The other day I had a new patient walk into my San Diego, California chiropractic office asking for treatment. He was bent over 45 degrees at the waist, complaining of lower back pain and saying “doc, I have no idea how I got this way but I am having trouble standing up and sitting down, can you help me?”

This is a common new patient presentation in our office. More often than not, the typical lower back pain patient can’t recall a specific cause of their lower back pain. Sometimes the pain has advanced enough to affect the nervous system resulting in sciatica nerve pain.

Patient’s like this always want an explanation as to how they got the way they are. So here is one common answer.

The joints, muscles and ligaments that allow movement, move the body and provide stability in the low back are among the biggest and strongest in the body. This being the case, it usually takes a significant single injury to damage these structures. A hard fall, car accident or a long day of strenuous lifting are examples of events that can cause lower back pain all by themselves.

However, most cases of back pain are caused by cumulative stress. Cumulative stress comes from bad posture (usually excessive sitting), poor lifting habits, awkward sleeping habits, etc. Cumulative stress also known as repetitive stress takes place over months or sometimes years.

The bottom line is that most lower back pain / injuries arise from events that seem small and insignificant by themselves but after months or years of exposure to these stresses lead to irritation of the joints and muscles resulting in back pain.

After the joints, muscles and ligaments of the lower back have been exposed to extended periods of stress, they become vulnerable to injury. This process follows a predictable path. The joint is stressed by some activity, the stress irritates the soft tissues around the joint, the irritation causes inflammation and the inflammation causes lower back pain, muscle spasm and scar tissue formation. Scar tissue limits joint motion, causes pain in the joint and is often sensitive to changes in weather. We all know someone that knows better than the weather man as to when it is going to rain. It is scar tissue build up and arthritis that causes joint pain when it is going to rain.

Once this process has begun, a severe case of lower back pain can arise from something as simple as picking a sock up off the floor or reaching for a cup of coffee.

Unfortunately for the patient, the little things that they do on a regular basis that stress their backs don’t become apparent until after they are in pain. I always advise my patients to pay special attention to the specific activities or movements that aggravate their backs while they are in pain. These are the activities that are often responsible for the cumulative stress that I discussed at the beginning of this article.

Joints are complex structures that in most cases are very durable and work without pain. However, the process described above can happen silently resulting in severe back pain for the person who has ignored proper back care through the course of their lives.

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