Mid-back rotation study in a dark studio with a faint spinal contour overlay

Spine · 07

Spine &
Back Pain

Mechanical back pain, sciatica and disc problems assessed properly, then treated with movement first.

01Understanding the problem

Most back pain is mechanical. It comes from load, posture, deconditioning and long hours in one position, and it improves with graded movement rather than rest.

A smaller group of patients have nerve compression, where pain travels down the leg with numbness or weakness. Separating these two groups early prevents both unnecessary scans and missed problems.

Symptoms we look for

Pain across the lower back, worse after sitting or driving
Pain radiating into the buttock, thigh, calf or foot
Numbness, tingling or a heavy feeling in the leg
Stiffness on getting out of bed that eases with movement
Pain on coughing, sneezing or bending forward

When to see an orthopaedic specialist

Leg pain is worse than back pain, or is spreading
There is weakness, foot dragging or persistent numbness
Pain follows a fall, or occurs with fever or unexplained weight loss
There is any difficulty controlling the bladder or bowels, which is an emergency
Pain has not improved after four to six weeks of sensible self-care

02Diagnosis

Named beforeit is treated.

Imaging is requested where it will change the decision, and the findings are shown to you on screen.

Neurological examination of power, sensation and reflexes
Movement testing to identify the directions that ease or provoke pain
X-rays where alignment, instability or arthritis is suspected
MRI where nerve compression is suspected or symptoms persist
Screening for hip pathology, which frequently mimics back pain

Orthopaedic surgeon reviewing a backlit X-ray during treatment planning

03Treatment options

Non-surgicalcare first.

Graded activity, walking programme and load management
Core and hip strengthening under physiotherapy guidance
Workstation, driving posture and lifting technique advice
Short-term medication for a painful episode
Selected injections for persistent nerve-related pain

Surgicaloptions.

Referral pathway for microdiscectomy in persistent nerve compression
Decompression for significant spinal canal narrowing
Stabilisation for instability or fracture
Fracture management for osteoporotic vertebral collapse

04Recovery

Acute episodes typically settle substantially within two to six weeks when movement is kept going.

Acute episodes typically settle substantially within two to six weeks when movement is kept going. The aim of treatment is to shorten the episode and reduce how often it returns.

Where nerve pain has been present for a long time, sensation can take longer to normalise than pain. A maintenance programme, not a single course of treatment, keeps the back reliable.

Timelines are typical rather than guaranteed. Your own plan is set at consultation.

05Questions patients ask

Frequentquestions.

Do I need an MRI for back pain?

Usually not at first. MRI is valuable when there is leg pain with neurological signs, when symptoms persist, or when surgery is being considered. Early scanning of simple mechanical pain often shows changes that do not explain the symptoms.

Is bed rest helpful?

Beyond a day or two, no. Prolonged rest weakens supporting muscles and slows recovery. Gentle, frequent movement within tolerance works better.

Will a disc prolapse need surgery?

Most settle without it. Surgery is considered for severe or progressive weakness, unrelenting nerve pain despite treatment, or bladder and bowel involvement.

Can I keep working with back pain?

In most cases yes, with adjustments to sitting time, lifting and travel. Complete withdrawal from activity tends to prolong the problem.