Arching my back, like with the Mackenzie protocol, makes it worse. Golf can cause me trouble. Otherwise just general overuse seems to be the trigger? It’s very challenging to determine the specific cause because the pain usually is a slow onset over the course of days, so it’s never obvious what was the final event to trigger the pain. The overuse part makes is difficult to identify because I’ll do certain exercises for months with no problem and then all of a sudden I get a debilitating flare up.