Four Potential Causes of Chronic Back Pain That Often Go Overlooked.  

Back pain is one of the primary conditions that bring our clients thorough our clinic doors in search of answers, pain relief and long-term solutions.

The stats support this: 84% of Canadians have experienced a low back pain episode1,2 and the incidence of chronic low back pain among those who have an episode of acute or subacute low back pain ranges from 34% to 59%.3,4

Generalized advice on “how to cure back pain” abounds, but the reality is that for many of us the true causes of our back pain are multi-factorial and there are many different causes and types of “back pain.”

A thorough assessment with a skilled orthopaedic Physiotherapist can be an excellent first step in the process of finding relief, but as a therapist that is entering my third decade of practice, I’ve learned that a big piece of my role as a healthcare practitioner must entail stepping back, considering and discussing the bigger picture with my clients, and doing the best we can to avoid missing important elements in their overall health.

This role is becoming even more essential with so many of our clients not having access to a primary care physician.

Many of these may not have been traditionally considered when considering the causes of or best treatment plans for “back pain.”

In this post, I’ll outline four additional sources or contributors to back pain that can easily be missed and that may be worth consideration if you have not improved despite receiving treatment that should help an musculoskeletal issue.

1. Your diet.

    Thankfully, this is an area that is getting more of the attention it deserves.

    The fuel we put into our body and our body’s response to that food can manifest in many ways, including pain. Chronic inflammation can create aches and pains in your muscles and joints that feel like they originate there.

    Giving your diet a once over is an excellent idea. There are many professionals availble these days offering dietary advice.

    Personally, I recommend consulting with a Registered Dietician. These are the science-based professionals with a full the full five-year university education in nutrition and are only able to use this term after vigorous training. The term “nutritionist” on the other hand is not regulated and you can call yourself this with as little as a weekend course on nutrition.

    Be selective about who you get your nutrition advice from as there are many fads and dietary advice that is not based on science.

    2. For females, stage of life changes should be considered.

    If you are a woman between 35-55 years old, it’s important to realize that your body is going to go through some big changes during this time of your life that can manifest as back pain in the form of muscle and joint aches, instabilities and injuries.

    Women’s health in the field of Physiotherapy has traditionally been thought of as primarily the treatment of pelvic floor issues, but any practitioner working with women during this period of life should be taking into account that perimenopause (the years prior to menopause during which can occur between the ages of 35-52) and menopause(a year after your last period) involve significant changes in many hormones, primarily estrogen and progesterone.

    This can manifest as joint and muscle aches due to the increase in laxity of connective tissues and a decrease in your body’s ability to manage inflammation.

    In addition to this, after 40 years of age, we begin to lose the ability to maintain and build muscle, which can lead to increased risk of injury.

    Talk to your healthcare providers, specifically your GP or gynaecologist, about the symptoms you are experiencing. They can assist with getting testing done to investigate where you are in your menopausal journey as well as discuss the symptoms you are having and whether it may be an appropriate time to consider treatment. Treatments such as hormone replacement therapy (HRT) may help with your back pain. It’s nothing to be ashamed of, as women we all go through it and it’s time we become more open to acknowledging all of the symptoms that come along with this natural journey of growing older and how to better navigate it.

    There was an excellent podcast recently on The Huberman Lab interviewing Dr. Mary Claire Haver which I highly recommend. You can access it HERE.

    3. Pain Referral from Internal Organs.

    This is an area that, for most physiotherapists, is not traditionally one we have a lot of expertise in. However, referred pain is most certainly something we are aware of and should always keep in mind as a potential differential diagnosis.

    I had one client in the past that ended up having a complete cessation his back pain after having his appendix removed suddenly. There had been no other signs or symptoms prior to this to suggest anything was wrong.

    If something isn’t responding over time to treatment in the way that you and your therapist expect, it may be worth considering, especially if you suffer from any inflammatory bowel conditions.

    4. Your sleeping position.

    There is a lot of talk about sitting at computers for long hour each day, but less talk about sleeping position, despite most of us spending 6-8 hours in these positions each night. The position we sleep in can be a significant contributor to the development of pain and injury.

    Usually, this is an element that most Physiotherapists will address during their initial assessment or at some point later on with our clients, but it is also something that often becomes more of a factor as our clients shift into middle age.

    Younger bodies have connective tissues that are more flexible and fluid and can withstand longer held positions without developing injury as easily. However, as we age, that “favourite sleeping position” may start to create some patterns in your body that lead to over-compressing some areas and/or overstretching others.

    My main intention in sharing these is not to raise alarm, but to encourage both clients and their healthcare teams to think bigger picture when approaching the potentially life-altering condition of chronic back pain and helping clients to receive the best and most appropriate care possible.

    Our team would be happy to help you wherever you are at in your back pain rehabilitation.

    You can book an assessment one of our Physiotherapists HERE.

    Katrina Sovio, Registered Physiotherapist/Clinic Director


    1. Gross DP, Ferrari R, Russell AS, et al.(2006) A population-based survey of back pain beliefs in Canada. Spine 31:2142–5.
    2. Hoy D, Bain C, Williams G, et al.(2012) A systematic review of the global prevalence of low back pain. Arthritis Rheum 64:2028–37.
    3. Henschke N, Maher CG, Refshauge KM, et al. (2008) Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ 337:a171
    4. The Huberman Lab: How to Navigate Menopause. June 3, 2024. Interview with Dr Mary Claire Haver.
    5. The Huberman Lab: How to Eat & Exercise for Health & Longevity. June 24, 2024. Interview with Dr Gabrielle Lyon.