern here is back pain brought on by activity and by arching backwards, in a young, active person.
So if you’ve got a sporty teenager with persistent lower back pain, especially pain that’s worse with arching and sport, this should genuinely be on the radar. It’s important not to miss, and it often is, so it’s well worth getting that one properly checked.
Bringing It Together — Which One Sounds Like You?
So those are the four most common causes of lower back pain, and the patterns are what matter. A disc is worst bending forward, putting socks on, and rolling over in bed. Facet joints are stiff in the morning, worse arching back and lying on your front, easing as you move. Stenosis is better sitting, worse standing and walking, with pain into the buttocks and legs. And a stress fracture is back pain with activity and arching, in a young, active person.
You might already be hearing the one that sounds like you. But remember — these overlap, they can happen together, and this is a guide, not a diagnosis. If your pain is persistent, getting it properly assessed is what turns “I think it might be this” into a clear answer and a plan.
And there’s one more thing worth knowing. These four are all about the structures — the pathology. But very often it’s the way you move, sit, and load your back that’s actually driving the problem in the first place. That mechanical side is the natural next thing to understand, because the habits and movement patterns you can’t see are often what quietly keep you in pain.
Joe Sharp
BSc (Hons) Physiotherapy
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