Back pain; it seems we all struggle with it at one point or another.

In fact, it’s the leading cause of disability in Americans 45 or younger, and half of all working Americans admit to having back pain each year. But, what’s causing your pain may surprise you. Eileen Eckert doesn’t know what caused her back to start hurting.

“It was a stabbing pain,” she explained. But like 45 percent of all women, she suffers from back pain that’s persisted for years. “It just got more and more painful,” Eckert said.

Linda Van Dillen, professor of physical therapy and orthopedic surgery at Washington University in St. Louis, said there are stressors that can set off back pain that have little to do with your back.

The 6 causes of back pain“Smoking changes the circulation, and circulation contributes or gives nutrients to all of the structures in your body,” Van Dillen explained.

Your mood can also make you ache. A recent study published in pain magazine shows the odds of having lower back pain were 1.6 times higher for subjects with symptoms of depression. Anxiety can also be a culprit. “People who are anxious tend to use their muscles more, contract them more and that can cause pain,” Van Dillen said.

Other problems can mask themselves as back pain, like a urinary tract infection, appendicitis or kidney stones. “A serious condition could be an aneurysm of the aorta, which is the vessel that supplies blood to the lower extremities,” Van Dille explained.

Even what you wear can have an impact. “Clothes can cause or can contribute to back pain symptoms if they’re very restrictive,” she said. “So for example people who wear tight jeans, they can’t move their hips very much.” And heels higher than three inches put seven times as much pressure on your feet, disrupting your center of gravity.

Two simple words that Van Dillen says can help? “Stay active.” Even if your back hurts she said, the more you move, the better it will be. Also, slouching puts an extra 100 pounds of stress on the lower back, resulting in muscle fatigue and the onset of back pain. For every inch your head drops forward as you’re slouching, the stress on your spine increases by 10 pounds.

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