By Susan Bunce, Registered Osteopath and Practice Principal at Broadwater Osteopathic Practice
Last updated: October 2026
The short answer: Recurring back pain is very common, and it usually doesn’t mean you’ve injured your back again. For many people, an episode settles as irritated tissue calms down, but the underlying sensitivity can hang around, so the next flare-up needs less to set it off. Research points to long spells of sitting, repeated awkward postures and previous episodes as common warning signs, though which factors matter most varies from person to person. The practical levers are how much load your back is coping with, how confident you feel moving and, possibly, how well you’re sleeping and coping with stress.
You bend down to pick up a sock and your back goes. No heavy lifting, no dramatic twist, just a sock. A moment later you’re gripping the doorframe, mentally rewriting your week and wondering what on earth you’ve done to yourself.
“Why does it keep coming back?” is one of the questions we hear most often at our back pain clinic in Worthing, and it’s usually asked with a bit of fear behind it. People arrive convinced that each recurrence is a fresh injury, that something has finally “gone”, or that this is simply their life now. In most cases none of that is true, and the real explanation is a lot more useful than “it just happens”.
Why does something as small as a sock set off my back?
Because your back was already running close to its limit, and the sock was the last straw. Most back pain is what clinicians call non-specific low back pain: the pain is completely real, but no single damaged structure shows up on an examination or scan. So an episode is better understood as a period when your back has become sensitive, not broken. Back pain can work a bit like an over-sensitive car alarm. It goes off for a passing bus, not just a burglar, and it can stay twitchy for a while after the noise stops. That is why the pain fades and then comes back — not because anything broke twice, but because the alarm never quite stopped listening.
The alarm’s trigger point moves up and down with what you’ve been doing. In clinic, I regularly see people who are completely convinced a trivial movement injured them. When we go through the week beforehand, there is almost always something else in the mix — a run of poor sleep, a heavy few days at work, a long drive, a stressful week, or simply doing much less than usual. The sock gets the blame, but it only added the last bit. If a sock caused the problem, the answer would be to avoid socks. If a low threshold caused it, the answer is to raise the threshold, and that’s a much more hopeful job.
Does a flare-up mean I have damaged my back again?
Usually not. Pain and damage feel identical from the inside, but they aren’t the same thing, and they can move independently. Plenty of people have significant findings on a scan and no pain at all, and plenty are in real pain with nothing injured. Back pain also tends to improve on its own within a few weeks, which is one reason the sensible response to a flare-up is rarely to panic. The hard part isn’t getting better once. It’s staying better.
How common is recurring back pain?
Very. In a 2019 study published in the *Journal of Physiotherapy*, researchers in Sydney followed 250 people who had recently recovered from an episode of low back pain. Within 12 months, 69% had another episode, 40% had one severe enough to limit their activity and 41% went back to a healthcare professional about it. The median time to a recurrence was 139 days, about four and a half months.[1] If your back has flared more than once, you’re in the majority, not the exception.
What makes recurrence more likely?
The same study found three predictors: frequent exposure to awkward postures, sitting for more than five hours a day and having had more than two previous episodes.[1] You can’t change your history, but you can do something about the other two. One caution: this is a strong study, but it is one study of one group of people, and recurrence figures vary between studies depending on how recurrence is defined. Treat 69% as a good guide, not a law of nature.
Does what I did last week matter more than what I did yesterday?
Yes, because flare-ups often reflect accumulated load rather than one event. Load isn’t only heavy lifting. A sudden jump counts, such as a long walk, a day in the garden or a big gym session after a quiet month. So does a sudden drop, such as a desk-bound week, illness or a long car journey. Long spells of sitting count, and so, plausibly, do poor sleep and a stressful few weeks.
That’s why “what did you do yesterday?” is usually the wrong question and “what have the last three weeks looked like?” is the better one. When we go back over the fortnight before a flare-up, there is often something else in the mix besides the movement that finally set it off.
Is sleep connected to back pain?
Yes, there’s a clear link, but the research can’t yet tell us which way it runs. A pooled analysis of 13 studies in the European Spine Journal, covering almost 2,000 people seeking care for low back pain, found that 58.9% said their back disturbed their sleep. That was 63% of people with recent-onset pain and 57% of those with persistent pain, and it became more likely as pain got worse.[2]
The catch is that this shows how common disturbed sleep is in people with back pain. It doesn’t show that poor sleep makes back pain return, and studies like this give a snapshot rather than proving cause and effect. So I’ll put it practically. If you’re sleeping badly and your back keeps flaring, sleep deserves attention in its own right. It isn’t proven to prevent a recurrence, but poor sleep is worth fixing anyway, and it may make it easier to stay active.
Can stress and worry make back pain come back?
They can play a part, and the way they do it is worth understanding. It’s a subject I care about professionally: my osteopathic degree included a two-year dissertation on stress, anxiety and musculoskeletal pain, and more than 25 years later it’s still one of the most reliable things I see in clinic. The International Association for the Study of Pain describes two patterns that look like opposites but can both keep back pain going.[3]
The first is avoidance. When you’re worried a movement will hurt you, you stop doing it. Straight after an injury that’s sensible. But once your tissues no longer need protecting, avoidance becomes part of the problem, and pain and disability can build. The second is overactivity: ignoring the pain, pushing on, then “catching up” at the weekend after a desk-bound week. Most people know which camp they’re in, and will tell you quite firmly. Neither works. What works is enough activity to build tolerance, at a pace your back can absorb, which usually means little and often rather than hard and rarely.
The same fact sheet lists pain catastrophising, which means worrying and ruminating about pain, and low confidence in your ability to manage it as risk factors for back pain becoming persistent.[3] None of this means the pain is “in your head”. Pain, sleep, stress and threat run on overlapping systems, so helping one often helps the others.
What can an osteopath do about recurring back pain?
An osteopath can work out what is driving your pattern and help settle an active episode, but shouldn’t promise to stop it coming back on their own. An osteopathic assessment looks at how your back, hips and pelvis move, how strong and confident you are in movement, and how you’ve been loading yourself. It also covers sleep, stress and what has changed recently, because those things can all bear on how a back behaves.
Where an episode is still active, hands-on treatment can help settle symptoms. NICE says to consider manual therapy, meaning spinal manipulation, mobilisation or soft tissue techniques, but only as part of a treatment package that includes exercise.[6] Hands-on work is a useful part of the package, not the whole of it.
What I wouldn’t claim is that osteopathy prevents recurrence by itself. The evidence for prevention points at exercise, education and load management, and if that’s what the research says, that’s what I should be telling you. The value of an assessment is working out which of those matters most for you, then building a plan you can keep up.
When is it worth getting recurring back pain checked?
It’s worth arranging an assessment if symptoms haven’t settled within a week of self-management, if your back pain keeps returning and each episode feels similar, or if it’s stopping you doing your normal activities or work. It’s also worth coming if you’re cutting back on what you do because you’re worried about causing harm, or if you simply want to know which factors matter most for your own back. You don’t need a dramatic story. “It keeps coming back and I’d like to know why” is a perfectly good reason.
When should I get medical help instead?
If back pain comes with certain symptoms, get medical help rather than waiting. Most back pain isn’t serious, but a small number of symptoms need urgent attention, and this is the section I’d most like you to read. The guidance below follows current NHS back pain advice.[4]
Call 999 or go to A&E if you have back pain and any of these
- pain, tingling, weakness or numbness in both legs
- a loss of feeling around your genitals or anus (sometimes called saddle numbness)
- changes in your bladder or bowels, such as difficulty peeing, or peeing or pooing yourself
- changes in how your penis or vagina feels during sex, or not being able to get or keep an erection or reach orgasm
- pain that started after a serious accident, such as a car accident
These symptoms can point to a rare but serious problem that needs urgent assessment. Don’t drive yourself to A&E. Ask someone to drive you, or call 999 and ask for an ambulance.
Ask for an urgent GP appointment or call 111 if
you have back pain and you feel hot, cold, shivery or generally unwell, or the pain is severe, started suddenly or is getting worse quickly.
See your GP if:
Your back pain hasn’t improved after managing it at home for a few weeks, is stopping you doing your day-to-day activities, or has you worried or struggling to cope.
Also see your GP if you’ve lost weight without trying to, if there’s a lump or swelling in your back or your back has changed shape, if the pain doesn’t improve with rest or is worse at night, you have a history of cancer and are experiencing bone pain.
Most people with these features won’t turn out to have anything serious, but they’re reasons to have the conversation sooner rather than later, and they’re exactly the kind of thing an osteopath would refer you for.
If you’re ever unsure which route to take, ring the practice on 01903 820206 or contact your GP. You don’t need to have worked out which is right before you ask.
What can an article not tell you?
An article like this can explain what tends to happen, what the evidence says and what generally helps. It can’t tell you what is causing your back pain. Non-specific back pain is diagnosed by assessment, not by description, which is why the same symptoms can come from quite different situations in two different people. If your symptoms are persistent, recurring or worrying you, the useful next step is an assessment rather than more reading.
Frequently asked questions about recurring back pain
Not necessarily. Many people who have had several episodes go on to have long stretches without symptoms
Usually yes, in a modified form — less volume, not none at all. If your pain is severe or getting worse rather than better, get advice first.
Not usually, and in most cases a scan wouldn’t change what you do next. We cover this in more detail in our guide to MRI and X-rays for back pain.
For most people, yes, with a gradual return. Start lighter and shorter than you think you need to, and build up over a couple of weeks rather than in one session. If a particular movement consistently reproduces your symptoms, that’s worth discussing rather than pushing through.
Many people find symptoms are worse first thing, when tissues have been still for several hours, and gentle movement usually helps. Pain that is consistently worse at night, or that doesn’t ease with movement at all, is a reason to speak to your GP.
An assessment and treatment can be useful at any stage. The focus tends to shift towards understanding what is maintaining the problem and what has changed. An osteopath will assess your movement, alongside exploring exercise and lifestyle factors too. They will often prescribe exercises to incorporate into your daily routines.
So why does back pain keep coming back?
A sensitive back has a lower threshold, and for many people, everyday load, long hours of sitting, poor sleep, stress and lost movement confidence can all push it lower. Not every factor applies to every person, and an assessment is how you work out which ones matter for you. None of them is dramatic, and all of them are workable. The most useful question isn’t “how do I fix my back?” but “what is making the next episode more likely for me?”
At Broadwater Osteopathic Practice in Worthing, our osteopaths assess how your back, hips and pelvis are moving, how you’ve been loading yourself and which factors matter most for your own pattern of symptoms. Where hands-on treatment is helpful we’ll tell you. Where the more useful work is in what you do between appointments, we’ll tell you that too.
To arrange an assessment, call us on 01903 820206 or book an appointment online. You can find us at 2 Sompting Road, Worthing, BN14 9EP.
This article provides general information and is not a substitute for individual clinical assessment. If you are unsure whether it applies to you, please speak to a healthcare professional.
References
- da Silva T, Mills K, Brown BT, Pocovi N, de Campos T, Maher C, Hancock MJ. Recurrence of low back pain is common: a prospective inception cohort study. Journal of Physiotherapy, 2019;65(3):159-165.
- Alsaadi SM, McAuley JH, Hush JM, Maher CG. Prevalence of sleep disturbance in patients with low back pain, corrected version. European Spine Journal, 2012;21(3):554-560.
- McCracken LM, Linton S, Shaw W, Pagé G. Psychology of back pain. International Association for the Study of Pain fact sheet, 2021.
- NHS. Back pain. Ongoing guidance, accessed October 2026.
- Pocovi NC, Lin CC, French SD, et al. Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial. The Lancet, 2024;404(10448):134-144.
- National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management (NG59). Published 2016, updated July 2026.
