Lumbar spine
Low Back Pain
Low back pain is a symptom, not a diagnosis. What matters clinically is whether it stays in the back or travels into a leg, because those two patterns have different causes and different treatments.
In short
Most low back pain is mechanical, improves substantially within weeks, and needs no imaging. The pattern that changes the assessment is pain travelling below the knee, particularly with numbness or weakness.
Where to go from here
Almost everyone gets low back pain at some point, and most of it improves. This page sorts which kind you are dealing with, because that determines whether a spine surgeon is the right person to see at all.
If the pain stays in your back
Aching or stiffness across the low back, worse with bending, lifting or sitting for long stretches, without pain travelling down a leg.
This is the largest group by a wide margin. It is usually mechanical, involving muscles, ligaments, discs and facet joints in some combination that is often impossible to separate precisely, and it generally improves over weeks.
What helps: staying active within tolerance rather than resting, returning to normal activity progressively, physical therapy where symptoms persist, and time. Exercise and conditioning have better evidence behind them than most interventions, and the specific type matters less than consistency.
What usually does not help: early imaging. It finds the degenerative changes that most adult spines have, which then get blamed for the pain and sometimes treated. Degenerative disc disease covers why that matters.
If this describes you and it is improving, you are on the path most people take out of this.
If the pain travels down your leg
Pain running into the buttock, thigh, calf or foot, particularly below the knee, and particularly with numbness, pins and needles, or weakness.
That points at a nerve root rather than the back itself, and it is a different problem. Start with sciatica.
If your walking distance is shrinking
Leg heaviness, aching or numbness that comes on after a certain distance on foot, eases within a few minutes of sitting, and improves when you lean forward on a trolley.
That pattern is lumbar spinal stenosis, and it behaves quite differently from either of the groups above.
If the pain is deep in one buttock
Pain low and to one side, worse getting in and out of a car, rolling over in bed, or standing on one leg, sometimes running into the back of the thigh.
The sacroiliac joint is a common source of this and is missed routinely, often after months of being treated as sciatica.
If you were injured at work
The clinical questions are the same, but the process around them is not. Documenting the mechanism, getting imaging appropriately, and handling work status is covered under injured patients.
When to be seen
Any red flag above, promptly. Loss of bladder or bowel control with numbness around the groin means the same day.
Leg symptoms that are not settling, or any weakness, sooner rather than later.
Back pain alone that has not started improving after several weeks, or that is getting worse rather than better, is reasonable to have examined. Much of that visit is working out which of the groups above you belong to, and that comes from the history and the examination rather than from a scan.
When surgery becomes reasonable
Back pain on its own is rarely a surgical problem, because an operation needs a specific structure to address. Surgery is considered when a clearly identified structure is compressing a nerve, or when instability or a slip is driving the symptoms.
References
This page is for general education and is not medical advice. It does not create a doctor-patient relationship, and it cannot account for the specifics of your own spine. For guidance about your situation, see a qualified physician. If you think you are having a medical emergency, call 911 or go to the nearest emergency department rather than waiting for an appointment.
Common questions
- Do I need an MRI for back pain?
- Usually not, and early imaging for uncomplicated back pain has been studied enough to say so confidently. It finds age-related changes present in most adult spines, which then get blamed for the pain. Imaging is warranted when there are leg symptoms, neurological findings, red flags, or when the answer would change the treatment.
- Why does my MRI look bad if my back is only mildly sore?
- Because imaging findings and pain correlate poorly. Disc bulges, degenerative change and facet arthritis are common in people with no pain at all, and become more common with every decade. A finding is a candidate explanation, not a verdict. Matching the film to the examination is what makes it meaningful.
- Should I rest?
- Not beyond the first day or two. Extended rest has not been shown to speed recovery and costs conditioning. Staying as active as the pain allows, and returning to normal activity progressively, is the better approach for most people.
- When does back pain need a surgeon?
- When there is a specific structural problem an operation can address, which usually means nerve compression producing leg symptoms, or instability. Back pain without a clear structural target is a poor surgical candidate, and being told otherwise is worth a second opinion.
Further reading
Worth reading next.
Where to be seen
Consultations for low back pain are available at all eight Academy offices.
Not sure which is closest? See the areas we serve, or call (312) 313-1086.