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Orthopaedics • Thoracic & Lumbar Spine

Back Pain

Medical terms: Dorsalgia • Low Back Pain • Mechanical Back Pain

Back pain is a symptom rather than one diagnosis. It may arise from muscles, joints, discs, ligaments or bone; it may also be referred from the hip, kidney, urinary tract, abdomen, chest or blood vessels. Most new lower-back pain is not caused by a dangerous disease and improves with continued safe activity and progressive rehabilitation.

The first priority is identifying the uncommon patient who needs urgent investigation. New bladder or bowel difficulty, numbness around the saddle region, rapidly worsening leg weakness, major trauma, fever, cancer warning signs, or sudden severe back and abdominal pain with faintness should not wait for a routine appointment or physiotherapy session.

Book an Orthopaedic Review Check warning signs ↓

Some back-pain patterns need emergency or urgent medical assessment

Seek Urgent Medical Help for These Warning Signs

  • New inability or unusual difficulty starting urination, inability to feel the bladder filling, loss of bladder or bowel control, or new sexual-function change together with back or leg symptoms.
  • New numbness around the inner thighs, genitals, buttocks or anus—the area that would touch a saddle—or altered sensation when wiping after using the toilet.
  • Rapidly worsening weakness or numbness in one or both legs, a new foot drop, inability to walk safely, or severe symptoms affecting both legs.
  • Back pain after a major fall, collision, crush injury or fall from height, especially with spinal tenderness, deformity, weakness or numbness.
  • Sudden severe back, flank, abdominal or groin pain with faintness, sweating, clammy skin, breathlessness, collapse or a known abdominal aortic aneurysm.
  • Sudden severe chest or upper-back pain with breathlessness, faintness, weakness, stroke-like symptoms or a markedly different pulse between limbs.
  • Severe back pain with fever, chills, confusion or feeling very unwell—particularly with diabetes, immune suppression, recent serious infection, spinal procedure, tuberculosis risk or intravenous drug use.
  • New persistent pain with unexplained weight loss, a history of cancer, pain that is progressively worsening or consistently severe at night, or a new lump.
  • Severe pain after a minor strain or fall in someone with osteoporosis, long-term steroid use, advanced age or a previous fragility fracture.

Cauda equina syndrome is uncommon, but the combination of back or leg symptoms with new bladder, bowel or saddle-sensation change requires emergency assessment and usually urgent MRI. Do not wait to see whether it settles overnight. Sudden severe pain with collapse may be vascular rather than orthopaedic and also requires emergency care.

A Simple Map of the Back

Thoracic spine The twelve mid-back vertebrae connect with the ribs and protect the chest.
Lumbar spine Five large lower-back vertebrae carry substantial load and allow bending and rotation.
Discs Cushions between vertebral bodies distribute load and permit movement.
Facet joints Small paired joints at the back of the spine guide motion and can develop age-related change.
Nerves and cauda equina Lumbar and sacral nerve roots supply the legs, bladder, bowel and saddle region.
Muscles, fascia and ligaments These tissues stabilise the trunk, transfer load and adapt to movement and activity.

What Pattern Does the Pain Follow?

Central or band-like lower-back pain Common mechanical pain may stay across the belt line and vary with bending, lifting, sitting, standing or changing position. The pattern can be very painful without implying serious structural damage.
One-sided lower-back or buttock pain Muscles, lumbar joints, the sacroiliac region or hip may contribute. Pain in the buttock alone is not automatically sciatica; sciatica usually follows a leg nerve pattern.
Pain travelling into a leg Nerve-root irritation can cause sharp, burning or electric pain, often with tingling, numbness or weakness. Hip, vascular and peripheral-nerve conditions may produce overlapping symptoms.
Leg heaviness while standing or walking Lumbar spinal stenosis may cause pain, numbness or weakness that improves with sitting or bending forward. Poor leg circulation can look similar and needs a different examination.
Mid-back or rib-region pain Thoracic joints, muscles, a compression fracture and rib conditions are possibilities, but lung, heart, aorta, stomach, pancreas and gallbladder disease may also refer pain to this region.
Flank pain or pain with urinary symptoms Kidney stones or urinary infection may cause pain toward the side of the back, sometimes with fever, nausea, blood in urine, burning urination or pain spreading toward the groin. This is not treated as routine spinal pain.

Common Causes of Back Pain

Non-specific mechanical back pain The most common category. Muscles, joints, discs and surrounding tissues may all contribute, but a single painful structure often cannot—and does not need to—be named before recovery begins.
Muscle or ligament strain A sudden lift, twist, new workout or prolonged activity may trigger local pain and protective spasm. The intensity of spasm does not reliably measure tissue damage.
Disc-related pain or radiculopathy A disc can contribute to back pain or irritate a nerve root. A protrusion on MRI matters only when its level and side agree with the symptoms and neurological examination.
Facet-joint and age-related change Disc-height loss, osteophytes and facet arthropathy become common with age and may or may not be painful. They are structural descriptions, not proof that the spine is “worn out.”
Lumbar spinal stenosis Narrowing around the nerves may cause leg symptoms during standing or walking. The scan severity, walking pattern, circulation and examination are considered together.
Vertebral compression fracture A weakened vertebra may fracture after minor force, especially with osteoporosis or steroid use. New focal pain and tenderness in a person at risk deserves prompt assessment.
Inflammatory back pain Conditions such as axial spondyloarthritis may cause prolonged morning stiffness, night pain and improvement with movement rather than rest. Age of onset and related eye, skin, bowel or joint symptoms help guide evaluation.
Pain referred from elsewhere Hip disease, kidney stones, urinary infection, pancreatitis, gallbladder disease, pelvic conditions, an abdominal aortic aneurysm and other medical problems can all be felt in the back.

A Painful Back Is Not Necessarily a Damaged Back

Pain can be amplified by poor sleep, stress, fear of movement, loss of conditioning and repeated flare-ups. These are genuine biological contributors—not suggestions that the pain is imaginary. A good plan addresses function, confidence and recovery barriers alongside the likely tissue source.

Back Pain, Sciatica and Cauda Equina Are Not the Same

Back-dominant pain Symptoms remain mainly in the lower back, sometimes spreading into the buttocks or upper thighs. Neurological loss is absent, and treatment commonly begins with activity and rehabilitation.
Sciatica or lumbar radiculopathy A lumbar nerve root is irritated, producing leg-dominant pain with possible tingling, numbness, weakness or reflex change. It deserves focused assessment but is not automatically a surgical emergency.
Cauda equina syndrome Several lower spinal nerve roots are severely compressed. New bladder, bowel, saddle-sensation or sexual-function change, particularly with bilateral or progressive leg symptoms, is an emergency.

The planned dedicated Sciatica guide will explain nerve-root patterns and treatment in greater depth. The key rule here is that ordinary leg pain and cauda equina warning signs must never be treated as interchangeable.

What Happens During an Orthopaedic Assessment?

  • History: onset, injury, pain location, leg symptoms, function, sleep, fever, weight change, cancer or infection history, urinary and bowel symptoms.
  • Movement and function: standing, walking, sitting, bending and other relevant tasks are assessed within safe limits.
  • Neurological examination: leg strength, sensation and reflexes, with heel or toe walking and nerve-tension tests when appropriate.
  • Hip and circulation: hip movement, pulses, skin temperature or vascular signs may be checked when symptoms overlap.
  • Abdominal or urinary assessment: flank tenderness, abdominal findings, urine testing or broader medical review may be needed when pain does not behave like a spinal problem.
  • Risk assessment: age, osteoporosis, steroid use, immune status, anticoagulants, cancer, recent infection and trauma influence urgency and testing.

There is no single bend, leg-raise test, tender spot or scan feature that explains every episode. The useful diagnosis is the one that fits the entire pattern and changes what should happen next.

Which Tests or Scans Might Be Needed?

No immediate imaging Often appropriate for new uncomplicated low-back pain, with or without non-progressive sciatica, when serious disease is not suspected. Early imaging does not usually improve recovery and may reveal unrelated age-associated changes.
X-ray Shows bones, alignment, some degenerative change and selected fractures. It does not directly show discs, spinal nerves or most soft tissues and is not a routine first test for every backache.
MRI Shows discs, nerve roots, spinal canal, bone marrow and soft tissue. It is urgent when cauda equina, serious infection or certain progressive neurological findings are suspected, and is selected in other cases when it can change treatment.
CT Gives detailed bone images and is useful for selected fractures, trauma or when MRI is not possible. CT of the abdomen may be chosen for a suspected stone, vascular or abdominal cause rather than a spinal question.
Blood and urine tests May help investigate infection, inflammation, kidney or urinary disease, metabolic bone conditions and other medical causes. They are selected according to history and examination.
Ultrasound Ultrasound may assess kidneys, urinary tract, abdomen, pelvis or the abdominal aorta when clinically appropriate. It does not show lumbar discs, the spinal canal or nerve roots and is not a lumbar-spine scan.

“No Scan Yet” Can Be an Evidence-Based Decision

When the examination finds no serious warning feature, immediate imaging often adds little and can shift attention toward common harmless changes. This is different from dismissing pain. The clinician should explain the working diagnosis, give safety-net advice and review the patient if the course is not as expected.

What Can I Do Safely at First?

  • Continue normal daily activity as far as reasonably possible and avoid prolonged bed rest.
  • Change position regularly. Short walks and comfortable movement are often better than trying to hold one “correct” posture all day.
  • Temporarily reduce the specific lift, twist or load that sharply worsens symptoms, then restore it progressively rather than avoiding it indefinitely.
  • Heat or a wrapped cold pack may provide short-term comfort. Protect the skin and stop if burning, numbness or discolouration occurs.
  • When lifting, keep the load manageable, hold it close and use the hips and legs—but remember that no single technique can prevent every flare.
  • Return to work or household tasks with temporary modification when needed; complete absence from activity is rarely the only option.
  • Ask a clinician or pharmacist before pain medicines if you have kidney, liver, stomach, heart or bleeding problems, are pregnant, or take anticoagulants or other medicines.
  • Do not rely on a belt, corset, traction device or passive treatment as a replacement for assessment and active recovery.

Seek review sooner if pain is worsening rather than fluctuating, new leg weakness or numbness develops, fever or systemic symptoms appear, or normal function is not beginning to return. Any cauda equina warning sign requires emergency assessment.

Treatment Depends on the Cause and Its Effect on Your Life

Education and self-management A clear explanation, encouragement to remain active and a plan for flare-ups are central. Recovery goals may include walking, sleep, household work, employment, travel, lifting and sport.
Physiotherapy and exercise Exercise may include mobility, trunk and hip strength, endurance, aerobic activity and graded exposure to meaningful tasks. The programme should reflect the diagnosis, ability and goals rather than a universal list.
Medicines Short-term options are considered after balancing benefit against gastrointestinal, kidney, liver, heart, bleeding, sedation and dependency risks. Back pain and sciatica do not automatically require the same medicine.
Manual treatment Mobilisation, manipulation or soft-tissue treatment may help selected patients when used as part of a package that includes exercise. It should not be described as permanently putting a displaced spine back into position.
Injections Image-guided spinal procedures are reserved for selected diagnoses after appropriate clinical and imaging review. They are not routine treatment for non-specific back pain and require procedure-specific risk counselling.
Specialist referral Cauda equina, progressive neurological loss, fracture, infection, tumour or vascular disease follows an urgent pathway. Persistent disabling nerve symptoms or severe structural disease may require higher-centre spine assessment.

SR Speciality Hospital evaluates back pain, coordinates proportionate investigations and provides appropriate non-operative care. Spine surgery, complex reconstruction, spinal tumour procedures and other advanced interventions are referred to suitable higher centres.

Useful Terms on a Lumbar X-ray or MRI Report

Disc desiccation or height loss The disc has lower water content or is thinner. These changes become common with age and may be painless.
Disc bulge A broad extension of disc tissue beyond its usual boundary. A bulge alone does not prove nerve compression.
Protrusion or extrusion More focal displacement of disc material. The size, direction, level and effect on nerves are interpreted clinically.
Annular fissure A small split in fibres around a disc. It can occur with or without symptoms.
Foraminal or lateral-recess stenosis Narrowing where a nerve travels or exits. The affected side and level should match the leg findings.
Central canal stenosis Narrowing of the main spinal canal. Symptoms, walking tolerance and neurological findings determine significance.
Nerve-root contact or compression The report describes the relationship between disc, bone and a nerve; not every contact causes symptoms.
Facet arthropathy Degenerative change in the small paired joints at the back of the spine.
Modic endplate change An MRI description of change near the vertebral endplates; it does not determine treatment by itself.
Spondylolisthesis One vertebra lies forward or backward relative to another. Grade, stability, symptoms and nerves all matter.
Compression fracture Loss of vertebral height due to fracture. The report may describe whether it appears recent or old.

Myth vs Fact

Myth Severe pain always means severe spinal damage.
Fact Muscle spasm and ordinary mechanical pain can be intense. Warning signs and examination determine urgency.
Myth A disc bulge is permanently out of place.
Fact Disc findings can change, and many occur without symptoms. A scan image is not a measure of recovery potential.
Myth Bed rest is the safest treatment.
Fact Prolonged bed rest usually increases stiffness, weakness and fear. Safe activity supports recovery.
Myth Every pain in the buttock is sciatica.
Fact Sciatica is a leg nerve-root pattern. Back, hip and surrounding tissues can refer pain to the buttock.
Myth Bending must be avoided forever.
Fact Temporary modification can settle a flare, but gradual restoration of bending and lifting is usually important.
Myth Everyone with back pain needs MRI.
Fact MRI is essential for selected serious or persistent patterns, but often adds little in uncomplicated early pain.

Frequently Asked Questions

Is lower-back pain usually serious?

Most episodes are not caused by fracture, infection, cancer or nerve emergency. A careful history and examination identify the smaller group who need urgent investigation.

How can I tell if it is muscular pain?

Pain after increased activity that varies with movement and has no neurological or systemic warning signs is often mechanical, but no single feature proves a muscle strain. Examination is appropriate when the pattern is severe, unusual or persistent.

What exactly is sciatica?

Sciatica describes leg symptoms from irritation of a lumbar or sacral nerve root. Pain is often sharp, burning or electric and may be accompanied by tingling, numbness or weakness. A dedicated Sciatica guide follows next in the planned sequence.

What is cauda equina syndrome?

It is severe compression of several lower spinal nerve roots controlling the legs, bladder, bowel and saddle region. New bladder or bowel dysfunction, saddle numbness or rapidly progressive bilateral symptoms requires emergency assessment.

Do I need an X-ray?

Not for every episode. X-rays may be chosen when fracture, alignment or a bone problem is suspected. They do not directly show discs or nerve roots and often show changes unrelated to pain.

When is MRI important?

MRI is urgent for suspected cauda equina and selected serious neurological or infectious patterns. It may also help when persistent nerve symptoms or another specific question would change treatment.

Can ultrasound show a slipped disc?

No. Ultrasound does not assess lumbar discs, the spinal canal or nerve roots. It may investigate kidney, urinary, abdominal, pelvic or aortic causes of pain when those are clinically suspected.

Should I stay in bed until the pain settles?

Usually not. Brief rest may be necessary during an intense flare, but prolonged bed rest delays return of strength and function. Alternate comfortable movement, short walks and task modification within tolerance.

Should I use a back belt?

Belts and corsets are not routine treatment for ordinary low-back pain. A brace may have a defined role for a selected fracture or after specialist advice, but prolonged self-directed use can encourage dependency and deconditioning.

Is it safe to bend and lift?

During a flare, reduce the loads and movements that sharply worsen symptoms. Long-term recovery usually includes gradual return to bending and lifting with manageable loads rather than permanent avoidance.

Why does the MRI look bad when my symptoms are mild?

Degenerative discs, bulges and facet changes are common with age and may exist without pain. Reports must be matched to symptoms, examination and function rather than judged by the number of findings.

Can kidney stones feel like back pain?

Yes. Stone pain often affects the flank and may move toward the lower abdomen or groin, with nausea, urinary symptoms or blood in urine. Fever with suspected obstruction needs urgent urological assessment.

Can osteoporosis cause sudden back pain?

Osteoporosis increases the risk of a vertebral compression fracture, sometimes after a minor movement or fall. New focal pain in someone with osteoporosis or long-term steroid exposure deserves prompt review.

When can I return to work, driving or the gym?

Return depends on safe movement, concentration, leg function, medicine effects and the demands of the task. Early modified activity is often preferable to complete avoidance, followed by gradual progression.

When is a spine-surgeon opinion needed?

Cauda equina, progressive neurological loss, instability, fracture, infection or tumour requires urgent specialist referral. Persistent disabling nerve symptoms despite appropriate non-operative care may also merit higher-centre assessment.

Related Patient Guides

These guides help distinguish spinal pain from nearby joint, kidney, urinary and vascular conditions.

Orthopaedics Hip Pain Groin / Outer-Hip / Referred Pain Read patient guide → Urology Flank Pain Kidney / Stone / Urinary Causes Read patient guide → Radiology Abdominal Aortic Aneurysm Ultrasound Screening / Surveillance / Emergency Distinction Read scan guide → Orthopaedics Sciatica Leg Nerve Pain / Numbness / Weakness Read patient guide →

A Note From Our Doctors

The information on this page is intended to help you understand your condition. It should not be considered a diagnosis or a substitute for a consultation with a qualified medical professional.

Every patient is unique. The same symptom can have different causes in different individuals, and the most appropriate investigations and treatment depend on your medical history, examination findings, age, existing medical conditions and test results.

At SR Speciality Hospital, we believe in treating the whole patient—not just a symptom, scan or laboratory report. Every treatment plan is individualised after careful medical evaluation.

Orthopaedic Consultation

Is back pain limiting sleep, walking, work or ordinary daily activity?

Bring previous X-rays or scans, reports and a medicine list. Mention trauma, fever, weight loss, cancer, osteoporosis, steroid use, leg weakness or numbness, urinary symptoms, and any bladder, bowel or saddle-sensation change.

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