What Causes Lower Back Pain? The Truth Might Surprise You

"A person experiencing lower back discomfort, illustrating a common presentation of mechanical back pain"

Lower back pain is something most of us will face at some point — sometimes once, sometimes over and over. And if you're dealing with it right now, you're not alone.

One of the most common questions I hear in the clinic is:

"Why is this happening to my back?"

Here's the honest truth: research shows that in less than 20% of cases, we can pinpoint an exact anatomical cause — like a disc injury or fracture. The other 80%? It's what's called mechanical, or non-specific, lower back pain. That means it doesn't always show up clearly on a scan or X-ray — but you still feel it, deeply. And it still interrupts your life.

That's because your back does more than you think. It supports every step you take. It lets you get up, lie down, lift, bend, breathe freely, and move through the day with ease.

When it hurts, everything can feel like a challenge — from work to sleep to just being present with your whānau.

What Is Mechanical Back Pain?

Mechanical pain refers to discomfort linked to how you move — or don't move. It can be triggered or worsened by posture, overuse, stress, fatigue, or how your nervous system is adapting to your environment. You might feel it as aching, stabbing, burning, stiffness — or a mix of all of these. But here's an important distinction: the intensity of pain doesn't always reflect the severity of the underlying issue.

I want to sit with that for a moment, because it genuinely surprises a lot of patients. A relatively minor mechanical irritation can feel intensely painful, while more significant structural changes sometimes cause very little discomfort at all. This is part of why I approach pain as a signal, not a diagnosis in itself — it's information your body is giving you, not a verdict on how "broken" something is.

So, What Can You Do?

Even when I can't always name a single, specific cause, that doesn't mean your body can't heal. Chiropractic care looks at how your spine, nervous system, and surrounding structures are working together — or not. My role is to assess not just the sore spot, but how your body is adapting, compensating, or struggling to regulate stress and movement.

After a careful assessment, I put together a plan that addresses:

• How you move — and how we can restore ease to movement patterns that have become guarded or restricted

• How your spine and nervous system are communicating — where restrictions might be creating static in that signal

• Daily habits — your work setup, sleep position, sitting patterns, lifting technique, and how much you're walking

• Breath and tension patterns — shallow breathing and chronic tension often go hand in hand with mechanical back pain

• Emotional and environmental stressors — stress genuinely shows up in the body, and the low back is a common place it settles

• Your body's natural rhythms and healing potential — working with what your body's already trying to do, not against it

I don't just aim to "fix" the pain. I aim to help you feel more connected to your body, more adaptable, and more free in how you move through your day. If your work setup is part of the picture, I've put together a full ergonomic setup guide that pairs well with this. And if you want to understand where you're starting from posturally, the 2-minute posture self-check is a good place to begin.

Do You Need a Scan?

Not always. In fact, in most cases, imaging doesn't change the care plan — and it can sometimes create unnecessary worry over findings that turn out to be common, even in people with no pain at all.

Scans are genuinely helpful when:

• There's been trauma, like a fall or accident

• There's bowel or bladder dysfunction

• There's progressive numbness or leg weakness

• Your symptoms haven't changed after a reasonable number of sessions of care

I'll always be upfront with you about this, and refer appropriately if any of these red flags are present. My job isn't to talk you out of imaging you genuinely need — it's to make sure you're not getting a scan reflexively when it isn't going to change anything about your care.

How This Connects to Your Nervous System

Mechanical back pain doesn't exist in isolation from the rest of your body. Chronic guarding, tension, and restricted movement in your low back are closely tied to how your nervous system is regulating stress more broadly. I go into this connection in more depth in Your Nervous System: The Hidden Superhighway Running Your Life — understanding that link often reframes how patients think about their pain entirely.

Frequently Asked Questions

Why can't my doctor find a cause for my back pain? This is extremely common — in roughly 80% of lower back pain cases, there isn't a single identifiable anatomical cause like a fracture or disc injury. This is called mechanical or non-specific low back pain, and it's a recognised, legitimate category, not a sign that nothing is actually wrong.

Do I need an X-ray or MRI for my back pain? Not usually. Imaging is most useful when there's been trauma, progressive weakness or numbness, bowel or bladder changes, or no improvement after a reasonable period of care. Outside of these red flags, imaging often doesn't change the treatment approach and can sometimes highlight findings that aren't actually causing your pain.

Does the severity of my pain reflect how damaged my back is? Not necessarily. Pain intensity and tissue damage don't always correlate — some minor mechanical issues cause significant pain, while some notable structural changes cause very little discomfort. This is part of why I treat pain as a signal to investigate, not a direct measure of damage.

Can stress actually cause lower back pain? Yes. Chronic stress affects muscle tension, breathing patterns, and nervous system regulation, all of which can contribute to or worsen mechanical low back pain. It's rarely the only factor, but it's often a meaningful one.

How long does mechanical back pain usually take to improve? This varies by individual, but with an appropriate care plan, many people notice meaningful improvement within a few weeks. Recovery tends to be more about consistency and addressing contributing factors than about finding one single "fix."

Final Thought

Lower back pain doesn't have to rule your life. And it certainly doesn't define your health. I want to help you understand your body — not just what hurts, but why — so you can move forward feeling supported, seen, and empowered.

If you're ready to get curious about your back pain and reconnect with your body, book a visit with me here in Māngere, or take the Nervous System Regulation Quiz if you're not sure where to start.

Let's begin crafting your recovery — together.

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About the Author

Dr Anupa Dharamsi is the founder and lead chiropractor at Handcrafted Chiropractic in Māngere, Auckland — a nervous-system-focused, trauma-informed practice supporting patients across South Auckland with a whole-body approach to care, nutrition, and long-term resilience.