Back Pain FAQ: Causes, Treatment, Exercises and When to Seek Medical Help

Back pain is common, but back pain is not a diagnosis. Where it hurts, how it started, what makes it worse or better, and what else is happening in your body can all provide important clues.

“My back hurts.”

That is one of the most common complaints we hear from new patients.

In Singapore, back pain is particularly relevant to modern working life. Long hours at a desk, prolonged sitting, driving, sedentary lifestyles and repetitive physical activities can all place demands on the spine and the muscles around it. Singapore's HealthHub reports that up to 80% of people in Singapore experience low back pain at some point in their lives.

Some people have had pain for a few days.

Others have been dealing with it for months or years.

Some blame their office chair.

Others think they are simply getting older, lifted something incorrectly, or have a “weak back.”

But before deciding what your back pain needs, there is a more important question:

Why does your back hurt in the first place?

At All Well Scoliosis Centre, one of the first things we do is take a detailed history and look at how your body moves.

Depending on your symptoms, history and clinical findings, imaging may also be appropriate.

And this is sometimes where a new patient asks:

“Why do you want me to get an X-ray? Isn't it just back pain?”

The answer is simple.

Because we don't have Superman vision.

But that does not mean everyone with back pain needs an X-ray.

In fact, most uncomplicated low back pain does not require routine imaging. Singapore's HealthHub notes that imaging is generally not needed for most cases, while further imaging may be considered when pain persists or when other symptoms raise concern. The American College of Radiology similarly recommends against routine imaging for uncomplicated acute low back pain without red flags.

So when imaging is recommended, there should be a reason.

An X-ray can provide information about the structure and alignment of the spine. It may help identify things such as spinal curvature, certain structural changes, previous injuries or other findings that may be relevant to the clinical picture.

But an X-ray cannot show everything.

It does not show every muscle, ligament, nerve or soft-tissue problem.

And an abnormal finding on an X-ray does not automatically mean that it is the cause of your pain.

Your pain tells us what you feel.

A proper assessment helps us understand what may be contributing to it.

What Causes Back Pain?

There isn't one single cause of back pain.

Back pain can be associated with muscles, joints, movement habits, physical activity, prolonged sitting, injuries, spinal changes, nerve-related symptoms and other health conditions.

Sometimes several factors are involved at the same time.

For example, someone who spends eight hours a day sitting may have:

Reduced movement throughout the day
Stiff hips or thoracic spine
Reduced muscular endurance
Increased neck and shoulder tension
Poor tolerance for prolonged positions
A previous injury that has changed how they move

It can be tempting to find one thing to blame.

“It's my posture.”

“It's my disc.”

“It's my scoliosis.”

“It's because I'm getting older.”

But the human body is rarely that simple.

Back pain is a symptom. It is not the whole diagnosis.

Where Does Your Back Hurt?

The location of your back pain can provide useful clues.

It does not tell us the diagnosis by itself, but it helps us understand which areas may need closer assessment.

Upper Back Pain: Neck to Shoulder Blades

Upper back pain commonly appears around the neck, shoulders and shoulder blades.

You may notice:

Tightness between the shoulder blades
Neck and shoulder tension
Aching after working at a computer
Discomfort after looking down at your phone
Stiffness after prolonged sitting
Increased tension during stressful periods

Common Causes and Contributors to Upper Back Pain

Poor or prolonged posture

Spending hours looking down at a phone, working at a desk or remaining in one position for too long can contribute to discomfort.

But there is an important distinction.

There is no single “perfect posture” that you need to hold all day.

Singapore's HealthHub specifically notes that there is no single best posture for preventing low back pain. The bigger issue can be spending too long in one position without enough movement.

This is something we explored in our article Posture Reset: Why Movement Matters More Than “Good Posture.”

Read: Posture Reset — Why Movement Matters More Than “Good Posture”

Muscle tightness

When certain muscles are repeatedly working while others are not contributing effectively, your body may develop tension and stiffness.

Stress and tension

Stress can affect breathing, muscle activity and the way you hold your shoulders.

You may not even realise that you are constantly tensing your neck and shoulders.

What Can Help Upper Back Pain?

Depending on the cause, helpful strategies may include:

Taking regular movement breaks
Improving thoracic mobility
Stretching areas that are restricted
Strengthening the upper back
Improving work and phone habits
Relaxing your shoulders
Practising better breathing patterns

You don't necessarily need an intense workout.

Sometimes your body simply needs more movement and better movement.

Mid Back Pain: Why Does the Middle of My Back Hurt?

Mid back pain, or thoracic back pain, is often overlooked.

Your thoracic spine sits between your neck and lower back. It contributes to posture, breathing mechanics, shoulder movement and overall spinal movement.

Common Contributors to Mid Back Pain

Poor sitting position

This can be particularly relevant to people who drive for long periods or spend most of their working day sitting.

Stiff joints

The thoracic spine is designed to move. When mobility becomes restricted, other areas may compensate.

Lack of movement

Your body was not designed to remain in one position for eight hours every day.

Long periods of sitting can contribute to stiffness and discomfort.

What Can Help Mid Back Pain?

Depending on your condition, you may benefit from:

Moving more throughout the day
Taking regular breaks from sitting
Improving thoracic mobility
Strengthening the mid-back
Opening up the chest
Improving sitting and driving habits

You don't have to wait until your back hurts before you start moving.

Movement is part of maintenance.

Lower Back Pain: What Causes It?

Lower back pain is one of the most common types of back pain.

It can affect your ability to sit, stand, walk, exercise, work and sleep.

Singapore's HealthHub identifies prolonged sitting, prolonged standing or bending, a sedentary lifestyle and repetitive activities such as frequent heavy lifting among common risk factors for low back pain.

Common Contributors to Lower Back Pain

Weak or poorly conditioned core and glute muscles

Your trunk and hip muscles contribute to stability and movement during everyday activities.

Limited hip mobility

If the hips are stiff, the way you move through your pelvis and lower back may change.

Poor lifting mechanics

Lifting isn't simply about how heavy something is.

How you position your body, how you control the movement and whether your body is prepared for the demand all matter.

Sudden increases in activity

Perhaps you suddenly started exercising again.

Or started a new sport.

Or spent an entire weekend moving furniture.

Your body may simply not have had enough time to adapt to the new demand.

What Can Help Lower Back Pain?

Depending on the cause, treatment and rehabilitation may include:

Core strengthening
Glute strengthening
Hip mobility
Progressive resistance exercise
Improving lifting mechanics
Walking and general physical activity
Gradually increasing exercise capacity

The goal isn't simply to make your back hurt less.

The goal is to help your body become stronger and more capable.

Can Exercise Make Back Pain Worse?

This is one of the biggest fears we hear.

People often think:

“My back hurts, so I should stop exercising.”

It is understandable to be cautious when movement has caused pain.

But complete rest is not generally recommended for uncomplicated low back pain. HealthHub advises staying active and notes that exercise can help relieve low back pain, while WHO recommends education and appropriate exercise among non-surgical approaches for chronic primary low back pain.

That does not mean you should ignore severe pain or force yourself through symptoms.

It means that fear of movement should not automatically become a reason to stop using your body.

You don't have to start with heavy weights.

You don't have to run.

You don't have to perform complicated exercises.

Start with appropriate movement.

Learn how to control it.

Build strength gradually.

Then increase the challenge as your body adapts.

The problem may not be that exercise is bad for your back.

You may simply not have learned how to move your body better yet.

If you have scoliosis or another spinal condition, exercise should be appropriately individualised. Our article Can I Exercise With Scoliosis? A Guide for Adults explores why having scoliosis does not automatically mean you need to stop exercising.

Strength and Mobility: Why Do Both Matter?

Strength and mobility are not opposites.

You need enough mobility to move your joints.

You need enough strength to control that movement.

And you need coordination to put the two together.

This becomes particularly important when someone has a long-standing spinal condition.

For example, scoliosis-specific exercise is not simply about “strengthening the back.” It may involve posture, breathing, body awareness, movement control and individualised exercise.

Our article on Scoliosis-Specific Exercises (PSSE) explores this approach in greater detail.

The broader lesson applies beyond scoliosis:

Your body needs both movement options and the strength to control them.

Is Surgery the Only Treatment for Back Pain?

No.

Surgery can be appropriate for certain spinal conditions, particularly when there is a specific structural problem or serious neurological involvement.

But surgery is not automatically the answer to every episode of back pain.

For chronic primary low back pain, the World Health Organization recommends a person-centred approach that can include education, exercise and other appropriate non-surgical interventions.

Depending on the cause and severity of your symptoms, conservative care may include:

Physiotherapy
Exercise therapy
Strength training
Mobility exercises
Movement retraining
Appropriate manual therapy
Education about movement
Lifestyle changes
Medical management when necessary

Physiotherapy is not simply about being handed a list of exercises.

It can be about learning how your body currently moves, understanding what it can tolerate and progressively building strength, mobility and confidence.

The goal is not only:

“How do I stop the pain?”

It is also:

“How do I help my body cope better with everyday life?”

What If My Back Pain Keeps Coming Back?

Recurring back pain deserves attention.

If your pain keeps returning every few weeks or months, simply waiting for it to disappear may not address the factors contributing to the problem.

Ask yourself:

Has my activity level changed?
Am I sitting for long periods?
Have I stopped exercising?
Have I become weaker?
Are my hips or thoracic spine stiff?
Have I had a previous injury?
Has my movement changed?
Am I repeatedly doing something that aggravates my symptoms?

Recurring symptoms don't necessarily mean something serious is happening.

But they are a reason to look beyond the immediate pain.

Don't just keep resetting the pain. Understand what keeps triggering it.

Could Scoliosis Be Related to My Back Pain?

Sometimes people discover scoliosis only after seeking help for back pain.

Others have known about their scoliosis for years but suddenly notice that their back has started hurting.

Having scoliosis does not automatically mean that scoliosis is the cause of your pain.

Pain can have many contributors, including muscles, joints, discs, physical conditioning, previous injuries, degeneration and movement patterns.

But if you have persistent back pain together with noticeable spinal asymmetry, it may be worth understanding the bigger picture.

Our article Why Does My Scoliosis Hurt Now? Causes of Adult Scoliosis Pain looks at why someone can have a spinal curve for years and develop pain later in life. It also explains why pain and scoliosis progression are not necessarily the same thing.

Read: Why Does My Scoliosis Hurt Now?

Pain does not automatically mean your scoliosis has progressed.

Why Does Spinal Alignment Matter?

When we assess someone with back pain, we don't only look at the painful area.

We consider how different parts of the body work together.

Your neck, thoracic spine, lumbar spine, pelvis and lower limbs form a connected movement system.

A change in one area can influence how another area moves or compensates.

This does not mean that one posture automatically causes pain.

It means that persistent symptoms deserve a broader assessment.

For people with scoliosis or another spinal alignment issue, our article Posture Correction for Scoliosis: Strength, Movement & Freedom explains why posture should be viewed as a functional skill rather than simply an aesthetic position.

Read: Posture Correction for Scoliosis — Strength, Movement & Freedom

Better posture is not about forcing yourself into one perfect position.

It is about having more movement options and better control.

Is Back Pain Related to the Nervous System?

Sometimes patients are surprised when we talk about the nervous system during a back or spine consultation.

They expect us to talk only about bones, muscles and joints.

But movement is controlled by the nervous system.

Your brain constantly receives information about where your body is, how it is moving and how much force is being applied.

It then adjusts muscle activity and movement accordingly.

This is one reason long-standing movement habits can become automatic.

It is also why improving movement isn't always as simple as being told:

“Sit straight.”

You have to learn how to recognise and control movement.

Our article Scoliosis, Neuroplasticity and the Brain-Body Connection explores proprioception, neuroplasticity and how the nervous system contributes to posture and movement.

Read: Scoliosis, Neuroplasticity and the Brain-Body Connection

The X-ray shows part of the structural picture.

It does not show the entire conversation happening between your brain and body.

Why Do We Ask So Many Questions During Your Consultation?

You may have noticed that our intake form is long.

There is a reason.

When someone tells us:

“My lower back hurts,”

that is only the beginning.

We want to know about your previous injuries, medical history, medications, lifestyle, activity level and other symptoms.

We also want to know whether there are warning signs that require medical attention.

For example, back pain can sometimes occur alongside symptoms that are unrelated to a simple muscle or movement problem.

We don't want to treat the wrong symptom.

We want to understand the bigger picture.

Back Pain Red Flags: When Should You See a Doctor?

Most episodes of back pain are not caused by a serious condition.

Singapore's HealthHub notes that most low back pain is not serious and that many cases improve within several weeks.

However, certain symptoms should not be ignored.

1. History of Cancer

If you have a current or previous history of cancer and develop unexplained back pain—particularly persistent pain or pain that is worse at night or at rest—medical assessment is important.

A history of cancer and unexplained weight loss are among the red flags considered in clinical imaging guidance.

2. Possible Infection

Back pain accompanied by:

Fever
Chills
Night sweats
A recent significant infection

may require prompt medical evaluation.

3. Recent Trauma

New back pain after significant trauma should be assessed.

Even relatively minor trauma can be important in people at higher risk of fracture, including older adults or people with osteoporosis.

4. New Back Pain at a Younger or Older Age

Age by itself does not mean that your back pain is dangerous.

However, age can influence the clinical assessment, particularly when there are other risk factors such as osteoporosis or a higher risk of fracture.

This is why we look at the whole history rather than using one number as a diagnosis.

5. Numbness, Weakness or Other Neurological Changes

Seek medical attention if you experience:

Significant numbness
New or progressive weakness
Neurological changes in the legs
Sudden foot drop
Loss of coordination
Increasing difficulty walking

These symptoms may indicate neurological involvement.

6. Cauda Equina Symptoms

This is an emergency.

Seek emergency medical attention if back pain is accompanied by:

Numbness around the groin, genital or saddle area
New loss of bladder or bowel control
Difficulty urinating or inability to urinate

These symptoms are recognised as important red flags for possible cauda equina syndrome.

7. Unexplained Weight Loss

Losing weight without trying, particularly together with persistent back pain or other concerning symptoms, should be medically assessed.

8. Persistent or Worsening Pain

Back pain that:

Continues to worsen
Does not improve over time
Is significantly worse at night or at rest
Persists for several weeks
Is accompanied by loss of function

may require further evaluation.

HealthHub specifically advises early medical review for unexplained weight loss, fever or night sweats, persistent pain after injury, pain that does not improve, and loss of function such as weakness or worsening balance.

These red flags do not automatically mean you have a serious disease.

They mean you should not simply assume the pain is caused by poor posture or tight muscles.

Your health matters.

Should You Get an X-Ray for Back Pain?

Not everyone with back pain needs an X-ray.

This is important.

Routine imaging is generally not recommended for uncomplicated acute low back pain without red flags.

However, imaging may become appropriate when there are concerning symptoms, certain risk factors, persistent symptoms, a history of trauma or other clinical findings that make imaging useful.

An X-ray may provide information about:

Spinal alignment
Curvature
Certain structural changes
Previous injuries
Bone and joint changes

But an X-ray is only one part of an assessment.

It does not replace your history or physical examination.

And it does not automatically tell us what is causing your pain.

This is particularly important because spinal degenerative changes can be seen on imaging even in people who have no pain. HealthHub highlights that imaging findings do not always explain back symptoms.

So when we recommend an X-ray, the question should not be:

“What does the X-ray show?”

It should be:

“Does this information help us understand the person's symptoms and make a better decision?”

What Is the Best Treatment for Back Pain?

There is no single “best treatment” for every person with back pain.

The right approach depends on:

Your symptoms
How long you have had them
Your medical history
Your physical condition
Your activity level
Your goals
The findings from your assessment
Whether there are any red flags

For one person, improving strength may be the priority.

For another, restoring mobility may be more important.

Someone else may need medical assessment before beginning exercise.

For chronic primary low back pain, WHO recommends a person-centred approach rather than relying on one treatment in isolation.

That is why personalised assessment matters.

Can Back Pain Be Prevented?

Not every episode of back pain can be prevented.

But you can improve your body's ability to handle everyday demands.

Think about your body as a long-term investment.

You don't wait until your car completely breaks down before servicing it.

Your body deserves maintenance too.

That may mean:

Move regularly.

Build strength.

Maintain mobility.

Take breaks from prolonged sitting.

Learn how to lift appropriately.

Recover when your body needs it.

Don't ignore persistent symptoms.

WHO also highlights physical activity, workplace ergonomics, sleep, mental well-being and education as important aspects of self-management and care for low back pain.

You don't need to transform your lifestyle overnight.

Small actions repeated consistently can make a meaningful difference over time.

The Truth About Your Back

Your spine is strong.

It is designed to move.

It is designed to support you.

And it is capable of adapting.

But like every part of your body, it needs the right conditions to function well.

Sometimes that means more movement.

Sometimes it means getting stronger.

Sometimes it means improving mobility.

Sometimes it means changing your daily habits.

Sometimes it means seeing a physiotherapist or other healthcare professional.

And sometimes it means getting medically assessed because your symptoms require a different level of care.

Back pain is not something you should automatically fear.

But it is also not something you should automatically ignore.

Listen to your body.

Understand your symptoms.

Ask questions.

Get the appropriate assessment.

Then give your body the tools it needs to move better and become stronger.

Move better. Get stronger. Live with confidence.

Consistent small actions can create big results.

Frequently Asked Questions About Back Pain

Is back pain normal?

Back pain is very common, but frequent or persistent pain should not simply be accepted as a normal part of getting older. Many episodes improve, but recurring or persistent symptoms deserve appropriate attention.

What is the most common cause of back pain?

There isn't one single cause. Back pain can be associated with muscles, joints, physical activity, prolonged sitting, movement habits, injuries, spinal changes and other health conditions.

Should I exercise if I have back pain?

For many people, appropriate exercise can be helpful. Complete bed rest is generally not recommended for uncomplicated low back pain. However, exercise should be appropriate for your symptoms and physical condition.

Is walking good for back pain?

Walking can be a useful way for many people to remain physically active. However, if walking significantly increases your symptoms or you develop neurological or other red-flag symptoms, seek appropriate medical advice.

Should I get an X-ray for lower back pain?

Not everyone with lower back pain needs an X-ray. Routine imaging is generally not recommended for uncomplicated acute low back pain without red flags. Imaging may be considered when there are concerning symptoms, risk factors or persistent symptoms where the results could influence management.

Can poor posture cause back pain?

Poor or sustained posture can contribute to discomfort, particularly when combined with prolonged sitting or limited movement. However, there is no single “perfect posture,” and posture is only one potential contributor to back pain.

When should I worry about back pain?

Seek medical attention if back pain occurs with significant weakness or numbness, saddle-area numbness, bladder or bowel changes, fever, unexplained weight loss, significant trauma, a history of cancer, or severe, persistent or worsening symptoms.

Can back pain be related to scoliosis?

It can be, but scoliosis is not automatically the cause of every episode of back pain. Pain can have multiple contributors, so understanding the individual's spinal structure, movement, history and symptoms is important.

Can back pain go away on its own?

Many episodes of low back pain improve within several weeks. Staying appropriately active and understanding how to manage symptoms can help recovery, although persistent or worsening symptoms may require further assessment.

Medical References

HealthHub Singapore — Low Back Pain. Information on prevalence in Singapore, common risk factors, red flags, exercise, imaging and self-management.
World Health Organization — WHO Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults. Evidence-based recommendations for education, exercise and other non-surgical approaches.
World Health Organization — Low Back Pain Fact Sheet. Global burden of low back pain and recommendations relating to physical activity, self-care, ergonomics and rehabilitation.
American College of Radiology — ACR Appropriateness Criteria: Low Back Pain. Guidance on when imaging is and is not appropriate and clinical red flags that may warrant further investigation.
NICE — Low Back Pain and Sciatica in Over 16s: Assessment and Management. Guidance on assessment, red flags and non-invasive management of low back pain and sciatica.
All Well Scoliosis Centre — Why Does My Scoliosis Hurt Now? Causes of Adult Scoliosis Pain. Patient education on adult scoliosis, pain, spinal changes and why pain does not necessarily mean scoliosis progression.
All Well Scoliosis Centre — Posture Reset: Why Movement Matters More Than “Good Posture.” Patient education on prolonged sitting, movement variability and postural control.
All Well Scoliosis Centre — Scoliosis, Neuroplasticity and the Brain-Body Connection. Patient education on proprioception, neuroplasticity and the relationship between the nervous system and movement.

Medical Disclaimer

This article is intended for general educational purposes and is not a substitute for individual medical assessment, diagnosis or treatment.

Back pain can have many causes. The information provided here should not be used to diagnose your condition or determine whether you need imaging, medication, physiotherapy, surgery or another form of treatment.

If you have severe, worsening or persistent symptoms, neurological changes, bladder or bowel changes, saddle-area numbness, significant trauma, fever, unexplained weight loss, a history of cancer or other concerning symptoms, seek appropriate medical attention promptly.