Why does my back pain keep coming back?

by Tim Beames, Physiotherapist and Pain Coach for Better Physio Group.

Tim Beames is a specialist physiotherapist with over 25 years of experience in persistent pain recovery. He sees patients at Better’s Soho clinic.

Book a session or free video call with Tim.

Check out his recent interview in The Physio Coach Podcast below.

If your back pain keeps coming back, you’re not alone, and you’re not imagining it. Persistent low back pain is one of the most common reasons people come and see us at Better Physio Group. It can be one of the most frustrating – you do the right things, you start to feel better, and suddenly, seemingly out of nowhere, you experience a flare and you’re back to square one. 

The natural response is to panic. To assume something is seriously wrong. To stop moving, cancel plans, and start Googling worst-case scenarios at 2am in the morning.

 But here’s what over 25 years of working with persistent pain has taught me: 

Persistent lower back pain, and flare-ups, are not a sign that your back is broken or that your recovery has failed. They are a normal – if unwelcome – part of the process. How you respond to them matters far more than the fact that they happen.

Most people assume their flare-ups are caused by something physical – a specific movement, a bad mattress, lifting something awkwardly. Sometimes there is a mechanical trigger. But more often recurrent back pain flares are driven by a combination of factors that have very little to do with the structure of your spine.

Research consistently shows that persistent low back pain is influenced by sleep quality,  stress levels, general physical activity, mood, and even how safe or supported you feel in your daily life. Your nervous system processes all of this information, and when the total load tips past a natural balance point, pain emerges – not as a sign of damage, but as your body’s response to everything that’s going on. It’s telling you that something bigger needs attention. 

This is actually good news, even if it doesn’t feel like it yet. Because it means there are multiple levers you can pull to reduce the frequency and intensity of your flare-ups – not just one quick fix.

Don’t stop – but do dial things down.  

This is probably the single most important piece of advice. When your back flares up, the natural instinct is to rest completely – lie flat, stop moving, wait for it to pass. But complete rest tends to make things worse rather than better. Your muscles stiffen, your nervous system becomes more vigilant, and you lose confidence in your body’s ability to move.

Instead, think of it as turning the volume down rather than switching off. If you normally walk for half an hour, modify this to walk for ten minutes. If you’re used to training in the gym, do a lighter, shorter session. If you sit at a desk all day, take more frequent breaks to stand and move. You’re  still active, just at a reduced level that feels manageable. 

Breathe – properly.  

When you’re in pain, your breathing changes. It becomes shallow, fast, and chest dominant. This keeps your nervous system in a heightened state of alert, which amplifies the whole pain experience. 

Slow, diaphragmatic breathing – in through the nose for four counts, out through the mouth for six – is one of the simplest and most effective ways to take the edge off a flare-up. The longer exhale activates the part of your nervous system responsible for calming things down. Five minutes of this won’t eliminate your pain, but it can genuinely reduce how threatening it feels. 

Move – gently and deliberately.  

Gentle movement during a flare-up isn’t about exercise. It’s about showing your nervous system that your body is capable of moving safely, even when the alarm is going off. 

A short walk around the block. Some gentle spinal movements – cat-cow stretches, pelvic tilts, or simply shifting between sitting and standing regularly. Nothing heroic. The message you’re sending is: “I hear you, but we’re okay.” 

Some people find that warmth helps – a warm shower or a hot water bottle on the lower  back before moving can make things feel less guarded. 

Check in with the bigger picture.  

When a flare-up hits, it’s worth asking yourself a few honest questions – not to find blame, but to understand context. 

1. How have you been sleeping recently? Sleep disruption is one of the strongest predictors of pain flare-ups, and it’s often the thing people overlook first. When your body doesn’t get adequate restorative sleep, your system becomes more sensitive and edgy, and more inclined to interpret ordinary sensations as threatening.
2. What’s your stress been like? Work pressure, relationship tension, financial worry, even the low-grade hum of a busy London commute – these aren’t separate from your back pain. They feed directly into how your nervous system perceives threat, and therefore how much pain you experience.
3. Have you been moving enough – or too much? Both extremes can trigger flare-ups. Prolonged inactivity and sudden spikes in activity are both common culprits. Consistency matters more than intensity.

Don’t go hunting for a single cause.  

This is a trap that catches almost everyone. “It must have been the deadlift on Tuesday.”  “I shouldn’t have sat on that train for two hours.” “It’s the new office chair.”

Maybe. But in most cases, a flare-up doesn’t have a single, neat cause. It emerges from the interaction of several factors – physical, psychological, lifestyle – that collectively push your system beyond its current tolerance. Looking for one culprit leads to unnecessary avoidance of activities that are almost certainly fine for you in the long run. 

Talk to someone  

Pain is harder when you carry it alone. If you have a partner, a friend, or a colleague you trust, let them know you’re having a rough patch. You don’t need them to fix it – sometimes just naming it out loud takes some of the weight off. 

And if you’re working with a physio, a flare-up is a perfectly good reason to get in touch. This is what we’re here for – not just the good weeks. 

Flare-ups settle. They always do. Most will ease within a few days to a couple of weeks, and they tend to resolve faster when you respond with calm, steady strategies rather than  fear and shutdown. 

But if your back pain keeps coming back – episode after episode, month after month – it’s worth looking at the pattern rather than treating each flare-up as a standalone event. 

At Better, this is where we start with most people who come to us with recurrent back pain. We look at the whole picture: how you move, how you sleep, how you manage  stress, what your daily habits look like, and what your nervous system has learned to do over time. Because the goal isn’t just to get through this flare-up – it’s to make the next one less likely, less intense, and less frightening. 

The research is encouraging here. People who take an active, whole-person approach to their back pain – combining graded movement, stress management, sleep optimisation, and a better understanding of how pain actually works – tend to see genuine, lasting improvement. Flare-ups become less frequent. The gap between episodes gets longer. Confidence returns.

If your back pain flare-ups are becoming more frequent, lasting longer, or stopping you from doing the things that matter to you, it’s worth getting assessed properly. Not with an MRI (which often shows “findings” that are completely normal and irrelevant), but with a thorough, face-to-face assessment that considers the full picture – your movement, your lifestyle, your history, and your goals. 

A small number of back pain presentations do need further investigation – particularly if you’re experiencing significant leg weakness, changes in bladder or bowel function, or pain that is genuinely worsening week on week despite everything you’re doing. If that applies to you, seek medical attention promptly. 

But for most people with recurrent back pain, the path forward is not more scans or more rest. It’s a structured, supported plan that helps you build resilience – physically and psychologically – so that your back stops being the thing that runs your life.

We approach back pain the way the evidence says it should be approached: as a whole person problem, not just a spinal one. That means we look at movement, nutrition, sleep, stress, and your support network – what we call the five lifestyle pillars – because all of these influence how your back feels and how quickly you recover. 

If you’re tired of the cycle – flare-up, rest, feel better, flare-up again – and you want to actually change the pattern, we’d love to help.

Tim Beames is a specialist physiotherapist with over 25 years of experience in persistent pain recovery. He sees patients at Better’s Soho clinic.

Tim’s website is full of more information about his practice.

Book a session or free video call with Tim.