Back pain is the great leveller. It can floor anyone and everyone, from elite cyclists to desk workers. It’s so common, in fact, that the most recent figures (2024) compiled by the UK's Office for National Statistics (ONS) revealed 2.9m people had problems linked to their back or neck, up from 2.6m in 2019.
Not surprisingly for anyone who’s ever suffered back pain, it’s not one single problem but an umbrella term for a whole family of conditions, each with its own triggers, symptoms and fixes.
That could be a sharp twinge between the shoulder blades or a dull, radiating ache that travels down your leg.
Understanding the source is not only key to recovery but to preventing it happening in the first place. Here, we reveal five of the most common culprits, what causes them and what you can do to ease the pain and keep your back moving freely.
Thoracic facet joint pain
What it feels like
This is pain from the spine, nestled between the shoulder blades, and can be anywhere from T1 to T12 of the thoracic spine (the spine is divided into five sections, of which the thoracic spine is one). The thoracic spine has 12 vertebrae – but is particularly common from T3 down to T6.
“The pain can be sharp, especially when you twist, and stems from a tightening of back muscles, including the rhomboids, erector spinae and trapezius,” says Somerset-based osteopath Ben Palmer.
“Because these muscles assist pulling, lifting and keeping our head upright, the pain might present itself as a shoulder issue, but it’s actually an upper-back problem.”
Why it happens and who’s at risk
“Poor posture’s a key one," says Palmer. "If your job is desk-bound or you’re a keen cyclist, you could be susceptible. It’s because your head is like a bowling ball, so if you’re crouched over for periods of time, that weight transfers down the neck through the back, creating stress.”
Over time, you develop a hunch, which can irritate the thoracic facet joints. These have little capsules [a cellophane-type cover to provide stability] around them that produce synovial fluid to nourish and lubricate the joint, but when the joint is inflamed, this fluid can become viscous, restricting movement.
It could also be because the joint’s out of position, so one side is stuck and the other isn’t."
How to fix it
“Seeing an osteopath or chiropractor is the way ahead," Palmer explains. "A masseur can help, too, albeit sometimes you’ll need to dig deeper than the muscles and into the joints.
"Specific exercises help. These include knee to chest, where you lay on your back and gently tighten your abdominal muscles, lifting both knees towards your chest.
"Hold for 30 to 60 seconds and relax. Rolling up a towel, placing it between your shoulder blades, before leaning over for a spot of self-massage, helps too.”
Stop it happening again
“If you’re on a computer all day, you need to reset," says Palmer. "That means sitting up straight and pulling your shoulder blades back.
"Hold for up to 10 seconds, then relax. Do this regularly throughout the day. It fires up the muscles of the back, which really helps.
"How you position your screen matters, too. Your monitor should be at eye level and your spine should have a gentle, natural curve rather than completely upright and straight.”
Sciatica
What it feels like
Sciatica refers to the pain that shoots down the sciatic nerve – the largest nerve in the body – which manifests itself as tingling or numbness of the back or bottom that may radiate down your leg.
“Often, the root cause of the pain is that the nerve’s inflamed. That might be down to muscle tightness irritating the sciatic nerve,” says Palmer.
“A bulging disc at the base of your spine’s also a culprit. Or it could be that your joint is arthritic or suffering stenosis, which is a narrowing of the aperture where the nerve comes out.
"Finally, sciatica can also strike when the nerve is caught on the head of the hamstring or scar tissue.”
Why it happens and who’s at risk
Do you sit all day? Work in an office? Are you a lorry driver? Then you’re potentially vulnerable because one of the causes is sitting for long periods. So, poor posture is bad, as is lifting heavy loads, such as sacks of compost.
How to fix it
“Nerves like being stretched. If you’ve got tightening in the buttocks or the hips, which is irritating that nerve, a good stretch offers great relief. Sitting on a ball in the sore buttock area can help, too.”
That said, like the others, you should seek out an expert first because if the cause of your sciatica is a popped disc, stretching could make it worse.
“The ‘straight leg raise test’ should establish whether the sciatic nerve might be pinching on a disc. If it’s a disc issue and you have private health care, get it scanned.
"You can ask the NHS [in the UK], who may scan it but will probably wait first to see if the symptoms calm down.
"That is unless you’re enduring severe symptoms including a loss of sensation around the genitals, which we call ‘cauda equina’. Thankfully, that’s uncommon.”
Osteopathy, chiropractic and physiotherapy can be effective for certain types of sciatica, particularly if it’s in the muscles.
Stop it happening again
Moving around and exercise really helps, although be mindful that if your disc is the problem, the shock of running can make things worse.
Stretching can also be beneficial. Strengthen your core muscles because they weaken from sitting. “Gym work is good but just note that lifting really heavy weights can cause disc problems, especially deadlifts if you don’t do them properly,” says Palmer.
Sacroiliac joint dysfunction
What it feels like
The sacroiliac joint sits where the pelvis and lower spine meet, with joint pain presenting itself as pain and stiffness in the buttocks or lower back, though the pain can also spread down one or both legs.
“This one’s quite hard to diagnose because its symptoms may mimic a range of other conditions like facet joint arthritis,” says Palmer.
Why it happens and who’s at risk
This pelvic joint acts as a shock absorber for the upper limb, transferring forces between your sacrum and your pelvis, plus down your legs.
“It can naturally loosen during pregnancy to allow the passage of a baby, which is why it’s quite common to have problems when carrying a baby,” Palmer explains.
“It’s easy to sprain or strain, which is often down to lifting or even shovelling. Sitting is another major irritant, especially if you have poor posture.
"I’ve also seen it with golfers, particularly older players who naturally stiffen over time. They should focus on thorough warm-ups.”
How to fix it
“Sacroiliac joint pain responds wells to osteopathy, chiropractic or physiotherapy. There are specific sacroiliac joint exercises,” says Palmer.
Trunk rotation is one example. You lie on the ground with your feet flat on the floor and arms out-stretched in a T-position.
Place your knees together, pointing to the ceiling. Then, with your shoulders pressed against the floor, drop your knees to one side as far you can comfortably. Perform 10 times on each side.
Stop it happening again
“Key preventatives include regular stretching in that area, plus keeping core and glute muscles strong,” says Palmer. Focusing on the deep muscles that support the pelvis is of benefit.
This includes single-leg bridges, clamshells and monster walks to prevent pelvic drop and rotation; hip thrusts and deadlifts to stabilise the posterior chain; and plank with knee taps to crank up pelvic stability.
Femoral nerve radiculopathy
What it feels like
This condition results in pain, numbness, tingling or muscle weakness that radiates from the back down to the groin and thigh.
“It’s caused by an irritated or compressed nerve, and I see it often in the older demographic where it radiates into the upper thigh and glutes muscles,” says Palmer.
The problem occurs at or close to the nerve root as it branches off from the spinal cord.
Why it happens and who’s at risk
Ageing is a significant cause, especially if you have arthritis. It’s due to a narrowing of the joints caused by a build-up of bone, which is down to deteriorating cartilage that helps the joints slides across each other smoothly.
Over time, this wears down and works its way to the bone, which then grows rougher than before. This can irritate.
Being overweight, pregnant or having bad posture are key causes, too. As are long periods of sitting, which can irritate the nerve in your groin beneath what’s called the inguinal ligament that travels down your leg.
“Repetitive lifting is another big cause," says Palmer. "You see that in builders who might be laying bricks and plumbers leaning forwards to sort out your pipes. That repetitive nature continuously focuses pressure into your back, resulting in weakness.”
How to fix it
Like all of these issues, you should seek formal diagnosis from a health expert first. Once cleared for movement, gentle progressive exercises under the guidance of the expert should reduce irritation, restore mobility and build strength.
One good exercise is ‘nerve mobilisation’ or ‘flossing’. You lie on your side with the affected leg on top. Bend your knee back toward your glutes (as if stretching the quad). As you bend the knee, tuck your chin in to your chest.
Then straighten your knee slightly while lifting your head up (extend neck). Perform 10–15 slow reps once or twice a day.
Stop it happening again
Strengthening your core helps, but see this as strengthening your whole body, not just seeking a six-pack. Exercising three times a week is good.
“I’m a fan of martial arts, especially in the morning. There’s something about training early that awakens your nervous system.
"Your movements are clearer, which means you’ll be sub-consciously more proactive to situations that could cause problems, like lifting from the knees, not bending from the hips.”
- Read more: Follow this free strength-training plan twice a week to avoid injury and get stronger on the bike
Lumbar facet irritation syndrome
What it feels like
The facet joints are the links between the bones of the spine, enabling you to bend and twist. Injury to one or more of the facet joints causes a chronic, dull pain that worsens with extension and rotation.
Stiffness of the back is common and is why you often see people struggling with his condition buckled forward as if their backs have gone.
“Spasms are also common,” says Palmer. “In fact, it’s a strange trait that people who have spasms tend to have more of them.
"It’s like the nervous system normalises spasms. The muscles around your hip area tighten up and pull you forwards and to the side, which is why it’s a struggle to straighten up.”
Why it happens and who’s at risk
“Prolonged extension or rotation is one of the main causes, which often happens in sport,” says Palmer. For instance, it could be golf, which has significant turning component.
"Road cycling, where you’re stretched out and might hyperextend, might be an issue, too. “Like many back issues, ageing and poor posture are common causes.”
How to fix it
A chiropractor, osteopath or physio might be able to unlock and open the joint depending on how chronic and severe the symptoms. But you may need referral for an X-ray. Stretching and low-impact exercise such as walking and swimming should help.
Stop it happening again
Similar to the other conditions, regular exercise helps, especially strength work. Pilates, martial arts… they’ll all bolster your back.
“The gym’s great, too, but beware of overly heavy weights. They can cause more harm than good if your form’s not great and the workload’s too much.
"Hence, pilates – a bodyweight exercise – is so beneficial. Pilates taps into your hamstrings, core, upper back, arms and neck muscles. It’s about supporting yourself, which seems to be much better for your back.”
