Why does my back hurt?

Back pain is one of the common ailments suffered today. In fact, almost 20% of the entire Singapore population suffers from back and neck pain at any one point in time.

Despite it being such a common ailment, determining the exact cause of back pain is often difficult. By breaking down back pain into stages, Physiotherapy treatment and Core Stability training can help alleviate pain and work towards preventing recurring back pain over the long term. Today, conservative treatment is able to resolve some 95% of back pain cases when attended to at the right time. Only 5% of patients really need surgery.


Complex interplay of structures

Your back is a complex supporting assembly, made up of a set of interacting structures such as joints, discs, ligaments, nerves, vertebrae and muscles. Pain is rarely a result of just one of these structures failing. More often than not, it is a combination of physiological and environmental conditions. Unless you address these conditions, you can expect recurring back pain. 

This makes treating back pain a challenging problem. The cause of back pain is normally multi-faceted, requiring a multi-pronged treatment approach. It is therefore necessary to accurately assess and treat the underlying cause and contributing factors in stages. Before we look at the different stages, it is important to understand first why your back hurts.

Why does your back hurt?

A common direct cause of back pain is the stress we place on our spine. To get an idea of the amount of pain that stress can cause, bend your index finger as far as it can go, away from the palm of the hand and hold it there. How does it feel?  Now think about how the same happens to your spine when you sit slouched for long periods at a time, bend over to pick something up or play sports, like golf.

The repeated and prolonged stress that is placed back affects our spine structures in a whole lot of different ways. It may cause our discs to bulge, our ligaments to over-stretch, muscles to strain and joints to wear down a lot quicker.

Your spine is capable of a great deal of movement. However, to keep that mobility and freedom, all of the structures must work together smoothly and efficiently, like a ‘well-oiled machine’. Pain arises when one of these parts fails, such as when a bulging disc, bony spur or inflamed ligament irritates or traps a nerve.

Good Back Health

In order to have good back health, the spine needs to be mobile in all its segments, not stiff or excessively loose. The muscles around the spine, hips and legs should be strong, flexible and balanced.  Whenever there is poor alignment, weakness, tightness or imbalance in these areas, the spine is vulnerable to injury.  This instability, better known as “core instability” often predisposes to back pain.

Poor core stability amongst low back pain sufferers

Studies have found that sufferers of chronic low back pain have delayed contraction of the deep abdominal muscles with movement. Subjects in the study without back pain were able to activate the core muscles first, in anticipation of movement, showing that deep abdominal muscles or core muscles served to stabilise the spine.

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The activation of the core muscles is effective in relieving back pain and preventing recurrences by providing the necessary support. Exercises that improve the strength and control of these deep core muscles are known as core stability exercises.

Three stages back pain

There are 3 different stages to back pain – acute, sub-acute and chronic. It is important that you seek the appropriate treatment for each stage.

Acute stage (The first few days) 

In the first few days of a back pain episode, the main objective is to relieve pain and inflammation.  Physiotherapists perform gentle hands-on techniques and teach the patient pain-relieving postures and exercises that reduce pressure on the painful structures.  They may sometimes use Traction to relieve nerve compression. To release a locked segment of the spine, it is important to note that only some physiotherapists trained in manipulation are able to do so safely. 

Physiotherapists also relieve pain and inflammation using special machines such as shortwave treatment (deep heat), interferential therapy (involving cross electric currents), ultrasound (using ultrasonic waves to promote healing) and TENS (Transcutaneous Electrical Nerve Stimulation – electric stimulation that blocks pain impulses to the brain).  

Sub-acute stage (from 3 days to 3 months) 

When the pain and inflammation have subsided, this is the time to mobilise stiff spinal joints, restore correct alignment, stretch tight muscles, strengthen weak muscles and start on a core stability programme.  The goal at this sub-acute stage is to restore a flexible and balanced, yet strong and stable spine.  If imbalance and weakness remains, the pain will take longer to resolve and chances of injury reoccurring are very high.  It is important to address contributing factors such as flat feet, poor ergonomics or sporting technique. 

Chronic stage (more than 3 months) 

When the pain has lasted so long, there are usually mal-alignments and biomechanical factors that have not been properly addressed.  The spine or pelvis may be out of alignment or causative factors may still be present, for example working on a laptop for long hours.  Pain-sensitive scar tissue will have built up over time because of the repeated injury and this will need to be broken down by deep tissue massage.  The core muscles, which act like a natural corset, are likely to be switched off and will need to be re-activated through core stability training.

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Creative Commons LicenseThis work by Core Concepts - Musculoskeletal Health Group is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Singapore License. This article was contributed by Singapore's Largest Physiotherapy Group - Core Concepts. In the spirit of promoting health education, you may copy, distribute and transmit the work under the conditions specified by the license. For articles re-printed with permission, copyright remains with the original copyright holder (author or publisher). Core Concepts's Creative Commons License does not apply in such cases.


  • Superman

    Yes… my back often in pain. And I think one of the solution is to sleep with a good bed. The mattress is the solution. Any recommendation?

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  • cindy.tan

    Dear Superman,

    I do agree with you that sleeping on a good bed is one of the solutions for back pain sufferers but it is not the only solution as there can be various contributing factors to back pain other than the bed.

    When choosing a mattress, select one that is firm enough to provide good support and alignment. Stomach sleepers would require firmer mattresses than back and side sleeper. Mattresses with convoluted foam usually provide sufficient support and comfort. Most importantly, try out mattresses for personal comfort before purchasing. Specialty memory foams and custom options are not always the most comfortable choice.

    If the pain persists even after changing the mattress, you might want to consider consulting a specialist to find out the cause of your back pain.

    Best Regards,
    Editor, MCR

  • karl

    my back hurt so much i don’t know what do do. . is this because i use computer all the time? i work in my computer for almost all the time. . . plz answer me . . thanks. .

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  • tazz73

    all sound easy but here in nsw of australia,the worker compensation is so much of a mess that workers doesnt get the right treatement on the right time.i have a back injury since 8 months,being to two physios,one was mc kenzy ,and i still have problems with pain.i done pool therapy,and doesnt feel better. the therm musculoskeletal is too complex ,doctors here doesnt know what to do,doesnt communicate either.

  • http://www.bestmattressreviews.com Zach Smith

    Back pain can be induced or alleviated by mattresses. If you are using a lumpy and uncomfortable mattress, you can experience back pain. Since comfort preferences are different from person to person, it is better to personally pick your mattress from the store so you can try it out. Firmer mattresses like memory foams can provide better back support for upper back pain sufferers. However, semi-firm mattresses prove to be better choices when it comes to lower back pain. You should know first your body type and your comfort preferences when you are buying so you can find the most ideal mattress for your sleep needs.

  • revolution9

    I always get back pains if I sleep in an uncomfortable bed

  • Erin Baird Holley

    My back hurts so much to where I can’t sit down or even hold my two boys! I can take Tylenol, aspirin, every NSAIDs there is on the market to help with the pain and it seems to ease up some but the pain  always comes back ten times worst. I have gotten X-rays, CT Scans everything and they can’t ever find the reason why I am in so much pain.. Someone please help…. 

  • Dfhaha

    just workout and smoke weed? haha

  • Aly9468

    My backpack has been super heavy throughout the whole day because I don’t have time to go put away some books in my locker. My classes are wayyy too far apart and my back is really hurting. What can I do? ): I don’t have any time between classes to put away my books. And my horrible bus driver is always late!

  • Sarbottam Bhagat

    i do have the similar problem as that of yours. i take muscle soothing pills and some pain killers. but the pain comes back much worse. X ray wont show anything unusual with the bone.

  • NRC

    Any work that involves leaning forward can cause backache. Research the best chairs and positions for working at a computer. Hoovering with a non-upright hoover or doing lots of work at the kitchen sink can also trigger it.

  • NRC

    I have a portable memory foam mattress topper that I take with me when I stay with other people. It is soft but supportive and really helps.

  • Sue

    Have you tried physical therapy? The good thing is that they can evaluate how your movements and posture help or instigate the pain. There is also something called a TENS unit. It uses light electrical activity to help with the pain. Those two combined are so helpful for chronic pain. Good luck.

  • Physiotherapy

    Yes, I am absolutely certain. I have not read it but it does look interesting.

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  • Iness

    Most of the time people hurt their back doing something simple like bending over to tie their shoes, or trying to get out of the recliner…or God forbid…they injure themselves sleeping! Things like that are NOT traumatic events and they shouldn’t ever cause your back to “go out.” They are really just an indication of a bigger underlying problem that you can correct right now http://the-natural-way.info/best-natural-back-pain-cure.php