What Are the Common Causes of Chronic Back Pain: How to Treat Them
John Coury, D.O
August 27, 2026
When back pain subsides within a few weeks, your body has handled the tissue healing on its own. But when discomfort lingers past the 12-week mark-despite rest, stretching, and over-the-counter medication-you are dealing with chronic back pain.
Chronic back pain is rarely caused by a single event. It typically stems from a combination of underlying structural issues and cumulative daily stress on your spine. Finding long-term relief requires identifying the precise root cause rather than just masking the symptoms.
When to Seek Immediate Emergency Care?
While most back pain can be safely managed through non-surgical care, seek immediate emergency medical evaluation if your pain is accompanied by sudden loss of bowel or bladder control, numbness in the groin/saddle area, high fever, or severe weakness in your legs. These can indicate a serious medical emergency known as Cauda Equina Syndrome.
What Are the Most Common Causes of Chronic Back Pain?
Degenerative Issues: The discs and joints naturally wear down with age. When paired with poor lifestyle habits, this combination weakens discs and reduces the spine’s ability to absorb everyday stress leading to prolonged, recurring pain.
Structural Issues: Conditions such as herniated discs or spondylolisthesis disrupt the spine’s alignment and irritate nearby nerves, causing pain that radiates into the hips, buttocks, or legs.
Lifestyle Factors: Excess body weight, smoking, prolonged inactivity, and excessive sitting place continuous stress on the spine. These factors don’t just contribute to pain – they actively worsen existing spinal problems over time.
Previous Injuries: Injuries from minor accidents, improper lifting, or sports-related strain can leave lasting structural changes that contribute to back pain long after the initial injury appears to have healed.
Recognising the Patterns of Chronic Pain
Causes of chronic back pain vary and often overlap. However, most patients share a recognisable pattern of symptoms. Consult a spine specialist if you notice any of the following:
- Pain lasting more than 12 weeks that doesn’t improve with rest or medication
- Recurring flare-ups that come and go over time
- Stiffness that limits bending, twisting, or everyday movement
- Pain that worsens after certain activities or prolonged positions
- Pain that interferes with sleep, work, or daily routines
- Pain that extends from the lower back into the hips, buttocks, or legs
Effective Non-Surgical Treatment Pathways
The vast majority of chronic back pain patients do not require surgery. At STL Spine Care, conservative care focuses on reducing inflammation, restoring alignment, and strengthening supporting muscles.
Physical Therapy: The starting point for most chronic back pain treatment plans. Physical therapy improves mobility and reduces strain on the spine by targeting:
- Weak core and glute muscles
- Tight hips and hamstrings
- Poor movement patterns
Medication: Non-opioid anti-inflammatory drugs and muscle relaxants reduce inflammation and ease pain, making it easier to participate consistently in rehabilitation.
Medications work best when used alongside therapy, not as a standalone solution.
Chiropractic Care: Manual spinal adjustments help restore mobility and relieve pain caused by joint restrictions or spinal dysfunction. Chiropractic care works most effectively as part of a broader, personalised treatment plan.
Spinal Injections: When pain continues despite other treatments, epidural steroid injections deliver anti-inflammatory medication directly around the affected area. They are particularly effective for nerve-related conditions such as sciatica caused by a disc bulge.
Tried physical therapy already? Read our guide on Why Physical Therapy Alone Doesn’t Always Fix Back Pain to learn why combined diagnostic approaches yield better long-term results.
Daily Habits That Support Spine Health at Home
Clinical treatment works best when supported by consistent daily habits. The following adjustments reduce unnecessary spinal strain and make each treatment session more effective:
- Walk regularly or swim to maintain mobility and prevent stiffness
- Avoid sitting for extended periods – take short 10–15 minute walking breaks throughout the day
- Use a supportive chair that promotes proper spinal alignment
- Position your laptop at eye level to reduce neck and upper back strain
- Avoid heavy lifting or demanding activities that aggravate existing symptoms
- Stay active and avoid prolonged bed rest or inactivity
- Keep a record of activities or movements that worsen your pain – this helps your specialist pinpoint triggers
- Stay consistent with physical therapy exercises, even when symptoms begin to improve
Take the Next Step Toward Lasting Relief
Chronic back pain is highly manageable, but waiting too long can narrow your non-surgical treatment options. Early diagnostic evaluation gives you the clearest path to active, pain-free living.
At STL Spine Care, our team of St. Louis spine specialists offers comprehensive diagnostic evaluations, non-surgical pain management, and personalized rehabilitation programs tailored to your lifestyle.
Unsure which path is right for your symptoms? Read our guide on Non-Surgical vs. Surgical Spine Treatments: How to Decide, or contact our St. Louis clinic today to schedule a consultation.
Frequently Asked Questions
I've rested for three months but my lower back still hurts. Is this chronic?
Yes. Back pain lasting over three months is considered chronic. Rest alone won’t resolve it if the underlying cause is structural or degenerative. A targeted treatment plan – not continued rest – is what creates long-term relief.