Whether it is running to catch the bus, picking up a cup of coffee, or getting into bed after a long day, for people with back pain, even the most routine movements can be a struggle. But what if the pain is not coming from your back at all?
The Hidden Dangers of Back Pain
Back pain is the single leading cause of disability worldwide, according to the World Health Organisation. In the UK alone, musculoskeletal disorders claim over 12 million working days each year. However, experts say it is not just about taking painkillers. Back pain may be a red flag for other major health issues, with research pointing to connections between spinal health and various bodily systems, from the gut to the heart.
New research shows that conditions such as heart disease, digestive issues, and even cancer are more common in people with back pain. "When treating patients with chronic back pain, it is not just about the spine," said Professor Zambelli Pinto, a musculoskeletal expert at the University of Technology Sydney. "We need to look beyond pain management to understand the link between back pain and other non-communicable diseases."
Poor Gut Health
Researchers have identified a link between the gut and spine, known as the gut-spine axis. This subtle network connects the gut microbiome with the immune system, inflammation, and pain, all of which can affect the back. The theory suggests that when the delicate balance of gut bacteria is disrupted—through stress, poor diet, or antibiotics—the gut lining becomes permeable, or "leaky." This allows fragments of harmful bacteria to escape into the bloodstream, triggering body-wide inflammation that can activate spinal nerves and wear away cartilage and joints over time.
When gut health is neglected, this inflammation can become chronic. Digestive issues like IBS, SIBO, and constipation can also cause back pain. In 2023, a study involving nearly 7,000 adults found that people who ate an inflammatory diet were 32 per cent more likely to report back pain. Conversely, anti-inflammatory diets such as the Mediterranean diet—rich in Vitamin D, calcium, and magnesium—have been shown to support back health by reducing inflammation and preserving muscle mass.
Pancreatic Cancer
Since back pain is common, even when it lingers for months, it is often dismissed as over-exercising or a pulled muscle. However, in some cases, it could indicate pancreatic cancer, experts warn. Pancreatic cancer is one of the deadliest forms of the disease, with only one in four patients living more than a year. It is typically diagnosed late because early symptoms are few. One warning sign may be persistent back pain that does not go away, according to Dr Jiri Kubes, medical director at the Proton Therapy Center.
"Because of the location of the pancreas, pain can radiate to the back and may feel quite non-specific," he added. "It is often described as a dull or persistent ache rather than a sharp pain." The pancreas, a small pear-shaped gland, sits deep behind the stomach. Due to its location and size, doctors cannot feel a tumour during a routine physical exam, but it can cause back pain often mistaken for a muscular issue. Dr Kubes said ongoing pain that cannot be explained by over-exertion should be taken seriously. "If you have ongoing back pain that cannot be explained and does not improve, it is important to get it checked. It is always better to rule out something serious than leave it too late."
Heart Disease
When thinking of heart attacks, many imagine chest pain, breathlessness, and palpitations. But back pain can also be a warning sign. Dr Oliver Guttman, a consultant cardiologist at St Bartholomew's Hospital, says many do not recognise the warning signs until it is too late. Coronary heart disease builds up over years as fatty deposits narrow the arteries around the heart, restricting blood flow. Symptoms may be silent until a heart attack occurs.
"Classic angina presents as central chest tightness, often radiating to the left arm or jaw," Dr Guttman explains. "However, angina can present atypically—particularly in women, older patients, and diabetics—with pain felt primarily in the back, with little or no chest discomfort." This occurs because cardiac pain is referred: the heart shares nerve pathways with other body areas, so the brain can misinterpret the source. "Back pain that comes on with exertion, is accompanied by breathlessness or sweating, or eases with rest should prompt urgent cardiac assessment."
Aortic Aneurysm
A weak spot in the heart wall that bulges outward—known as an aortic aneurysm—can also cause back pain. "This separate but related emergency can present as a severe tearing back pain," Dr Guttman explains. "Most back pain is not related to the heart and is likely musculoskeletal. But key red flags are pain triggered by exertion, associated breathlessness, sweating, nausea, or radiation to the arm or jaw."
Pelvic Floor Dysfunction
In women, when pelvic muscles—which support the bladder, uterus, and bowel—do not work properly, this can lead to incontinence, constipation, and pain during sex. It can also cause lower back pain. "We do know that pelvic floor dysfunction and back pain—especially when someone has urinary incontinence—are commonly seen together," says Dr Arianna Mitropoulos, a clinical specialist at Brigham and Women's Hospital. "But most people do not associate the core with the pelvic floor, even some clinicians."
Since the pelvic floor and diaphragm are interconnected, dysfunction can disrupt diaphragm function and contribute to back pain. "If the pressure in your trunk changes, it affects your posture," Dr Mitropoulos explains. Tension in the pelvis can also cause referred pain in the lower back. "Tight muscles tend to be weak because they are already in a contracted state. All those muscles connect to the tailbone, which is linked to the spine." To strengthen the pelvic floor and reduce back pain, imagine trying not to urinate, tightening and releasing the pelvic floor muscles repeatedly. Try to do this ten times in a row, holding each contraction for ten seconds.
