Back pain is incredibly common with 619 million people worldwide as living with low back pain in 2020, estimated by the WHO, making it the leading cause of disability globally.

Sometimes, the reason for an aching back seems obvious. Perhaps you lifted something awkwardly, did more in the garden than usual, returned to exercise after a break or spent several hours sitting in the same position. A muscle strain can leave you feeling sore, stiff and tender, but you would generally expect things to gradually improve.

But what if they don’t? What if the pain keeps returning, starts travelling elsewhere, or you’re increasingly relying on painkillers just to get through the day?Sometimes it’s the pattern around your pain, rather than the pain itself, that tells you it’s worth taking a closer look.

What Does a Back Muscle Strain Usually Feel Like?

A muscle strain happens when muscle fibres are overstretched or injured. In the back, this can cause localised pain, tenderness, stiffness or discomfort when you use the affected muscles.  There may be an obvious trigger, such as lifting, exercising or making a sudden movement, although that’s not always the case.

Most importantly, uncomplicated muscular pain would generally be expected to show a trend towards improvement. You might still have good days and bad days, but gradually you’re able to move more comfortably and get back to your usual activities.  If that isn’t happening, there may be other factors worth considering.

1. Your Back Pain Keeps Coming Back

Does your back settle down for a while, only for exactly the same problem to return a few weeks or months later?  You’re certainly not alone. Recurrence is common following an episode of low back pain. Research published in The Lancet found that around 7 in 10 people who recovered from an episode of low back pain experienced another episode within the following 12 months.

It can be tempting to treat every flare-up as another isolated strain. But when something repeatedly returns, it’s worth looking at the bigger picture.  Factors such as strength, mobility, the way you’re moving, changes in activity, your working environment and the physical demands you’re placing on your body may all be relevant.  Instead of only asking “Where does it hurt?”, it may be time to ask “Why does it keep happening?”

2. The Pain Travels Beyond Your Back

A straightforward muscle strain will often feel relatively localised. Pain that travels can be different.  For example, lower-back symptoms may sometimes be accompanied by pain, tingling, numbness or unusual sensations extending into the buttock or leg. Neck problems can similarly be accompanied by symptoms around the shoulder or into the arm.

There are several possible explanations for these symptoms, and experiencing them doesn’t automatically tell us what is causing your pain.  However, if you’re experiencing persistent radiating pain, numbness, tingling or weakness, it’s worth getting appropriately assessed rather than assuming you’ve simply pulled a muscle.

3. You’re Having Regular Headaches as Well as Neck Pain

Back pain isn’t the only ache that can become part of the background of everyday life.  If you’re regularly experiencing headaches alongside neck pain, stiffness or restricted neck movement, don’t automatically dismiss the two as unrelated.

Headache disorders are extremely common. To reference The World Health Organisation once more, it estimates that around 40% of the global population – approximately 3.1 billion people – were affected by headache disorders in 2021.

There are many different causes and types of headache. One of these is cervicogenic headache, where pain is referred from structures in the neck and felt in the head.  That doesn’t mean that neck pain is responsible for every headache. Far from it. But if headaches are becoming a regular occurrence and you’re also experiencing problems with your neck, having the whole picture assessed can be more useful than simply accepting recurring headaches as normal.

A sudden, extremely severe or unusual headache, or a headache accompanied by symptoms such as weakness, confusion, problems speaking or significant changes to your vision, requires urgent medical attention.

4. You’re Regularly Reaching for Painkillers

Taking appropriate pain relief occasionally is very different from realising that painkillers have quietly become part of your normal routine.  Perhaps you need them to make sitting at your desk manageable. Maybe you’re taking them before exercise, relying on them to get to sleep, or automatically reaching for them whenever your neck or back begins to ache.  Pain relief can have a useful role, but regularly needing medication to manage recurring symptoms is a good reason to consider what is driving those symptoms.

This is particularly relevant for people experiencing frequent headaches. The NHS warns that taking painkillers too often can itself cause medication-overuse headaches, creating a cycle in which medication taken for headaches can ultimately contribute to them becoming more frequent.  If you’re frequently using painkillers, don’t suddenly stop prescribed medication. Speak to your GP or pharmacist for advice about your medication, while also considering whether the underlying musculoskeletal symptoms need assessment.

5. Rest Helps – Until You Start Moving Again

You’ve rested your back. It feels better.

Then you return to work, start exercising again, spend a day gardening or simply get back to normal life – and the pain returns.  When this happens repeatedly, taking another few days off may not address the reason symptoms keep coming back.  For most uncomplicated low back pain, current guidance encourages people to remain active and continue normal activities as far as possible, rather than spending prolonged periods resting in bed.

The important question may therefore be what happens when your body is asked to move and cope with normal loads again.  If certain movements or activities repeatedly trigger the same symptoms, an assessment may help identify areas of strength, mobility or function that could be contributing.

6. You’ve Started Changing the Way You Move

Sometimes we adapt to pain without really noticing we’re doing it.  Perhaps you’ve stopped bending normally and now crouch carefully to pick something up. You might turn your entire upper body instead of rotating your neck, favour one side when walking or standing, or avoid certain exercises because you’re worried about setting the pain off again.

Initially, those adaptations may simply be your body’s response to something that hurts.  But if you’re still moving differently weeks later, or your world is gradually becoming smaller because of the things you’re avoiding, that’s worth paying attention to.  Pain is important, but so is function. Looking at how comfortably and confidently you’re able to move can provide useful information about what’s going on.

7. It Isn’t Improving as You’d Expect

Recovery isn’t identical for everyone, so there isn’t a single deadline by which every sore back should have disappeared.  What matters is the overall direction.

Are you gradually able to do more? Is movement becoming easier? Are episodes becoming less intense or less frequent?  Or has nothing really changed?

Persistent pain, worsening symptoms or discomfort that continues to interfere with your work, exercise, sleep or everyday activities shouldn’t simply become something you learn to live around.  Sometimes, getting it assessed can help you understand what may be contributing to the problem and what you can do next.

When Back Pain Needs Urgent Medical Attention

Most back pain isn’t caused by a serious medical condition. However, there are symptoms that shouldn’t wait for a routine chiropractic or physiotherapy appointment.

Seek urgent medical advice if back pain is accompanied by symptoms such as:

• New loss of bladder or bowel control
• Numbness around the genitals, buttocks or saddle area
• Significant or rapidly worsening weakness or loss of sensation
• Severe pain following significant trauma
• Fever or feeling significantly unwell alongside your back pain

These symptoms don’t necessarily mean that something serious is wrong, but they do require appropriate medical assessment.

Stop Treating Every Flare-Up as a Separate Problem

An aching back after an unusually strenuous weekend may simply settle and disappear.

But recurring pain, symptoms that travel, restricted movement, regular headaches alongside neck problems or an increasing reliance on pain relief can all be reasons to stop looking at each episode in isolation.

At Avalon Chiropractic, you can book an appointment online with one of our chiropractors or our physiotherapist. Both can assess musculoskeletal problems, although the approach to assessment and treatment may differ depending on which service you choose.

If you’re unsure which type of appointment would be most suitable for what you’re experiencing, you can contact the clinic before booking and our team can help point you in the right direction.  Because sometimes the most useful question isn’t simply:

“How do I make this pain go away?”

It’s:

“Why does it keep coming back?”

Sources

• World Health Organization – Low back pain (2023)
• da Silva T et al., Recurrence of low back pain is common: a prospective inception cohort study, Journal of Physiotherapy (2019)
• World Health Organization – Headache disorders (2024)
• NHS – guidance on headaches and painkiller/medication-overuse headaches
• NICE – guidance on low back pain and sciatica