Last updated: December 2025
Reviewed by: Dr. Sandra A. Do, DPT, OCS, FAAOMPT (Manual Therapy Associates)

Back pain that comes and goes is common—and it usually isn’t random. In many cases, symptoms fluctuate because your back is sensitive to certain “inputs” (like sitting, bending, lifting, stress, or poor sleep). When those inputs decrease, pain settles. When they return, pain can flare again.

The encouraging part: intermittent back pain often follows a pattern. Once you understand your triggers and improve your back’s capacity, flare-ups tend to become less frequent, less intense, and easier to calm.

Why symptoms fluctuate instead of staying constant

Many flare-ups are a “load and tolerance” issue. On lower-load days (more movement breaks, less repetitive bending, better sleep), tissues and the nervous system calm down. On higher-load days (long desk time, repeated bending/lifting, higher stress), the same area can become irritated again—even if nothing new is “damaged.”

That’s why you might feel good for a week, then flare after a long drive, yardwork, travel, a busy workout week, or a stressful stretch at work.

Common reasons intermittent back pain happens

Intermittent back pain can come from different sources, and sometimes more than one factor is involved:

• Muscle strain or protective tension: Overuse, awkward lifting, or stress can trigger muscle guarding. Symptoms may improve, then return with repeat overload.

• Joint stiffness/irritation: Facet joints (in the spine) or the sacroiliac (SI) joints can ache after prolonged sitting or in the morning, then feel better as you move.

• Disc sensitivity: Bending, twisting, or sustained sitting can increase symptoms, while changing positions or walking may calm them.

• Nerve irritation (sometimes sciatica): Symptoms can wax and wane and may travel into the buttock/leg or include tingling that comes and goes.

• Lower overall tolerance: Deconditioning and repeat “same-position” days (lots of sitting, fewer movement breaks) can lower your back’s capacity.

Common flare-up triggers to watch for

If your pain feels unpredictable, these are often the missing pieces:

• Sitting too long without breaks (especially on soft couches)

• Repeated bending/twisting (laundry, gardening, shoveling)

• Sudden jumps in workouts, hiking, or sports

• Lifting with a rounded back or holding weight far from your body

• Poor sleep and high stress (both can increase muscle tension and sensitivity)

Helpful clues to describe your pattern

This isn’t a diagnosis—but it is useful information to share with your provider:

• Localized tight/sore pain often behaves like muscle/soft-tissue overload.

• Worse with sitting or bending can suggest a flexion-sensitive pattern.

• Pain/tingling down the leg is more consistent with nerve irritation.

• Worse during high-stress, low-sleep weeks can reflect higher sensitivity and tension.

What to do during a flare-up (first 48–72 hours)

Most flare-ups improve faster with smart movement than with complete rest.

1. Keep moving in a safe range.
   Short walks and gentle mobility often help more than bed rest. The goal is “calm, consistent motion,” not pushing into sharp pain.

2. Modify the aggravator.
   Break up sitting (stand, walk, change positions). Keep loads close to your body. Reduce repetitive bending temporarily, then build back up.

3. Use comfort strategies if they help.
   Heat, a warm shower, or ice can make movement easier. Choose what helps you move more comfortably.

4. Track what changes it.
   A simple note like “worse after 60 minutes sitting” or “better after walking” helps you (and your therapist) spot the driver faster.

How to reduce flare-ups long term

If pain keeps returning, the solution is usually a plan—not a single stretch.

• Build capacity: Strengthen core/hips and improve endurance so daily tasks don’t overload you.

• Change daily inputs: Micro-breaks every 30–60 minutes, posture variety, and hip-hinging mechanics for bending/lifting.

• Support recovery: Sleep, stress management, and consistent activity (like walking) reduce sensitivity over time.

When back pain is a “don’t wait” situation

Seek urgent medical care if back pain comes with loss of bowel or bladder control, numbness in the groin/saddle area, high fever, unexplained weight loss, major trauma, or progressive weakness/numbness in the legs.

This article is for education and is not a medical diagnosis.

How manual physical therapy can help

A focused evaluation can identify the “why” behind your flare-ups—mobility restrictions, strength deficits, movement patterns, or nerve sensitivity. Manual physical therapy typically combines hands-on treatment with targeted exercise and education so you understand:

• what triggers your symptoms,

• what to do when they flare, and

• how to build long-term resilience.

If you’re in the Arvada area and you’re tired of guessing, a personalized plan can make your back feel more predictable again.

FAQ: Back pain that comes and goes

Is intermittent back pain normal?
It’s common, but recurring flare-ups usually mean there’s a repeat trigger (or several) worth addressing.

Should I rest or keep moving?
Most people do best with gentle movement and “relative rest,” not prolonged bed rest. Walking is often a great starting point.

Can a herniated disc cause pain that comes and goes?
Yes. Disc symptoms often vary with sitting, bending, and twisting, and many people improve with the right progression of activity and strengthening.

Why is my back worse in the morning but better later?
Stiffness after staying in one position overnight is common. A gradual warm-up and gentle mobility usually helps.

When should I see a physical therapist?
If pain keeps returning, lasts more than 1–2 weeks without improvement, radiates down the leg, or you’re unsure what triggers it, an evaluation can help you break the cycle.

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