Back Pain (Chronic)
Most back pain improves — the job of a doctor is to rule out the small fraction that needs imaging.
Back pain is called chronic once it persists beyond 12 weeks. The vast majority is mechanical — muscle, ligament, or disc strain — without a specific lesion on imaging. Modern treatment prioritises staying active, targeted exercise, and pain education over bed rest and early MRI.
Causes & risk factors
- Mechanical / muscular strain
- Disc degeneration or herniation
- Facet joint arthritis
- Poor posture and prolonged sitting
- Osteoporotic vertebral fractures
- Less common: infection, inflammatory spondyloarthritis, malignancy
Symptoms
- Aching or stiffness in the lower or upper back
- Pain worsened by specific movements or positions
- Radiating pain down a leg (sciatica) when nerve roots are involved
- Morning stiffness in inflammatory causes
- Reduced range of motion
How it's diagnosed
- Clinical assessment — usually no imaging in the first 6 weeks without red flags
- Red-flag screen: night pain, weight loss, fever, neurological deficit, bladder or bowel symptoms
- MRI when red flags are present or symptoms persist beyond conservative treatment
- Blood tests for inflammation when inflammatory causes are suspected
Evidence-based treatment
- Stay active — the old "strict bed rest" advice is outdated
- Paracetamol or NSAIDs per label for flares
- Structured physiotherapy with a graded exercise programme
- Cognitive behavioural therapy for persistent pain
- Injections (facet, epidural) for selected cases
- Surgery only for specific structural problems like severe disc prolapse with nerve compression
Prevention
- Strengthen core and glutes with regular exercise
- Ergonomic workstation and regular micro-breaks
- Lift with the legs, not the back
- Maintain a healthy weight; quit smoking
Related symptoms
Back Pain (Chronic) — FAQ
Do I need an MRI for my back pain?
Usually not in the first six weeks unless red flags are present. Early imaging often shows incidental findings that lead to unnecessary treatment.
Is walking good for chronic back pain?
Yes. Graded walking is one of the best-studied first-line treatments for mechanical back pain.
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This page is general information, not medical advice for any specific person. For diagnosis and treatment, book a consultation.