The main causes of muscle pain on both sides of the back spine when walking include physiologic factors and pathologic factors. 1 Physiological factors: most of the muscle pain on both sides of the back spine is caused by physiological factors. For example, prolonged sitting and standing, stooping and laboring, getting cold, etc. These factors will lead to tension and spasm of the lumbar back muscles and accumulation of acidic metabolites, resulting in strain and aseptic inflammation of the lumbar back muscles, leading to the occurrence of pain symptoms. 2. Pathologic factors: mainly related to degenerative lesions of the lumbar spine, specific infections, autoimmune diseases and osteoporosis. (1) Degenerative lesions of lumbar spine: the main ones are lumbar disc herniation, lumbar spondylolisthesis and lumbar spondylolisthesis, because lumbar spondylolisthesis will compress and stimulate the muscles on both sides of the spine when walking, which will lead to muscle pain on both sides of the spine when walking. (2) Specific infection: when there is a specific infection such as tuberculosis of the lumbar vertebrae, the abscess of the lumbar vertebrae will stimulate the muscles on both sides of the spine and muscle pain will occur. (3) Autoimmune diseases: When suffering from autoimmune diseases such as ankylosing spondylitis, the swollen lumbar vertebral joint capsule will produce inflammation, ligament damage or thickening, joint instability, causing lumbar dorsal muscles to compensate for the congestion and edema, and painful symptoms will appear. (4) Osteoporosis: Osteoporosis results in decreased stiffness of the lumbar vertebrae, disorders of the joints and other structures around the lumbar vertebrae, and unstable lumbar vertebrae leading to pain in the muscles on both sides of the back spine when walking. The symptoms alone cannot determine the cause of muscle pain on both sides of the spine when walking, but need to be combined with the characteristics of the medical history and other test results to make an accurate judgment, it is recommended to clarify the cause of the disease under the guidance of a doctor.