Lower back pain is a common problem. Almost everyone will experience it at some point in our lives. Some of us will experience it more than once. A common question we get asked is ‘what causes lower back pain’?

Research shows that we can identify specific causes of lower back pain less than 20% of the time. Over 80% of the time we are unable to identify a specific anatomical cause.

We use our back in everything we do. We use it when we get out of bed in the morning. We use it while walking around. We use it while we are at work. We use it doing daily tasks at home. When we have back pain it has the potential to impact every aspect of our day. It’s one of the most common reasons that people take time off work.

People use many different words to describe their back pain. Aching, shooting, stabbing and burning are common feelings described. It is important to remember that the intensity of pain doesn’t always match the severity of what causes lower back pain.

When pain impacts our life in every way we want to know what is causing it so that we can address it. As mentioned, we can identify what causes lower back pain in 20% of cases.


Mechanical lower back pain

The remaining 80% of lower back pain falls into a category called “mechanical lower back pain”. Mechanical lower back pain refers to pain that we can’t attribute to a specific structure in the back. It is also pain that changes based on movement, position, or activities where we use our back. It encompasses almost all the other strains, sprains, and pains that we get in our backs.

Mechanical lower back pain doesn’t show up on an x-ray or a scan. It is also difficult to test for specific structures in the back. When we move, all the structures in our back move. It is difficult to say with certainty which specific structure causes lower back pain. We have tests that are helpful for identifying problems that need urgent attention.


Even though we are unable to identify specific causes of lower back pain in over 80% of cases, we can still treat it. Your physiotherapist will perform a thorough assessment. Then based on your symptoms, will come up with a tailored rehabilitation plan.

This rehabilitation plan will address ALL the factors that contribute to your pain and recovery.

  • How you move
  • How you work
  • How you sleep
  • Your stress levels
  • How you interact with your environment
  • The medication you take

Most back pain resolves within 6 to 12 weeks when we address the factors which contribute to it.

Do I need a scan?

In most instances an x-ray or scan is not helpful for helping your pain. In over 80% of cases it won’t show an anatomical cause for your lower back pain. X-rays and CT scans deliver a dose of radiation to the area they are imaging. If a scan is unlikely to provide useful information then it is best to avoid.

There are some times when an x-ray or scan is necessary.

  • If you are having problems with your bladder and bowel function
  • If your pain is the result of a fall or blow to the back and your physiotherapist suspects you may have a fracture.
  • If you have leg pain that isn’t resolving after 6 weeks.

Your physiotherapist will be able to discuss these with you and refer to the appropriate pathway should you need an x-ray or scan.

What to do

If you have lower back pain, your health professional may not be able to identify a specific cause for it. This doesn’t mean that you won’t get better, most back pain resolves in 6 to 12 weeks.

Your physiotherapist will perform a thorough assessment. Then will develop a rehabilitation plan with you. This plan will address all the factors that contribute to your pain. They will be able to guide you if you need an x-ray, scan or a referral to another specialist.