Back Pain

Back pain affects nearly everyone at some point. Most episodes are mechanical (muscle/ligament strain, disc-related, posture-related) and settle within a few weeks with simple measures. A minority are serious and need prompt evaluation. Keeping active — not bed rest — is what evidence consistently supports.

Red flags — see a Health Expert urgently

• Numbness around the anus/genitals, loss of bladder or bowel control, progressive leg weakness — possible cauda equina; dial 112.
• Severe back pain with fever — possible spinal infection, abscess.
• Back pain in a person with cancer or recent significant infection — rule out spread.
• Back pain after significant injury (fall, road accident) — rule out fracture.
• Back pain with unexplained weight loss, night sweats, persistent night pain — rule out cancer, TB.
• Pain in a child or older adult with reduced movement — evaluate.
• TB of the spine (Pott's disease) is a significant Indian differential — chronic back pain with low-grade fever, weight loss, night sweats deserves a TB work-up.

Common, non-serious patterns

• Muscle strain — sudden after lifting, twisting, unusual activity.
• Posture-related — long hours at a desk, on a phone, or in poor ergonomics.
• Disc-related — pain that radiates down a leg (sciatica); see Sciatica and Herniated Disk pages.
• Arthritis of the spine (spondylosis) — older adults; chronic aching.
• Inflammatory back pain — young adults; morning stiffness, improves with movement.

What actually helps — most cases

• Keep moving — bed rest beyond 1-2 days usually makes back pain worse.
• Simple pain relief — NSAIDs (with food) for a short period; simple pain relievers if NSAIDs not suitable.
• Heat and cold packs.
• Gentle walking, stretching, yoga — but avoid forceful spine manipulation from untrained practitioners.
• Physiotherapy — for persistent or recurring pain; includes posture, core strengthening, ergonomics.
• Weight management, regular exercise — long-term.
• Ergonomics — chair height, screen level, frequent micro-breaks, don't look down at phones for hours.
• Stop smoking — strongly linked with worse back pain and disc problems.

When imaging and specialist care help

• Most back pain does NOT need an X-ray or MRI in the first 6 weeks.
• Imaging is worth doing when red flags are present, or when pain/disability persists beyond 6 weeks.
• MRI findings often show changes (disc bulges, "degeneration") that are also seen in pain-free people — treat the person, not the image.
• Surgery helps specific situations — severe nerve compression with weakness, instability, cauda equina, fractures — not typical "bad back." Seek a second opinion before elective back surgery.