Understanding back pain
Most back pain is mechanical in origin — arising from muscles, ligaments, facet joints, or discs — and resolves within weeks regardless of specific treatment. However, a small proportion of back pain is caused by serious pathology (fracture, infection, tumour, cauda equina syndrome) that requires urgent investigation and treatment.
The role of an orthopedic evaluation is to identify these red flags, reassure when serious pathology is unlikely, and provide targeted treatment for the specific cause. Imaging (X-ray, MRI) is not routinely needed for simple back pain and is ordered when clinical findings suggest a specific structural problem or when symptoms have not responded to initial treatment.
- Muscle strain and ligament sprain — most common, usually self-limiting
- Disc herniation — back pain with leg pain (sciatica), numbness or weakness
- Spinal stenosis — leg pain with walking, relieved by sitting or leaning forward
- Facet joint pain — localised back pain, worse with extension and rotation
- Spondylolisthesis — vertebra slipping forward, often causes chronic low back pain
- Red flags — unexplained weight loss, fever, history of cancer, progressive neurological deficit
Related: Orthopedics → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Treatment and management
Early management focuses on maintaining activity (avoiding bed rest), simple pain relief (paracetamol, NSAIDs), and early physiotherapy. Evidence supports graded activity and exercise as the most effective approach for most back pain, helping to restore function and prevent recurrence.
For specific diagnoses (disc herniation with progressive weakness, spinal stenosis limiting function, spondylolisthesis with instability), specialist intervention including injections or surgery may be considered. Dr. Gautam discusses the expected natural history, evidence for each treatment option, and realistic timelines for improvement.
| Diagnosis | Typical approach | When specialist care helps |
|---|---|---|
| Simple mechanical back pain | Activity, exercise, analgesia | If not improving after 4–6 weeks |
| Disc herniation with sciatica | Physiotherapy, NSAIDs, time | Progressive weakness or severe pain not responding to treatment |
| Spinal stenosis | Exercise, activity modification, injections | Walking distance progressively limited |
| Spondylolisthesis | Core strengthening, bracing | Increasing pain or neurological symptoms |