Quick Answer
Most back pain resolves on its own within a few weeks. However, seek immediate care for back pain with numbness, weakness, loss of bowel/bladder control, fever, or severe trauma. See a doctor if pain lasts more than 6 weeks, worsens progressively, or occurs with unexplained weight loss.
🚨 Call 911 or Go to ER Immediately If:
These are RED FLAGS indicating possible serious conditions:
- Loss of bowel or bladder control (may indicate cauda equina syndrome - a medical emergency)
- Numbness or weakness in legs that's getting worse
- Saddle anesthesia - numbness in groin, inner thighs, or buttocks
- Severe trauma (car accident, fall from height)
- Back pain with fever and feeling generally unwell (may indicate infection)
- Inability to walk or stand due to severe pain or weakness
- Back pain with chest pain (could be heart or aortic problem)
📅 See Your Doctor Soon If:
- • Pain lasting longer than 6 weeks despite home care
- • Pain progressively worsening over days or weeks
- • Pain radiating down one or both legs below the knee
- • Numbness or tingling in legs (without other red flags above)
- • Age over 50 with new onset back pain
- • History of cancer
- • Unexplained weight loss
- • Long-term steroid use or osteoporosis
- • Pain worse at night or when lying down
- • Morning stiffness lasting more than 30 minutes
- • Pain not improving with rest
Common Causes of Back Pain
Most Common (Usually Not Serious)
- • Muscle strain: From lifting, twisting, or poor posture
- • Ligament sprain: Overstretching of ligaments
- • Disc degeneration: Normal wear and tear with age
- • Facet joint arthritis: Arthritis in spine joints
- • Poor posture: From prolonged sitting or standing
More Serious Conditions
- • Herniated disc: Disc pressing on nerve causing leg pain
- • Spinal stenosis: Narrowing of spinal canal
- • Spondylolisthesis: Vertebra slipping forward
- • Compression fracture: Especially in osteoporosis
- • Kidney stones/infection: Pain in flank area
Rare but Serious (Red Flags Above)
- • Cauda equina syndrome: Nerve compression requiring emergency surgery
- • Spinal infection: Osteomyelitis or discitis
- • Cancer: Primary spine tumor or metastasis
- • Aneurysm: Abdominal aortic aneurysm
- • Spinal fracture: From trauma or osteoporosis
Home Treatment for Non-Serious Back Pain
For mechanical back pain without red flags:
- • Stay active: Bed rest is NOT recommended - keep moving gently
- • Heat or ice: Ice first 48 hours, then heat (15-20 min sessions)
- • Over-the-counter pain relief: Ibuprofen or acetaminophen as directed
- • Gentle stretching: Knee-to-chest, cat-cow stretches
- • Good posture: Avoid prolonged sitting, use lumbar support
- • Gradual return to activity: Don't rush back to heavy lifting
Expected timeline: Most back pain improves within 4-6 weeks with conservative care
What Your Doctor Will Check
Physical Examination
- • Range of motion tests
- • Neurological exam (reflexes, strength, sensation)
- • Straight leg raise test for nerve involvement
- • Palpation for tenderness and muscle spasm
Imaging (if needed)
- • X-rays: For fractures, alignment, arthritis
- • MRI: For disc herniation, nerve compression, soft tissue
- • CT scan: Better bone detail than X-ray
- • Note: Imaging often NOT needed for acute back pain without red flags
Treatment Options
Conservative Care (First Line)
- • Physical therapy: Core strengthening, flexibility, posture training
- • Medications: NSAIDs, muscle relaxants, nerve pain medications
- • Spinal manipulation: Chiropractic or osteopathic treatment
- • Epidural injections: For severe nerve pain not responding to other treatments
- • Lifestyle modifications: Weight loss, ergonomic improvements
When Surgery May Be Considered
- • Progressive neurological deficits (weakness getting worse)
- • Cauda equina syndrome (emergency)
- • Severe pain not responding to 6-12 months of conservative treatment
- • Significant functional impairment affecting quality of life
- • Spinal instability or deformity
Prevention Tips
- • Strengthen your core: Planks, bridges, abdominal exercises
- • Maintain good posture: Shoulders back, neutral spine
- • Lift properly: Bend knees, keep load close, don't twist
- • Stay active: Regular exercise, avoid prolonged sitting
- • Maintain healthy weight: Reduces stress on spine
- • Quit smoking: Smoking reduces blood flow to discs
- • Ergonomic workspace: Proper desk and chair height
Medical Review
Reviewed by: Ricardo Hamilton, MD
Last Updated: November 26, 2025
Sources: American College of Physicians Back Pain Guidelines, North American Spine Society, Mayo Clinic, National Institute of Neurological Disorders and Stroke