Whether it’s running to catch the bus, picking up a cup of coffee or getting into bed after a long day, for people with back pain, even the most routine of movements can be a struggle.
But what if the pain isn’t coming from your back at all?
Back pain is the single leading cause of disability in the world, according to the World Health Organisation, and in the UK alone, musculoskeletal disorders are claiming over 12 million working days a year.
But experts say it’s not just as simple as taking a couple of painkillers, back pain may be a red flag for other major health issues – with research pointing to a connection between the health of our backs and an array of bodily systems, from our guts to our hearts.
New research shows the incidence of conditions such as heart disease, digestive issues and even cancer are higher in people with back pain.
‘When treating patients with chronic back pain, it’s not just about the spine,’ said Professor Zambelli Pinto , a musculoskeletal expert at the University of Technology Sydney.
‘We need to look beyond pain management to understand the link between back pain and other non–communicable diseases.’
Here, the Daily Mail outlines which health conditions could be disguised as back pain, and when to see your GP…
It may be a symptom of over exertion but there are a host of other reasons that you could be in a lot of discomfort
Poor gut health
Researchers have pinpointed a link between the gut and spine, dubbed the gut–spine axis – a subtle network that links the gut microbiome with the immune system, inflammation and pain, all of which can impact our backs.
The theory is that when the delicate balance of bacteria in the gut is disrupted – through stress, poor diet, or antibiotics – the gut lining becomes permeable, or ‘leaky’.
This allows fragments of harmful bacteria to escape into the bloodstream, triggering body–wide inflammation that can activate spinal nerves and wear away at cartilage and joints over time.
And when we’re not looking after our gut health, this inflammation can become chronic. But it’s not just wide–spread inflammation; digestive issues like IBS, SIBO and constipation can also cause back pain.
In 2023, a real–world study involving nearly 7,000 adults found that people who ate an inflammatory diet were 32 per cent more likely to report back pain.
On the other hand, anti–inflammatory diets, such as the Mediterranean diet which is rich in Vitamin D, calcium and magnesium – has been shown to support back health by reducing inflammation and preserving muscle mass.
The pancreas is a small gland tucked deep behind the stomach
Pancreatic cancer
Since back pain is fairly common, even when it lingers for months, it’s often written off as over–exercising or a pulled muscle.
However, in some instances it could point to pancreatic cancer, experts say.
Pancreatic cancer is one of the deadliest forms of the disease, and just one in four patients live more than a year.
The disease is typically diagnosed at a late stage, when treatment is difficult, because it causes few symptoms early on.
But one of the warning signs people may notice is persistent back ache that doesn’t go away, Dr Jiri Kubes, medical director at Proton Therapy Center, says.
‘Because of the location of the pancreas, pain can radiate to the back and may feel quite non–specific,’ he added.
‘It’s often described as a dull or persistent ache rather than a sharp pain.’
The pancreas, a small pear–shaped gland, sits deep behind the stomach.
Because of its location – and its relatively small size – doctors can’t feel a tumour during a routine physical exam, but it can cause back pain often mistaken for a muscular issue.
As such, when pain is ongoing and cannot be explained by over–exertion or a specific event, Dr Kubes said it should be taken seriously.
‘If you have ongoing back pain that cannot be explained and does not improve, it is important to get it checked. It is always better to rule out something serious than leave it too late.
‘Recognising potential warning signs and acting early can make a significant difference.’
Heart disease
When we think of heart attacks, many of us will imagine a stressed middle–aged business man who is addicted to nicotine and reliant on takeaways clutching his chest in agony.
But the symptoms can be more subtle than chest pain, breathlessness and palpitations – back pain can also be a warning sign.
The problem is, says Dr Oliver Guttman, a consultant cardiologist at St Bartholomew’s Hospital, is that many of us don’t recognise the warning signs until its too late.
Coronary heart disease can build up over years, as fatty deposits cling to the walls of the arteries around the heart, making them narrower and restricting blood flow.
People may notice changes in retrospect, but many symptoms are silent.
‘Classic angina presents as central chest tightness, often radiating to the left arm or jaw’, Dr Guttman explains.
‘However, angina can present atypically – particularly in women, older patients and diabetics – with pain felt primarily in the back, with little or no chest discomfort.
‘This occurs because the cardiac pain is referred: the heart shares nerve pathways with other body areas, so the brain can misinterpret the source,’ he continued.
‘There are many other causes that could explain it – but in some cases, it will be heart related.
‘Back pain that come on with exertion, is accompanied by breathlessness or sweating, or eases with rest should prompt urgent cardia assessment.’
Aortic aneurysm
A weak spot in the heart wall that begins to bulge or balloon outwards – known as an aortic aneurysm – can also cause back pain.
‘This separate but related emergency can present as a severe tearing back pain,’ Dr Guttman explains.
‘Most back pain of course is not related to the heart and most likely is musculoskeletal.
‘But the key red flags are: pain triggered by exertion, associated breathlessness, sweating, nausea or radiation to the arm or jaw.’
Pilates movements can also help to strengthen the pelvic floor and reduce back pain
Pelvic floor dysfunction
In women, when the pelvic muscles – which support the bladder, uterus and bowel – aren’t working as they should this can lead to incontinence, constipation, pain during sex.
But it can also lead to something else: lower back pain.
‘We do know that pelvic floor dysfunction and back pain – especially when someone has urinary incontinence – are commonly seen together,’ says Harvard expert Dr Arianna Mitropoulos, a clinical specialist at Brigham and Women’s Hospital.
‘But most people don’t associate the core with the pelvic floor, even some clinicians.’
Since the pelvic floor and the diaphragm are interconnected, when the pelvic floor isn’t functioning properly, it can disrupt how the diaphragm works, which may contribute to back pain.
‘If the pressure in your trunk changes, it affects your posture,’ Dr Mitropoulos explains.
Tension in the pelvis can also lead to referred pain, meaning discomfort is felt in a different area – often the lower back.
‘Tight muscles ten to be weak because they’re already in a contracted state,’ she says. ‘All those muscles connect to the tailbone, which is inherently linked to the spine.’
To help strengthen your pelvic floor and reduce back pain, imagine that you are trying not urinate, tightening and releasing the pelvic floor muscles repeatedly.
Try to do this ten times in a row, repeating until you can hold a contraction for 10 seconds.
