Back Pain

Back pain can start suddenly (‘it shoots in the back’), but also very gradually. Recovery is also very variable. On this page, we list the most common causes. 

Lower back pain

Of all types of back pain, pain in the lower back is by far the most common. These are the most common types of lower back pain:

Lumbago

In this condition, the pain suddenly ‘shoots’ into the lower back and the back muscles stiffen. The back becomes stiff and can no longer move properly. The pain can be intense to very intense. Usually, the symptoms are temporary and the body appears to fully recover. However, lumbago is not harmless: in more than half of the cases, a lumbago attack recurs within a year. Chronic back complaints can result. Read all about the causes of lumbago and what you can best do about it:

More info about hernia and lumbago.

It shot in the back: lumbago

Hernia

In a hernia, the intervertebral disc (discus) is torn. The liquid inner part then pushes its way out and can potentially compress a nerve. This results in severe pain or loss of function in the leg. The symptoms depend on the location in the back and whether or not a nerve is compressed. In the acute phase, there is usually a lot of pain and stiffness in the back and sometimes pain in the leg.

Read more about hernia and lumbago here

IDD

The abbreviation IDD stands for Internal Disc Disruption. It refers to local damage in the intervertebral disc. According to one of the world's leading back scientists, Dr. Nikolai Bogduk, this is the most common cause of lower back pain. He concludes this from advanced scientific research. Unfortunately, IDD is usually not visible on an MRI or X-ray, which means the diagnosis often cannot be made. This does not mean there is no cause or that the complaints are ‘psychological’. In the Netherlands, the term IDD is not often used.

Three examples of IDD (each showing one half of the disc).

Left: an initial tear with leakage of nucleus content
Center: a tear inside the annulus, without leakage of nucleus content
Right: a larger tear with leakage of nucleus content

Discopathy

In discopathy, the disc is also damaged, just like in IDD, but on a larger scale and often involves the entire disc. Unlike IDD, discopathy is clearly visible on X-rays and MRI. For example, the height of the disc may have decreased to less than half of the normal situation, which is clearly visible.

In discopathy, the disc can bulge significantly in various ways without it being a hernia, causing complaints.

Vertebral and pelvic joints

The joints of the spine (the pelvic joints and vertebral joints) can, like all joints in our body, cause complaints. These can be inflammations, but often involve movement restrictions, degeneration (wear), bony growths, and thickening of the joint capsule.

Ankylosing spondylitis is a rheumatic condition in which the pelvic and vertebral joints gradually stiffen. In severe cases, the entire spine including the neck can hardly move anymore.

Pain from sleeping

Many people with back complaints know from experience: it can make a big difference which mattress and in which position you sleep. Research has shown that adjusting the sleeping position can have a significant effect on both the number of days with back pain and the intensity of back pain. Read more about causes and solutions for back pain caused by sleeping.

Muscle pain

The cause of lower back pain and chronic back complaints is often attributed to muscles. This is usually incorrect. Muscles are often hard and sensitive, but that is generally a consequence and not the primary cause. The real cause lies much deeper, such as a tear in the intervertebral disc (discus), a hernia, or a narrowing (stenosis). Abnormalities in the vertebral joints can also cause hardening and - over time - pain in muscles.

Local hardenings, even if secondary, can cause pain and this can also radiate. These pea-shaped hardenings are called ‘trigger points’. Examples of such trigger points and radiation areas are:

Examples of trigger points (from Travell & Simons, the Trigger Point Manual)

Stenosis

A stenosis is a narrowing. This can arise from various causes and also in different places in the spine. It can be the cause of back complaints, but also of sciatica, foot drop, and other loss of function symptoms. Read more about stenosis here.

Sciatica

Sciatica is a term derived from the large leg nerve, the sciatic nerve. If this nerve is pinched somewhere, sharp pain can occur in the leg. It is actually not a diagnosis but a symptom. It is also not a direct cause of back pain, but it is related to it, and for clarity, we include it in this overview.

There are various causes of such a pinching, such as a hernia and various stenoses (narrowings) in the spine. In addition, a thickening of the small deep gluteal muscle piriformis is named as a cause. This would reduce the passage along this muscle, the so-called piriformis syndrome.

Read more in our article about Sciatica.

Sciatica: pain in the area served by the sciatic nerve. The degree of radiation can vary.

Upper back pain and pain behind the shoulder blade

Complaints high in the back differ significantly from lower back complaints. The reason is the rib cage. This limits the movements in the individual thoracic vertebrae. As a result, the disc is much less stressed and tears in a disc occur much less often in the upper back than in the lower back. The same applies to hernias. However, something else takes their place: the connections between the ribs.

Stuck rib-vertebra joints

The ribs are attached at the front to the breastbone and at the back to the vertebrae. With every inhale and exhale, there is movement between the ribs and vertebrae and also with the movements of the thoracic vertebrae. If the shoulders hang forward for a long time, these rib-vertebra connections remain tense for an extended period. This can lead to restrictions and unpleasant complaints. An incorrect sleeping posture is probably the biggest cause, see the section at the bottom of this page.

This condition is quite unknown - even among doctors and therapists - but occurs frequently. It is recognizable by a vague, irritating pain behind the shoulder blade accompanied by a ‘strange feeling’ radiating to the arm, under the armpit, or through a rib extending to the front of the chest. It can sometimes resemble an (impending) heart attack, especially if the symptoms are on the left side. See below about the effect of sleeping posture on these complaints.

Trigger points

Just like in other parts of the back, pain can also arise in the upper back due to irritation of muscles, tendons, etc. Trigger points can develop in various places here as well.

Examples of trigger points (from Travell & Simons, the Trigger Point Manual)

Trigger points in the upper back can be caused by a problem in the rib-vertebra connections.

Sleeping posture and upper back pain

Just like with lower back pain, sleeping posture can also be important for upper back pain. This is especially true for the most common sleeping position, the stable side position:

Because the upper arm drops down until it rests on the mattress, tension arises behind the shoulder blade. This is stressful for the rib-vertebra connections and can lead to complaints.

This is easily solved by sleeping with a body pillow:

The upper arm rests on the body pillow. The rib-vertebra connections are in a relaxed position and the tension between the shoulder blades decreases drastically. It also ensures that the neck and lower back are relaxed, allowing the upper back to relax even more. Read more about improving sleeping posture.

©2026, Author: Jan Willem Elkhuizen, physiotherapist and movement scientist