Back Pain

What Causes Back Pain?

There are as many causes of back pain as there are letters in the alphabet. The good news is that the vast majority of back pain is mechanical in nature – which means it was caused by a movement or awkward position or something mechanically affecting the back from the outside.  This generally makes this sort of back pain relatively straightforward and relatively simple to deal with. This is not to minimise how uncomfortable and debilitating it can be, but hopefully you can find this reassuring and it can help ease your anxieties.


The most common form of sudden mechanical back pain is a simple muscle strain. A muscle strain is caused by a muscle moving beyond its full length, or contracting and workind at an odd or unusual angle that is not used to working in.

A muscle is made of many of fibres and in a strain some of these fibres get a bit disturbed. the body’s natural repair processes including inflammation cause of the area to get warm and to become a bit uncomfortable. this is designed to help it heal it’s usually takes between 4 and 6 weeks depending on how severe the strain is. Even a very severe muscle strain will repair itself.

Muscle strains can happen anywhere in the back and in fact anywhere in the body. They are extremely common. The more common places in the back for people to experience this type of strain is in the upper back at the back of the shoulder near where the upper part of the shoulder blade approaches the spine – sometimes you can feel this in the neck as well.  Another common spot is in the middle to lower back across the lower part of the ribs, and also where the low back attaches to the pelvis/

How do you know you have a muscle strain? A classic example of a muscle strain is bending over or reaching quickly and experiencing a sharp pain this pain can then be reproduced with that same movement and sometimes casually can also then create a more generalized and diffuse ache around the area. Occasionally the area can be sore to the touch as well. Generally muscle strain pain is eased when the muscle is not being overused or overstretched and typically these strains take between 4 and 6-weeks to heal fully.


You might be wondering what the difference between a sprain and a strain is. As explained above a strain is with as a little bit of destruction of the muscle fibres as a result of a movement. A strain is a disruption of the tissues that attach bones together.  It’s very uncommon for simple daily movements to cause a sprain – ligaments are extremely strong tissues and usually disrupting and require some sort of outside force or trauma such as a fall or an accident.

Even if you do have a sprain please don’t panic!  You’re not going to fall apart. most ligaments particularly the ones in the back are relatively small and there are lots and lots of tissues such as muscles, tendons (the body is quite clever that way setting up multiple redundancies in order to protect you from major injury in minor activitieswhich connect muscles to bone), fascial tissue and other ligaments holding everything together.

The body is quite clever that way. There are multiple redundancies in order to protect you from major injuries during minor daily activities.

What can you do for your sprain or strain?

The worst thing that you can do is simply lay in bed. Bedrest used to be the main advice given to people many years ago before they really understood tissue healing. In order for tissues to heal properly they have to move – and move along with the kinds of movements and experience the kinds forces that the normal tissue has to deal with on a daily basis. If you don’t move the tissues at all – you lie in bed and don’t move because you’re afraid or because it’s a little bit uncomfortable – those tissues don’t experience the forces that they need to experience while they are healing you will develop a blob of scar tissue instead of new healthy tissues that are lined up correctly to perform their job in the future. This could put you at risk of future injury.

Generally speaking if you have a strain or a sprain in their relatively mild you want to make sure that you’re eating well and that you’re getting good sleep. The body tends to heal most during the nighttime hours. During the day you want to perform gentle movements as normally as possible. This might mean that you are not doing the explosive movements that you might do on a sports pitch, if you are a sports person –  but you could probably do things pottering around the house and going to the shops and doing gentle to moderate levels of activity.

No matter your background, the most important thing is to keep the gently moving. This helps promote circulation which brings important healing compounds to the area and help flush out debris and immune molecules that have done their job.  And additionally those very important gentle movement forces help the tissues get the signals they need to line up properly and to heal well for the future.

You pain and movement range should steadily improve. Don’t jump straight back into high levels of activity without gradually approaching that level of activity.

Joint problems

Joint problems are much less common than muscle strains.  A lot of people think that the most common joint problem is something being “out of place”. There is absolutely zero proof that this happens and in fact the evidence suggest the opposite. Joints are extremely tough structures and typically the only way of joint is going to go “out of place” is if you experience of trauma like a high impact accident. In this fine we would call this a spondylolisthesis. Many people have small naturally occurring spondylolisthesis but these are not something that anybody should try to “put back into place”.

Unfortunately over the years many therapists have continued to use this very outdated language which sets people up with a very strong mental image of physical damage which simply isn’t there. This creates fear, which is the number one correlate to the development of persisting pain. This fear also causes people to not move beacuse they are worried about moving – or they have to move in only ‘certain ways’, which inevitably creates more problems.  I want to avoid all of these things by being correct in the terms that I use and explaining them well.

All of that said, the most common joint problems in the back are minor facet joint irritations.  Very commonly a facet joint can become irritated by an awkward movement typically extending the back in some way or extending and rotating it. This typically feels like a sharp pain that takes your breath away which passes very quickly after changing your position – but then sometimes you develop a painful muscle spasm around the area which continues to produce a different kind of discomfort.

What do I do if I have a joint problem in my back?

Typically these joint irritations will fade and resolve themselves within 3 to 4 days. In fact if you come for treatment too soon it can be difficult to impossible to fully assess and treat you because the area is too reactive. Typically when I have had patients with this problem I advise them to wait a couple of days before booking in to see me and to perform the self care activities that provide specifically for them in the meantime. Sometimes comprehensive self care advice is all people need for future managing of these particular kind of joint irritations.

When can back pain be serious?

Obviously any significant discomfort is serious for the person who is experiencing it. What I mean by serious here is a non-mechanical cause for your pain that needs further investigation.

All of the kinds of back pain we’ve discussed so far are mechanical causes that usually come on suddenly and resolve relatively quickly. If you have a pain in your back that has been growing steadily, that’s not alleviated by changing your position, if it’s worse at night,  or if your otherwise unwell you need to get your back pain checked out.  You might find it interesting to read the case study about Mrs S who called me for back pain but who was actually passing a kidney stone. Back pain is most commonly mechanical – but it can be a symptom of many serious conditions –  so if in doubt get it checked out

You should also get checked out if you have any pain or pins and needles in your arms, hands, legs or feet.  If you are experiencing pain down both of your legs or pins and needles or numbness inyour legs or if you’re having difficulty with your bowel or bladder or sexual function or you have numbness in your saddle area you need to go to accident and emergency immediately.

With most types of back pain, osteopathic treatment and sometimes clinical sports massage can help you feel better.  I can also advise you on ways to help prevent it from recurring, and give you strategies to help manage it yourself if it does.  If you have persisting back pain, we can discuss other evidence based strategies for managing chronic back pain in a way that allows you to live your life to the fullest

If you need a medical referral, I’ll help ensure you get the right care. Read more about me, and then book in today for an assessment at either the London or Ascot clinic. 

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I am registered with the following:

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I do not accept AXA/PPP or BUPA or direct bill AVIVA for the reasons outlined here:

I've never been to an osteopath - does treatment hurt?

I use very gentle techniques, and avoid 'the crack' that sometimes people are afraid of.  Sometimes people will experience a little bit of discomfort, but I aim to minimise that -and I'll walk you through what to expect in your situation before asking if you are OK for me to proceed.  You can always tell me to stop if you are not comfortable.

Can I bring someone with me?

Yes! You are always welcome to bring someone with you into your session if you would be more comfortable.  If you are under 18, you must come in with a parent.

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The Kensington Clinic is a large airy room within a modern sports physiotherapy centre, and the Ascot clinic is a residential garden studio.

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