Back Pain That Comes and Goes: What It Might Mean

Many people experience back pain that isn’t constant. It’s common to feel fine one day, but wake up the next with a stiff and rigid back, or have a dull ache that lasts for days before suddenly ‘disappearing’. When the pain subsides, it’s easy to believe we’re ‘all better,’ which is why this type of intermittent pain is often “easy to ignore”.

However, from a chiropractic perspective, these intermittent episodes are anything but a minor signal. They are often a key characteristic of a long-term functional issue in the spine—a subtle dysfunction and alignment problem in the spinal segments known as ‘Subluxation’. Low back pain is the single leading cause of disability worldwide, and one of its fundamental traits is that it is ‘recurrent’.

A pain-free period may not mean ‘complete healing,’ but rather a ‘dormant phase’ where the underlying problem is lurking beneath the surface.

Intermittent pain is often related to your body’s ‘Pain Threshold.’ Imagine your spine is a ‘cup’ holding water. Even if the cup is 80% full, the water doesn’t spill. This 80% represents the ‘fundamental spinal problem’ we will discuss in the next section.

Pain occurs when this cup overflows—that is, when the ‘pain threshold’ is crossed. The following daily triggers can  act as the ‘faucet’ pouring more water into a cup that is already 80% full. When the water overflows (pain occurs), resting or changing activities might lower the water level (pain disappears), and you feel fine. But the cup is still 80% full.

1. Poor Posture: The Silent Spinal Stress

Modern life, especially long hours of office work or driving, has made “poor posture” one of the biggest enemies of spinal health.

• Accumulated Load: Slouching or maintaining an ‘Anterior Pelvic Tilt’ (an excessive curve in the lower back) continuously places “unnecessary stress” and “chronic loading” on specific spinal segments.
• Muscle Imbalance: This posture weakens the glutes (buttocks) and abdominal muscles, while making the hip flexors and back muscles short and stiff.
• Nervous System Adaptation: When poor posture is maintained for a long time, the soft tissues around the spine adapt to that abnormal position, losing flexibility and potentially even compressing spinal nerves. Research shows that prolonged poor posture is a clear potential risk factor for lumbar (low back) injuries.

The reason pain ‘comes and goes’ may be that the spine is already stressed from poor posture (80% of the cup). The act of sitting for a long time (the faucet) adds cumulative load. When the limit is reached, pain (overflow) occurs. If you rest or move on the weekend, the load decreases, and the pain temporarily disappears.

2. Mental Stress: The Invisible Muscle Tension

Stress isn’t just a ‘mood’ problem. Mental stress puts our body into a ‘fight or flight’ response state.

• Muscle Hyper-tension: The stress hormones released in this state “increase muscle tension” and can reduce blood flow, manifesting as back pain.
• Increased Pain Sensitivity: Psychological factors like anxiety or depression can “heighten” the perception of pain and play a significant role in acute pain progressing to chronic pain.
• Physical Manifestation: From a chiropractic viewpoint, stress causes ‘maladaptation’ in the body’s ‘homeostatic mechanisms’. When you’re stressed, you might unconsciously hunch your shoulders or your back muscles might become chronically tense, which, in turn, can subtly shift the spine’s alignment. Chiropractic can help break this cycle of pain by addressing the ‘physical traces’ that stress leaves on the body (muscle tension, poor alignment).

3. Sleep Quality: A Failure to Recover

Sleep is one of the only times the spine, which is compressed all day, can “rest and recover”. During this time, the discs between the vertebrae rehydrate and recharge.

• Lowered Pain Threshold: Chronic sleep deprivation “lowers the pain threshold,” making you more sensitive to pain.
• Risk of Chronic Pain: One large-scale study found that long-term ‘poor sleep quality‘ significantly increases the risk of “chronic and disabling back pain,” regardless of daytime physical activity levels. Pain and insomnia are in a “reciprocal relationship,” where each worsens the other.
• The Secret of Morning Pain: This is one of the main reasons for “back pain in the morning that goes away”. If you sleep on an unsupportive mattress or in a bad position, the spine cannot recover and instead accumulates inflammation. When you wake up and start moving, these inflammatory substances circulate, and the pressure on the disc changes, causing the pain to temporarily subside.

The ‘Real’ Problem Behind the Pain: The Root Cause From a Chiropractic Viewpoint

If the lifestyle habits mentioned earlier (posture, stress, sleep) are the ‘triggers’ (the faucet), the following issues are the ‘vulnerable spinal environment’ ready to accept the pain—the 80% of water already in the cup (the root cause). At Total Health Chiropractic, we focus on finding and correcting this root cause.

1. Spinal Alignment Issues and Joint Restriction

This is what’s known in chiropractic as ‘Subluxation’ or ‘Joint dysfunction’. It refers to a state where the spinal joints are not functioning optimally or have “a decrease in motion”.

Due to poor posture, stress, or minor past traumas, a specific segment of the spine can become stiff. When this happens, the joints above and below must ‘compensate’ and move more to make up for it. If a joint doesn’t move properly, the surrounding muscles go into a protective muscle spasm and inflammation occurs, causing pain. When a vertebra shifts slightly out of its proper position, it can press on surrounding nerves, causing “unexplained” or “constantly recurring” pain, or even numbness or weakness radiating to the limbs.

2. Muscle Imbalances

Spinal alignment “directly influences muscle function”. If a spinal joint is misaligned or dysfunctional, the nerve signals from the brain to the muscles may not be transmitted properly. As a result, some muscles become “overactive” and chronically tight, while others become “underactive” and weak.

This isn’t just a ‘feeling.’ Research shows that in low back pain patients, structural changes are observed in the deep stabilizing muscles of the spine (e.g., the multifidus), such as atrophy (shrinking) or fat infiltration. Furthermore, a prospective study has shown that an imbalance in the gluteal (hip) muscles is associated with the future development of low back pain.

Many patients with chronic pain might feel that “adjustments are only temporary”. This may be because the underlying muscle imbalance has not been resolved. A true chiropractic approach should aim to normalise nerve flow through spinal adjustments to allow muscles to ‘work’ properly, while simultaneously breaking the spine’s ‘compensation patterns’ by incorporating exercises to strengthen weakened muscles.

3. Early Disc Irritation

The ‘intervertebral disc’, the shock-absorbing cushion between the vertebrae, is a common source of pain. A disc can be bulging or herniated (where the inner nucleus ruptures out), irritating nerves.

“Morning back pain” can be a typical sign of an early disc problem. As mentioned, discs ‘rehydrate’ by absorbing water while lying down at night. If there is already micro-damage or irritation to the disc wall, the disc, which has become swollen with water overnight, irritates the nerves more strongly in the morning. When you get up and start moving, gravity causes water to leave the disc, lowering the pressure and reducing the pain. This is why morning pain “gets better with movement,” and it means the disc problem is not resolved just because the pain is gone.

These three ‘root causes’ do not operate in isolation. Rather, they create a ‘vicious cycle’ that worsens each other:

1. (Joint Restriction) A spinal joint becomes stiff.
2. (Muscle Imbalance) The deep spinal muscles weaken (underactive).
3. (Disc Irritation) The spine’s support weakens, placing excessive load on the disc.
4. (Protective Spasm) The irritated disc causes surrounding muscles to tighten.
5. (Worsened Joint Restriction) The joint restriction from step 1 becomes even worse.

Intermittent pain is the warning light that appears as this vicious cycle progresses toward chronic pain.

“It only hurts sometimes…” Why You Shouldn’t Ignore Intermittent Pain

1. The ‘Natural History’ of Low Back Pain is ‘Recurrence’

As mentioned, many people worry this pain might be an “early warning sign of a chronic condition”. That concern is entirely valid. Long-term studies on low back pain consistently show that it is not a ‘one-and-done’ illness, but “typically a recurrent condition”. Most acute pain resolves within a few weeks, but it is well-established that “chronic or recurrent symptoms are common”. ‘Pain that comes and goes’ is the very picture of this ‘recurrent’ nature.

If you mistake the absence of pain for a ‘cure’ and neglect the underlying functional issue, the spine can progressively develop more serious problems like degenerative changes or disc herniation. Intermittent pain is an “early warning sign” on the road to ‘Chronic pain‘ (pain lasting more than 3 months).

2. ‘Yellow Flags’: The Psychological Traps That Foster Chronicity

The transition from acute to chronic pain is heavily influenced not only by physical factors but also by “psychosocial factors,” which are known as ‘Yellow Flags’.

‘Yellow Flags’ include “Fear avoidance behaviour”, a negative attitude that the pain will cause serious damage, and feelings of depression or anxiety.

A patient experiencing intermittent pain becomes afraid of ‘hurting again’ and starts to fear and avoid certain movements. However, this reduction in activity makes the spinal joints stiffer (joint restriction) and the muscles weaker (muscle imbalance). This creates a vicious cycle where, eventually, even smaller triggers can easily cause pain. Chiropractic plays a role in educating patients so they no longer fear pain and can move safely again, and in restoring joint function.

When is Professional Help Needed? (Warning Signs)

Not all pain is an emergency, but knowing “when to pay attention” is crucial. Chiropractic professionals are trained to evaluate a patient’s symptoms to determine if chiropractic care is appropriate, or if it’s a ‘Red Flag’ requiring immediate medical attention.

Signs You Need a Chiropractic Consultation

The following symptoms suggest a functional problem in the spine and could be evaluated by a chiropractor.

• Pain that lasts for more than a few days or “keeps recurring”.
• Pain that “appears regularly” in connection with specific activities (e.g., waking up, sitting for a long time).
• A reduced range of motion and feeling “stiffness”.
• “Radiating pain” that travels into the buttocks, legs, shoulders, or arms.
• “Numbness or tingling” in the arms or legs.
• Frequent “headaches or migraines” along with back pain (this is often related to alignment issues in the cervical spine (neck)).

‘Red Flags’ That Require Immediate Medical Attention

A well-trained chiropractor should always prioritise patient safety. If the following ‘Red Flag’ signs are present, they may indicate a serious condition such as a tumor, infection, fracture, or Cauda Equina Syndrome. In this case, the chiropractor will not attempt an adjustment and will immediately refer you to a hospital (emergency room).

Table 1: My Back Pain: Where Should I Go?

How Can Chiropractic Help Intermittent Pain?

Chiropractic is not just a treatment to ‘get rid of’ pain; it is a “holistic” approach that aims to correct the ‘dysfunction’ causing the pain, helping the body to heal itself.

1. First, Identify the Root Cause (Accurate Diagnosis)

“Identifying the root cause” is the first step. On your first visit to Total Health Chiropractic, we will perform a detailed history and physical examination. This isn’t just about pressing on the sore spot; it involves a comprehensive assessment of your “posture,” “range of motion,” and “spinal alignment”.

If nerve compression is suspected, physical tests like the “Straight Leg Raise” will be performed. If necessary, imaging tests like X-rays or MRIs may be ordered to check for “disc problems” or “degenerative changes”. This process is essential to accurately “differentiate” whether the cause of pain is joint restriction, muscle imbalance, or disc irritation.

2. Second, Restore Joint Function (Spinal Adjustment)

The core of chiropractic treatment is the ‘Spinal Manipulation’ or ‘Adjustment‘. This is a technique where a trained specialist applies a “controlled force” to a specific, dysfunctional joint, using their hands or a small instrument.

The goal of this procedure is not to ‘force bones into place,’ but to “improve spinal motion” in stiff joints and “restore joint function,” thereby reducing pressure on the nerves. You may hear a ‘popping’ sound during this process, which is due to pressure changes within the joint capsule.

Multiple high-quality studies (systematic reviews and meta-analyses) have demonstrated that spinal manipulative therapy (SMT) can be effective for “pain reduction” and “functional improvement” in chronic low back pain patients, and has “equivalent or superior effects” to physical therapy or standard medical care (like medication). Recent clinical practice guidelines also recommend spinal manipulation for low back pain and disc-related pain.

3. Third, Prevent Recurrence with ‘Maintenance Care’

This is the most critical approach for those with ‘pain that comes and goes.’ Chiropractic care doesn’t end with the adjustment. It provides a comprehensive prevention strategy that includes “lifestyle modification,” “customised exercise programs,” and “ergonomic advice”. This is a fundamental solution that aims to strengthen weak core muscles and corrects poor posture.

Particularly important for patients with ‘intermittent pain’ is the concept of ‘Maintenance Care’. This ‘proactive care’ approach involves regularly checking and managing spinal function even when there is no pain, contrasting with “symptom-guided treatment” (seeking care only when it hurts).

A remarkable randomized controlled trial (RCT) published in PLOS ONE in 2018 provides a clear answer for your ‘on-and-off’ pain. This study followed patients with recurrent/persistent low back pain for one year, dividing them into a ‘Maintenance Care’ group (regular care even without pain) and a ‘Symptom-Guided Treatment’ group (care only when in pain). The results were striking. The ‘Maintenance Care’ group reported a statistically significant fewer total number of ‘days with bothersome low back pain’ over the year compared to the ‘Symptom-Guided Treatment’ group.

Furthermore, another study on patients with work-related low back pain found that the group receiving chiropractic ‘Maintenance Care’ had a lower “disability recurrence rate” than groups receiving ‘maintenance care’ from physical therapists or physicians. This suggests that to break the cycle of ‘pain that comes and goes,’ proactively managing spinal function when you are not in pain may be more effective.

Final Thoughts

‘Back pain that comes and goes’ is not a minor inconvenience to be ignored. It is a ‘warning sign’ from your spine, and beneath it may be hiding fundamental biomechanical issues like spinal alignment problems, muscle imbalances, and early disc irritation.

Just because the pain is gone does not mean the problem is solved. A ‘symptom-guided approach’—temporarily covering up the pain with medication or massage only when it hurts—may lead to chronic pain or degenerative changes in the spine over the long term.

Chiropractic offers a holistic approach that aims to find the root cause of the pain, restores the function of the spinal joints, and may further break the vicious cycle of pain through scientifically-backed ‘Maintenance Care’.

Even if you are not in severe pain right now, if your back pain ‘comes and goes’ and leaves you confused, consider consulting with a professional at Total Health Chiropractic to check the fundamental health of your spine.