The most common causes of lower back pain are muscle strain, joint irritation, disc injury, and nerve irritation. However, lower back pain is often multifactorial, which means more than one structure or movement issue may be contributing at the same time.

Many episodes settle well with the right advice, sensible activity, and guided rehabilitation. If you want a broader overview, see our guide to lower back pain or explore other common causes of back pain.

What causes lower back pain most often?

Most lower back pain comes from relatively common musculoskeletal causes rather than a dangerous spinal problem. The biggest groups are muscle and soft tissue injuries, disc-related irritation, spinal joint pain, nerve irritation, and referred pain from nearby regions such as the hip or pelvis.

Muscle and soft tissue causes of lower back pain

Muscle and soft tissue overload is one of the most common causes of lower back pain. It often develops after lifting, repeated bending, sport, gardening, poor load tolerance, or a sudden increase in activity.

• Pulled back muscle
• Core stability deficiency
• Delayed onset muscle soreness (DOMS)

These problems often respond well to temporary load reduction, gradual return to movement, and progressive strengthening. In some cases, a physiotherapist may also prescribe core stability training to improve spinal control and load tolerance.

Can discs cause lower back pain?

Yes. A lumbar disc can become irritated, bulge, or herniate and cause lower back pain. Some disc injuries stay local to the back, while others irritate a nearby nerve and create pain, tingling, or numbness into the buttock or leg.

• Bulging disc
• Herniated disc
• Degenerative disc disease

Disc-related pain can be aggravated by prolonged sitting, bending, lifting, coughing, or repeated flexion movements.

Joint and spinal causes of lower back pain

Not all lower back pain comes from muscles or discs. The joints and bones of the lumbar spine can also become painful, especially when movement control, posture, loading, or age-related change is involved.

• Facet joint pain
• Spondylosis
• Spondylolisthesis
• Spinal stenosis
• Spondylolysis

These causes can become more noticeable with standing, walking, arching backward, or longer periods of activity.

Why does nerve irritation cause lower back pain and leg symptoms?

Nerve-related lower back pain happens when a spinal nerve becomes irritated or compressed. This often causes pain that spreads into the buttock, thigh, calf, or foot rather than staying only in the lower back.

• Sciatica
• Pinched nerve
• Nerve pain

If your symptoms travel below the knee, feel electric, or include pins and needles, nerve irritation becomes more likely.

Can the hip or pelvis cause lower back pain?

Yes. Pain from the pelvis, sacroiliac joint, deep gluteal region, or hip can feel very similar to lower back pain. That is why a thorough assessment often looks beyond the lumbar spine alone.

• Sacroiliac joint pain
• Piriformis syndrome
• Hip pain referral patterns

Other possible causes of lower back pain

Some lower back pain has a less common but still important cause. These presentations deserve extra thought when symptoms do not fit the usual pattern or recovery is not progressing as expected.

• Pregnancy-related back pain
• Osteoporosis
• Ankylosing spondylitis
• Fractures

When should you worry about lower back pain?

Most lower back pain is not serious, but a few features deserve prompt review. You should seek professional advice if your pain follows significant trauma, causes progressive weakness, includes numbness that is worsening, spreads strongly into the leg, or is not settling as expected.

What is the best treatment for lower back pain?

The best treatment depends on the cause of lower back pain, symptom behaviour, and how long it has been there. For many people, treatment includes a clear diagnosis, reassurance, movement advice, progressive exercise, pain management strategies, and a sensible return to work, sport, or daily activity.

• Back pain physiotherapy
• Strength and mobility exercises
• Load management and pacing
• Postural, lifting, and ergonomic advice
• Guided return to bending, walking, work, or sport

A physiotherapist may also help you work out whether your symptoms fit a muscle, disc, joint, or nerve pattern and then tailor treatment accordingly. For broader public guidance, the World Health Organization also outlines key facts about low back pain.

What should you do next if your lower back hurts?

If you are unsure what is causing your lower back pain, the next step is to get the right assessment early. That helps identify the main pain drivers, rule out more serious causes, and build a practical recovery plan that suits your goals and daily life.

In the meantime, avoid complete rest, keep moving within reason, and change positions regularly. Gentle walking, easier movement, and gradual reloading are often more helpful than doing nothing.

FAQs about the causes of lower back pain

What is the most common cause of lower back pain?

The most common cause of lower back pain is usually a muscle or soft tissue strain, often combined with reduced load tolerance, joint irritation, or disc sensitivity. Many people do not have one single structure to blame.

Can stress cause lower back pain?

Stress does not directly injure your spine, but it can increase muscle tension, pain sensitivity, poor sleep, and reduced recovery. That can make lower back pain feel stronger or last longer.

Does a bulging disc always cause lower back pain?

No. Some bulging discs cause no symptoms at all, while others irritate nearby tissues or nerves and become painful. Scan findings need to match your symptoms and clinical assessment.

Why does lower back pain keep coming back?

Recurring lower back pain often reflects a combination of load spikes, deconditioning, stiffness, poor recovery, stress, and incomplete rehabilitation. Identifying the pattern usually matters more than chasing one label.

Do I need a scan for lower back pain?

Not always. Many people with lower back pain do not need imaging early on, especially if symptoms fit a straightforward musculoskeletal pattern and there are no red flags.

References

1. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-747. doi:10.1016/S0140-6736(16)30970-9
2. Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-2367. doi:10.1016/S0140-6736(18)30480-X
3. Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368-2383. doi:10.1016/S0140-6736(18)30489-6
4. World Health Organization. Low back pain. Published June 19, 2023. Accessed April 14, 2026.
5. Australian Commission on Safety and Quality in Health Care. Low Back Pain Clinical Care Standard. Accessed April 14, 2026.