What actually causes back pain?

In many cases, back pain is caused or made worse by a self-fulfilling cycle: we're taught to protect our backs, so we avoid loading them, which makes them weak and unprepared for everyday demands - which leads to more pain and injury.

Is it okay to exercise with back pain?

In most cases, yes. Avoiding movement entirely makes the back weaker and less capable over time. The goal is to modify activity to stay within a tolerable pain range while continuing to move and load the back progressively.

Why does my back hurt when I do everyday activities?

If the demands of daily life exceed what your back can handle, pain happens. This is usually a sign that the back has been undertrained - not that it's damaged or fragile. Building back capacity through progressive loading is the fix.

What does 'lifting with your legs, not your back' actually do?

While well-intentioned, this advice has contributed to a pattern of avoiding back loading altogether. Over time, this leads to a back that is weak and unprepared for the natural bending, twisting, and rotation that life requires.

For anyone with a "Bad Back" - A letter from your Physical Therapist

Hannah Breal, PT, DPT
4 days ago
4 min read

About the Author: Hannah Breal, PT, DPT is the co-owner of Made 2 Move Physical Therapy in Charleston and Charlotte. She helps athletes and active adults rebuild strength, mobility, and confidence so they can move pain-free for life.

Made 2 Move Physical Therapy – Charleston | Daniel Island | Mount Pleasant | Charlotte

The number one cause of back pain isn't posture. It's not bad form. It's not sleeping in the wrong position.

It's a self-fulfilling cycle - and most people have been stuck in it for years without realizing it.

What we were taught about our backs

Keep your back straight. lift with your legs, not your back. don't round. don't twist. your spine is strongest in neutral.

We've basically been taught our entire lives that our spines need protecting. that they're fragile.

Physical therapist working with a patient on back pain recovery through movement and loading at Made 2 Move PT

And if you've had back pain or a back injury before, chances are you've been avoiding loading your back - even in neutral. you squat to pick things up instead of bending over. you don't deadlift because it's hurt your back before. you avoid rounding, twisting, and bending at all costs.

And then life happens. you move a couch. you do some manual labor. you pick up the dog food. you try a new workout class with a lot of back and core work.

And your back hurts - for days.

It reinforces everything you believed: you must have done something wrong. you must have a bad back.

But here's another way to look at it: your back wasn't prepared for that. not because you moved wrong, or because your back is bad - but because you don't load it. you don't train it. you don't move it enough.

Why don't we freak out when our biceps are sore?

When your glutes are sore after leg day, you feel good about it. when your biceps are sore, you think "I probably did too much" - but you don't panic. you don't swear off curls forever. you don't stay in bed for three days.

But when our backs are sore, we freak out. we assume something is wrong. we rest, protect, and avoid.

And then we're surprised when our backs can't handle anything.

This is the self-fulfilling cycle. and it's keeping a lot of people in pain.

A patient who thought he just had a bad back

A patient - let's call him Sam - came in after a group fitness class wrecked him. lots of twisting, bending, more back work than usual. he woke up barely able to move and was terrified something was seriously wrong.

As we talked, I learned this wasn't new. it had been going on for decades. he saw the chiropractor every couple of weeks. he couldn't sit on a plane or in a car for more than two hours. he couldn't stand for long periods of time without his back acting up.

He thought it was just normal for him. he'd always chalked it up to having a bad back.

What we figured out: he had spent years learning how to avoid using his back. and his back had become incredibly weak, stiff, and incapable as a result.

A lot of people go to physical therapy and are taught how to NOT use their back. how to protect it. how to move around it.

What I did instead was teach Sam how to make his back more prepared - how loading it and stressing it in the right amounts was the only way to make it more capable.

Your back is not made of glass

Our spines are designed for movement. with 33 vertebrae and hundreds of joints, the spine is literally built to bend, twist, rotate, and extend. we have muscles specifically for each of those movements.

(Verify exact vertebrae count with a clinical source before publishing)

The problem isn't that your back is weak. the problem is that it's been undertrained - and now the demands of daily life are more than it can handle.

Think about what happens when you completely stop loading your knees - no squatting, no lunging, no stairs. you lose the strength and ability to do those things. same exact thing happens with your back.

Use it or lose it. and most of us have lost it.

The fix isn't more rest. it's not more protecting. it's building a back that can actually handle your life.

In Part 2 of this series, we'll get into the specific movements your spine was designed for and exactly how to start training them - without blowing your back up in the process.

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Written by Hannah Breal, PT, DPT, Co-Owner of Made 2 Move Physical Therapy, helping Charleston and Charlotte move pain-free for life.