Back
Low back pain
Low back pain is among the most common reasons adults seek medical care, and in the large majority of cases no single structure can be identified as the source. This is described as non-specific low back pain, and it is a legitimate clinical category rather than a failure to find the answer: the muscles, discs, joints and ligaments of the lumbar spine all carry pain fibres and frequently contribute together. The assessment is directed less at naming a structure than at identifying the minority of cases where something specific is present.
What causes it
Causes are usually described in categories, because pinpointing one structure is often neither possible nor necessary.
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Non-specific mechanical pain
The large majority. Pain that varies with posture, movement and load, without features pointing to a specific pathology.
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Radicular pain
Pain travelling into the leg along a nerve root distribution, which is assessed differently because a specific structure is implicated.
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Degenerative change
Disc degeneration, facet joint arthritis and stenosis. These are common with age and are only part of the explanation when they correspond to the symptoms.
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Specific pathology
Fracture, infection, inflammatory arthritis and malignancy together account for a small proportion, and are what the assessment is screening for.
Assessment and the role of imaging
Current guidance advises against routine imaging for uncomplicated low back pain, and the reason is practical rather than economic.
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History and examination first
The purpose is to place the pain into one of the categories above and to screen for the features that would change management.
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Why early imaging often does not help
Degenerative findings are present in a large proportion of people without pain. Imaging in the absence of warning features has not been shown to improve outcomes and can lead to treatment directed at incidental findings.
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When imaging is indicated
Significant trauma, neurological deficit, suspicion of infection or malignancy, or pain that persists despite appropriate treatment.
Common questions
Do I need an X-ray or MRI?
Usually not at first. In the absence of warning features, imaging rarely changes treatment in the early weeks, and degenerative findings are common in people without pain.
Should I rest?
Brief relative rest during the most acute phase is reasonable, but prolonged bed rest is not recommended. Returning to ordinary activity as pain allows is associated with better recovery.
Why does it keep coming back?
Recurrence is common. Factors associated with it include deconditioning, load at work, and periods of inactivity, which is why exercise is emphasised for prevention as well as treatment.
Is it caused by my posture?
Posture is one factor among several and is rarely a complete explanation on its own. Sustained positions and how loads are handled tend to matter more than any single "correct" posture.
General reference information, and not advice about your own case. It may not reflect the most recent guidance or what is offered on a given day — call (201) 408-5151 to check.
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