When Back Pain Flares Without a New Injury

Your pain got worse. But did you have an actual injury to your back?

This is an important distinction, because an increase in pain doesn’t always mean there has been a new injury or more damage to your back.

Back pain can be frustrating like that. You might have been doing really well, training consistently and barely thinking about your back. Then suddenly you wake up sore, sitting feels uncomfortable again or a movement that was completely fine last week starts bothering you.

The immediate thought is often: What have I done?

Sometimes there is an obvious reason. You lifted something awkwardly, significantly increased your training or had a clear incident that changed your symptoms. Those situations deserve appropriate assessment.

But sometimes there isn’t a new injury at all.

Pain is influenced by much more than the condition of the tissues themselves. Your recent training load, sleep, stress, time spent sitting, recovery, previous experiences with pain and even the context you’re currently living in can all influence how sensitive something feels.

We often describe this using the biopsychosocial model. Essentially, pain is influenced by biological factors, psychological factors and what is happening socially and environmentally around you.

Your nervous system is constantly taking in information from your body and environment. Your brain then has to interpret that information alongside previous experiences, memories, expectations and what is happening in your life right now.

Sometimes the warning system becomes more sensitive.

You might notice a few whispers first. If the LOAD continues to build, those whispers can become louder.

LOAD = mental, physical, emotional.

For some people, the pattern is very physical. Maybe your back becomes more sensitive after several big training days in a row. Maybe long periods sitting at a desk aggravate it. Maybe symptoms are more noticeable at particular points in your menstrual cycle.

But your total load isn’t only physical.

LOAD = mental, physical, emotional.

Work becomes stressful. You get a promotion. You have a job interview. Your workplace starts discussing redundancies. Money gets tight. You commit to something enormous. You have a baby.

Good stress is still stress. Exciting changes can still add load to the system.

I notice this in myself. When life gets particularly busy, I tend to develop little warning signs that I’m probably pushing my recovery. Sometimes it’s a cold sore. At different times I’ve noticed swollen glands, hints of getting sick, migraines or skin irritation around my eye.

Scott has his own versions. When we opened our first gym, there was a period where his gums became so irritated that I remember him biting into an apple and seeing blood everywhere. More recently, he’ll occasionally notice a tooth or toe starting to ache when everything else in life is ramping up.

Does that mean stress definitively caused every one of those symptoms? No.

But it does mean we’ve become much better at noticing our individual patterns and asking what else is happening when our bodies start getting louder.

And importantly, none of this means your pain isn’t real.

Psychological or social contributors to pain don’t mean pain is imaginary or “in your head”. They are simply part of the enormous amount of information your nervous system is processing.

Pain is a response produced by a very complicated human system. It isn’t a direct measurement of how much damage exists in a particular body part.

This is why understanding your own triggers can be so useful.

If your back becomes sore every time you significantly increase your training volume, the answer isn’t necessarily to stop training. We might temporarily reduce the amount you’re doing, keep the movements that feel comfortable and gradually build your capacity back up.

The same applies if sitting, certain movements or another factor seems to contribute. Rather than becoming afraid of that activity forever, we can work out what you currently tolerate and progressively build from there.

A flare-up can therefore be information rather than failure.

It might tell us that something about your current physical load, recovery, stress or environment has changed and that your body needs a temporary adjustment.

Of course, not every episode of back pain should simply be ignored. New or significantly different symptoms, neurological changes, major trauma or symptoms that aren’t behaving as expected are reasons to seek an appropriate assessment.

But for many people with recurring back pain, learning that more pain doesn’t automatically mean more damage can completely change how they respond when symptoms return.

Instead of immediately thinking:

“I’ve hurt my back again.”

The question becomes:

“What’s changed, and what does my body need from me right now?”

IS it time to sort out that recurring niggle?

Maybe you DO know your triggers, but you don’t know how to reduce their impact.

Or maybe your flare-ups are becoming more frequent, more intense or hanging around for longer.

Our physiotherapists can help you look at the bigger picture, understand the patterns around your pain and work out what you can safely continue doing while building your capacity back up.

Book an appointment with By Design Physiotherapy & Strength in North Hobart and let’s work out what might be contributing to your back pain and what you can do about it.