Lower back pain that isn’t just from your chair: what your body says about pressure at work

“My physiotherapist told me to buy a better chair. I bought one. On holiday it didn’t hurt for a single day. Then on Sunday evening it started again.”

I hear this sentence, in various versions, more often than I would expect. Lower back pain that settles during a holiday and returns with the return to the office. That is bad in the weeks before a deadline and bearable once the project has been handed in. That gets worse after a meeting with a particular person. People who notice this are often confused and a little frightened. Does it mean I’m imagining the pain? That it’s “all in my head”?

No. And because this question matters so much, I will be clear from the start: the pain I am writing about is real. It isn’t imagined, it isn’t exaggerated and it isn’t a sign of weakness. This post is about what we know of the link between lower back pain and pressure at work, why the body sometimes speaks where words stay silent, and what you can do — always alongside medical care, never instead of it.

Doctor first — and why

Before anything else: if your lower back hurts, your first port of call is your GP. Not because every back pain is dangerous — most aren’t — but because the rare cases that need quick action must be ruled out. Doctors call these red flags.

They include, for example, pain after a fall or injury, fever together with the pain, unexplained weight loss, a history of cancer, weakness or increasing numbness in the legs, numbness in the area between the legs, and problems holding or passing urine or stools. With the last two you need to see a doctor straight away, and with severe symptoms call emergency services (112 in Slovenia).

Everything that follows in this post applies only after a doctor has taken a look. A psychological view of pain is not a substitute for an examination. It is a complement that comes into play once serious physical causes have been ruled out or while treatment is under way and the pain still drags on.

What we know about lower back pain

According to large international reviews, lower back pain is the leading cause of years that people around the world live with limited ability to work and manage daily life. So it is very common — and at the same time surprisingly hard to explain.

The professional literature often states that in about 90 per cent of people with lower back pain, no single precise anatomical cause can be identified. This is called non-specific lower back pain. It doesn’t mean there is nothing going on in the body. It means the pain doesn’t come from one point that could be shown on a scan and fixed. Scans often show wear-and-tear changes that people without pain have too, and people in severe pain sometimes have almost flawless results.

I wrote about this experience, when the tests are fine but the pain remains, in “The tests are normal, but it still hurts”: what therapy knows about psychosomatics. Something similar is true of lower back pain: because it doesn’t come from one point, many factors influence it at once — physical load, movement, sleep, general health, and also emotions, fear and the environment in which a person lives and works.

Yellow flags: what predicts whether the pain will stay

In the late 1990s in New Zealand, Nicholas Kendall, Steven Linton and Chris Main prepared guidelines for doctors that described, alongside red flags, yellow flags as well. These don’t point to a dangerous illness, but to psychological and social circumstances that increase the likelihood that acute pain will develop into long-term pain.

They include the belief that pain is dangerous and that movement does harm, avoiding activities out of fear of pain, low mood and withdrawal from others, the sense that nobody believes you, and difficulties and dissatisfaction at work. Reviews of research published later by Steven Linton and by Tamar Pincus and colleagues confirmed that psychological factors such as distress and low mood are important predictors of whether pain becomes long-term — often better than the test results themselves.

Why does this matter? Because it means we can influence the course of pain by routes other than medication or surgery. Not because the pain is “psychological”, but because the nervous system processes pain as a whole — together with everything a person is carrying at the time. You will find a short explanation of this link in the knowledge base under pain and emotion.

What work has to do with it

In 2000, a group of Dutch researchers led by Wilhelmina Hoogendoorn systematically reviewed research on psychosocial factors at work and lower back pain. The two best-supported risk factors were low job satisfaction and little social support at work. Not stress as such, but above all how a person experiences their work and whether they can lean on the people around them.

This matches what people describe. The pain often doesn’t get worse with the most work, but with the most loneliness in work. With a project you carry alone because the others “don’t have time”. With a manager whose reactions you can’t predict. With a team in which problems aren’t talked about.

The physical explanation isn’t mysterious. Under prolonged tension, muscles unconsciously prepare for defence: the shoulders rise, the stomach tightens, the back stiffens. Sleep becomes shallower, the body has less time to recover, and a nervous system on standby processes pain signals more sensitively too. The knowledge base entry chronic stress describes how this drags on through weeks and months, and the post Physical signs of burnout that we blame on everything else covers other bodily signs.

A body that carries a role in the system

In relational family therapy, in which I am training, we see the workplace as a system similar to a family. It has roles that nobody officially assigned but everyone knows: the one who holds everything together, the one who smooths over conflicts, the one who always says “yes”, the one who gets the blame when something goes wrong.

These roles are often very similar to the ones we had at home. A child who had to grow up too early will, as an adult, often be the one in the team who carries more than their share. And because it is a role they have always known, they don’t experience it as a burden but as something self-evident. You will find a short explanation under roles in the family.

In such a position, overload sometimes shows up first not in words but in the body. The person doesn’t say “this is too much” — perhaps because they don’t know how, perhaps because in their system it wasn’t allowed to be said. But the back says it. Not as a symbol or metaphor, but as a very concrete response of a body that has been under tension for too long and has no other outlet.

This view doesn’t mean that pain is a “message” to be decoded, after which it will disappear. It means that alongside the pain it sometimes makes sense to ask: what am I carrying that nobody sees? Who in this system knows how much is too much for me?

The cycle of fear and avoidance

One of the best-researched routes by which short-term pain becomes long-term is the so-called fear-avoidance model described by Johan Vlaeyen and Steven Linton.

It goes like this: pain triggers fear that something serious is happening in the body. Fear leads to avoidance — the person stops bending, stops going for walks, stops lifting their child. Avoidance calms things in the short term, but in the long term it weakens the body, increases sensitivity and often low mood too. And then the pain with the next movement is even worse, which confirms the fear. The circle closes.

The same cycle can turn at work. A person starts avoiding meetings that make them tense, tasks that have already hurt, people around whom they tighten up. Life narrows, but the tension doesn’t go away; it moves into anticipation. I wrote about how anxiety sets off the body before a thought has even formed in What happens in the brain during anxiety — and why the body reacts before you think.

The good news is that the circle can be opened at several points — through understanding that pain doesn’t necessarily mean damage, through a gradual return to movement with professional support, and through someone also addressing the pressure that feeds the tension.

How one such conversation might sound

This is what a conversation about pain that drags on might look like (composite, not a real person):

“My doctor says the results are nothing special. Physio helped a little. But every Monday it’s the same.”
“When is it worst?”
“In the morning, when I’m driving to work. And after meetings with the director.”
“What happens at those meetings?”
“Nothing special. He asks, I answer. For everything, for the whole team.”
“For the whole team?”
“Yes, because the others don’t come. I’m just the one who comes.”
“How do you sit in those meetings?”
A pause. “Like I’m waiting for a blow.”

This conversation doesn’t explain the pain. But it shows something the person hadn’t connected before: that besides the chair and posture there is another load that no scan measures. And that they carry it alone — physically, too.

A realisation like this can be a relief, because the pain gains a context. It can also hurt, because it opens questions about work, role and relationships that the person hadn’t allowed themselves to ask before. Both are fine.

Exercise: a pain and pressure diary

This exercise doesn’t treat the pain. It helps you see a pattern you would otherwise miss, and gives you information that may also be useful for your doctor or physiotherapist. You can start today.

1. Rate the pain three times a day. In the morning, at midday and in the evening, rate it on a scale from 0 to 10. Don’t think about it too long — write down the first number that comes to mind.
2. Next to it, write what was happening. One line: who you were with, what you were doing, how you slept. Don’t explain, just record.
3. Add one question about tension. Where in your body is there tension right now — shoulders, jaw, stomach, back? The short body scan exercise in the knowledge base can help with this.
4. After two weeks, look at the whole. Can you see days, hours or people with which the pain is higher? Can you see circumstances in which it eases? You will also find a template for this kind of record under diary of bodily signs.
5. Choose one small shift. Not a big decision, but one experiment: a break after a particular meeting, a short walk instead of lunch at your desk, one sentence with which you share a task. Watch whether anything changes.

People are often surprised at how clear the pattern is once they see it on paper. Sometimes, though, there is no pattern — and that too is important information, telling you that the answer must be sought elsewhere.

Where this view doesn’t apply

I want to be very clear here, because the link between pain and stress is easily misused.

Not every lower back pain is connected to work. Backs also hurt because of injuries, inflammatory diseases, changes in the spine, pregnancy, too little movement and other physical causes. Psychosocial factors are one influence, not the only one and not always the most important.

Physical load is real. A job where you lift heavy loads, stand for long periods or sit for eight hours at an unsuitable desk strains the body even without any stress at all. In such cases the first step is to sort out the workplace, not therapy.

The pain isn’t your fault. If someone says “it’s just stress” or “you’re doing it to yourself”, they haven’t understood what the research says. Psychological factors don’t mean you create the pain or that you could get rid of it by willpower. They mean the body is a whole and that everything you carry affects the pain.

Therapy doesn’t replace medical treatment. If the pain gets worse, changes, or any of the red flags appear, you need to go back to the doctor — regardless of what you have learnt about yourself and your job.

How talking can help

Psychotherapy doesn’t heal a back. But it can help with the part of the pain that no pill reaches: the fear that amplifies it, the role that has become too heavy, the relationships at work and at home that feed the tension.

In relational family therapy we explore where the patterns we carry into relationships come from — including those that make it easier for someone to have a sore back than to say “I can’t manage”. When a person recognises these patterns, they can often allow themselves a different response. Sometimes the tension in the body eases with it. I can’t promise that, because every person is different. But I do know that pain is lighter when you don’t carry it alone and without words.

If you are interested in how therapists who work with pain and tension through the body go about it, you can read The body says what we cannot put into words: an introduction to body psychotherapy. And if you notice that pain or illness returns to a schedule, you may also relate to When you fall ill every Friday: the body that waits for the weekend.

What to remember

• Lower back pain is real, even when pressure at work affects it — it isn’t “all in your head”.
• See a doctor first: red flags need a quick examination; with severe symptoms call 112 (in Slovenia).
• Yellow flags — fear, avoidance, low mood and little support at work — predict whether the pain will stay.
• In a work system, the body sometimes carries a role that words aren’t allowed to voice.
• A pain and pressure diary helps you see the pattern — and give your doctor better information.