Back pain won’t go away

8 Signs You Should See a Doctor for Your Back Pain

Be sure to get evaluated by a professional if you have severe back pain coupled with any of these warning signs:

  • Pain that won’t go away. If your severe back pain doesn’t improve with rest or hasn’t subsided within a week of home treatment, you should be checked by a doctor.
  • Severe back pain that extends beyond the back. See your doctor if you are experiencing pain that shoots down into your leg — especially all the way to the bottom of your leg. This could indicate something more serious than a strained muscle, such as a damaged disk in your back.
  • Numbness, tingling, or weakness. If your back pain is accompanied by numbness or tingling in the legs, back, or anywhere else in your body, you should get to your doctor right away. Any unusual weakness should also be evaluated by a doctor.
  • Pain after an accident. If your back pain began after a fall or an injury, be sure to get a doctor’s evaluation. You should also be sure to call your doctor if you experience any swelling or redness on your back.
  • Pain that is worse at certain times. See a doctor if your pain gets significantly worse at certain times or in certain positions, such as lying down. Increased pain at night is also a warning sign of something more serious.
  • Problems with your bowels or urination. If you have trouble with bowel movements or urination, these symptoms might be associated with your back pain. Be sure to tell your doctor about these symptoms.
  • Unexplained weight loss. If you’re losing weight without trying, it may be related to your back pain, and you should seek medical attention.
  • Fever. If you’re experiencing a fever along with your back pain, you should call your doctor.

When you’re experiencing back pain, it’s important to diagnose and treat any underlying medical problems that might be causing or contributing to your symptoms.

In general, back pain should not be ignored — if the underlying condition isn’t treated, it will likely worsen, in terms of joint degeneration or chronic muscle spasm. “If pain is sensed for a long enough time, the body will adapt to a ‘new normal’ and potentially lessen the pain sensation. But that does not mean that the pain is ‘gone’ or that ‘it’s better.’ The body has just adapted to a new, lower functioning level. And there will most likely be another area of the body that starts to sense pain,” says Tamlyn.

How do you know when that achy pain in your back is more than you can handle alone? Experts agree — if your back pain is in conjunction with any of the following symptoms, skip the at-home remedies for in-office help.

There are several red flags that doctors look for when evaluating low back pain.

The purpose of these warning signs is to detect fractures, tumors, or infections of the spine. If you have any of these red flags along with back pain, see your doctor as soon as possible.


Sure, your back just could be achy and tight from the flu, but an unresponsive fever accompanied by back pain also could be a sign of a serious infection. “It’s indicative of something more systemic,” says orthopaedic surgeon Richard Guyer, MD, founder of the Texas Back Institute and Associate Clinical Professor of Orthopaedics at the University of Texas Southwestern Medical School.

What to expect: Your primary care doctor can rule out an infection. If it is an infection, antibiotics may be prescribed. If your doctor rules out an infection, a couple days of rest can be helpful. Sometimes back pain can be a result or a secondary consequence of an infection causing the fever. But once you start to feel better, doctors typically recommend slowly resuming your daily activity. Resting more than a day or two can actually make your back pain worse.


If you’ve had a serious trauma — such as a fall from a height or a car accident — or if you’ve had a relatively minor trauma and you’re over 50, your doctor will want to take a serious look at your back pain. Even falling down a few steps when you’re older can cause a fracture.

What to expect: Your doctor will probably take an X-ray to look for fractures. If no fractures are found, you may manage your pain with medication and later your recovery with physical therapy.

Numbness or Tingling

You might think that you can stop numbness or prickly tingling with over-the-counter medication, but this is usually an indication of nerve irritation or damage and is clinically more significant than your typical pain, says New York City chiropractor Todd Sinett, author of The Truth About Back Pain. If that pins-and-needles feeling won’t go away, you may be experiencing one of several conditions — such as a herniated disc, spinal stenosis — that can cause nerve pressure. “If left untreated, prolonged nerve irritation and damage can lead to permanent disabilities,” says Sinett.

About 80% of adults experience back pain at some time in their lives. It’s one of most common reasons people see a doctor or miss work. The pain can range from a dull ache to sharp, sudden and debilitating pain.

For most people, back pain is mechanical in nature, which means the elements of your back and how they move together has changed. Possible conditions could include:

  • Muscle or ligament strain: Heavy lifting or a sudden awkward movement can strain the muscles or ligaments in your back. Also, if you are overweight or in poor physical condition, the constant strain on your back can cause muscle fatigue and muscle spasms.
  • Bulging or ruptured disk: Disks are the cushions between the bones in your spine. You can have bulging or ruptured disks that may or may not cause pain by compressing a nerve root and causing pain that radiates into the leg.
  • Arthritis: Disks may narrow over time and cause your vertebrae to grind together causing pain.

Most back pain — even severe back pain — goes away on its own in four to six weeks with self-care, such as rest, heat or ice, over-the-counter pain medication and exercise.

Surgery often is effective to correct a spinal deformity or instability issue. Surgery also is helpful to treat pain radiating down a leg due to compression of a nerve root in the spine if other conservative treatments have failed. However, surgery is not considered a good treatment for generalized back pain.

So how do you know when to see your doctor about your back pain? Here are a few causes or symptoms that indicate it is time to schedule an appointment:

  • Follows a fall, blow to your back or other injury
  • Is constant or intense pain, especially at night or when you lie down
  • Spreads down one or both legs, especially if the pain extends below your knee
  • Causes weakness, numbness or tingling in one or both legs
  • Occurs with swelling or redness on your back, which could indicate an infection
  • Occurs with unintended weight loss
  • Occurs with new bowel or bladder control problems

Also, if you have a history of cancer, talk with your health care provider about any new pain you are experiencing, including back pain.

T.K. Schiefer, M.D., is a neurosurgeon in Eau Claire, Wisconsin.

When To See A Doctor For Back Pain

Back pain ranks as one of the more common ailments from which people in the U.S. suffer. Anywhere from 60-80% of U.S. adults experience back pain, according to the University of Maryland Medical Center (UMMC). Figuring out when to see a doctor for back pain can be a difficult question, as waiting too long can increase pain later on and may risk serious complications.

How many people see a doctor for back pain?

At any given moment, that leaves up to 31 million people in the U.S. with low back pain, according to the American Chiropractic Association (ACA). Each year, about 50% of working adults in the U.S. report back pain. It’s one of the leading causes for missing work. And, unfortunately, many of these people aren’t sure when to see a doctor for back pain. This can lead to even more days off.

The condition disables more individuals younger than 45 than any other cause, and forces 13 million people to visit a back pain doctor annually, according to UMMC. All the doctors’ visits and treatment plans make for an expensive public health issue. Nationally, people spend about $50 billion annually to find relief.

The following video gives a brief overview of the science of back pain.

What causes back pain?

Although back pain is distressingly common, some causes are preventable.

The risk for experiencing back pain increases as you age, especially if you’re overweight or don’t exercise. Having a job that requires frequent lifting or spinal twisting can also exacerbate your risk for lower back pain.

You can mitigate many of the risk factors by being proactive. Quitting smoking—another way to increase the likelihood of lower back pain—exercising, and keeping a normal body weight can all help keep your body and back healthy. Sitting and standing with good posture, and bending your knees to lift objects instead of bending at the waist also work to keep your spine healthy and reduce the risk of low back pain.

The effect of stress on pain

Just as lifestyle factors can influence back pain, so too can stress.

A team at Carnegie Mellon University has found long-term psychological stress may be linked to increased inflammation and swelling. The research, published in the Proceedings of the National Academy of Sciences, shows chronic stress decreases the body’s ability to regulate inflammation. Many diseases are linked to inflammation, including chronic pain, stroke, and heart disease.

The study found those under serious long-term stress had less ability to control the hormone cortisol. Previous research has found those with chronic stress suffer from more common colds, leading researchers to question if the immune system was hindered by increased cortisol production and if there is a link between stress and inflammation.

The study group included 276 health adults. The group completed an intensive stress interview and was then exposed to a virus causing the common cold. After a five-day quarantine, they were monitored to see if the virus caused an infection. In Cohen’s first study, 276 healthy adults completed an intensive stress interview and were then exposed to a virus that causes the common cold and monitored in quarantine for five days for signs of infection and illness. Those under long-term stress were more likely to have fallen ill with the virus.

It was found that experiencing a prolonged stressful event was associated with the inability of immune cells to respond to hormonal signals that normally regulate inflammation. In turn, those with the inability to regulate the inflammatory response were more likely to develop colds when exposed to the virus.

Acute versus chronic pain

Unfortunately, some causes of low back pain are not prevented as easily. Disorders such as osteoporosis can lead to spinal compression fractures. Arthritis can also lead to back pain.

And, just as not all causes of back pain are equal, the discomfort typically falls into one of two categories: acute or chronic.

Acute back pain frequently heals on its own, while chronic sufferers benefit from treatment plans. Acute pain typically lasts fewer than six month and usually results from sustaining an injury. Chronic pain, however, may result from a condition such as osteoporosis, a degenerative disc disease, or arthritis. Chronic pain lasts longer and may require ongoing effort to manage.

What are common back pain symptoms?

Not all back pain is created equal; there are several different types of back pain and many different symptoms of back pain. Some of the most common areas for back pain are the upper, middle, and lower back, but you may also experience pain that is directly related to the sciatic nerve, low back strain, or back pain that only occurs at night.

Upper and lower back pain is the most common symptom, obviously. You may also experience pain in any area of the back that ranges from:

  • Aching and stiffness in the neck, along the spine, or in the low back
  • A chronic ache in the lower back
  • Difficulty standing for long periods of time or pain in the low back when doing so
  • Any sharp pain that is the result of physical activity (like lifting a box or playing a game of catch)
  • Pain related to the sciatic nerve
  • Lower back strain

Low back strain is one of the most common symptoms of back pain. This pain occurs when you do something that stretches the muscles and ligaments in your lower back beyond their capacity. This can happen when you exercise too strenuously without a proper warm-up, lift something improperly, fall, or bend over repeatedly. Once again, being overweight or out of shape can contribute to low back strain.

Sciatic back pain

Pain related to the sciatic nerve–the nerve that runs from the low back down both legs–can be both severe and debilitating. This type of pain may get worse when you sit and may make it difficult to move one or both of your legs. It can be either a constant ache or a shooting pain down the back or the side of the body. People who experience this type of back pain may have it only on occasion or may experience damage to the sciatic nerve that makes the pain part of their daily life.

Sciatic pain can be caused or exacerbated by many things, including:

  • Pregnancy
  • Being overweight
  • Wearing high heels
  • Not getting adequate exercise to build supportive back and abdominal muscle

Whatever the cause, if symptoms worsen, consult a doctor for back pain, as we’ll discuss.

When to see a doctor for back pain

There are many times when to see a doctor for back pain. Back pain can have a huge impact on your life, both in immediately serious ways and as a constant source of stress that can lead to mental health issues and lower quality of life.

See a back pain doctor–or regular doctor–immediately if your back pain is accompanied by:

  • Sharp pain in the middle or upper range of your back, as this could be a sign of heart attack
  • Numbness or tingling in your arms and legs
  • Pain that moves down your leg or gets worse when you bend forward
  • A fever or other sign of infection, such as redness or swelling
  • Bowel or bladder control problems
  • Unintended weight loss

If you have sudden onset back pain of any type, such as back pain that occurs after a high-impact car crash, bad fall, or injury, contact a back pain doctor immediately.

Avoiding quality of life issues

While these immediate and serious causes of back pain must be dealt with, there are other cases that may be more obscure or subtle that still have a huge effect on your quality of life. When back pain affects the plans you make, the amount of time you spend with friends or family, or limits the activities you engage in, it might be time to see a doctor for back pain.

For example, night time back pain is one of the least common types of back pain. This is pain that specifically occurs when you lay down. In fact, a person may be fine and not feel pain during the day but experience pain as soon as they turn out the lights. This can be caused by a number of things, including serious issues such as problems with the spine, scoliosis, or kidney stones, or it can be a symptom of tumors of the spine or cancer.

All persistent pain should be discussed with a back pain doctor, but night time back pain in particular should be addressed quickly as it can affect quality of sleep and subsequent ability to heal.

You should also talk to a back pain doctor if your back pain:

  • Hasn’t improved after a week with management strategies, such as hot/cold therapy
  • Is constant and intense
  • Hampers your daily activities in a substantial way

Our post on the subject talks more about how untreated chronic pain can lead to depression and other mental health challenges. Finding help at the beginning of symptoms can go a long way towards avoiding these issues.

How to find a back pain doctor near me

Finally, talking to a back pain doctor who is specifically trained in pain management, rather than general care, can be incredibly important for managing symptoms. A primary care doctor can help begin the process. But, a back pain doctor can better diagnose the cause of your pain and suggest strategies for reducing or preventing it in the future.

As we discuss in our earlier post on the subject, finding a back pain doctor comes down to these key steps:

  1. Talk to your insurance company
  2. Talk to your primary care physician or other medical practitioner
  3. Talking to family and friends for recommendations
  4. Using an online search tool to find reviews

So, when to see a doctor for back pain? When it’s accompanied by symptoms that point to serious complications, such as infection, tumors, or heart attacks. Beyond that, it’s important to talk to a doctor for back pain before it drastically reduces your overall quality of life. While back pain is a common issue, each person experiences it differently. Find a back pain doctor in your area who can help you diagnose the cause of your pain and get you back to your best life.


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Left-sided back pain that won’t go away

A 68-year-old man came to the emergency department complaining of left-side thoracic back pain, after 5 days of outpatient treatment with analgesics did not help him. His pain started after physical labor, but he did not recall any trauma. A review of his medical history revealed only coronary artery disease, with coronary stent placement several years before this event. He had not been hospitalized recently, undergone an invasive procedure, or taken antibiotics.

On examination, a left thoracic paraspinal muscle was tender without fluctuance, overlying skin redness, or a lesion. An elevated white blood cell count of 12,300/mcL was the only laboratory test with abnormal results. The patient did not have fever, and results of urinalysis, chest radiograph, and abdominal sonogram were normal. Computed tomography (CT) images of the abdomen and pelvis showed inflammation of a left thoracic paraspinal muscle.

Thirty-six hours after admission, the patient developed fever (38.8°C). His physicians obtained a blood culture. The fever recurred (at 38.9°C) the following day, and 2 more blood cultures were done. His back pain did not improve despite analgesics, intravenous antibiotics, and physical therapy; therefore, on the eighth day in the hospital, magnetic resonance imaging (MRI) was performed (FIGURE).

MRI of the back

An MRI of the patient’s back showed a lesion in the left thoracic paraspinal muscle.

What is the diagnosis?

by The American Chiropractic Association

Does Back Pain Go Away on Its Own?
Eighty percent of people suffer from back pain at some point in their lives. Back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections. Most cases of back pain are mechanical or non-organic, i.e., not caused by serious conditions, such as inflammatory arthritis, infection, fracture, or cancer.
What Causes Back Pain?
The back is a complicated structure of bones, joints, ligaments, and muscles. You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to back pain. While sports injuries or accidents can cause back pain, sometimes the simplest of movements-for example, picking up a pencil from the floor-can have painful results. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate back pain. Back pain can also directly result from disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss.
Back injuries are a part of everyday life, and the spine is quite good at dealing with these often “pulled” muscles. These very minor injuries usually heal within 1 or 2 days. Some pain, however, continues. What makes some pain last longer is not entirely understood, but researchers suspect that the reasons may include stress, mood changes, and the fear of further injury that may prevent patients from being active. In addition, sometimes a painful injury or disease changes the way the pain signals are sent through the body, and, even after the problem has gone away or is inactive, the pain signals still reach the brain. It is as if the pain develops a memory that keeps being replayed.
Will Back Pain Go Away on Its Own?
Until recently, researchers believed that back pain will “heal” on its own. We have learned, however, that this is not true. A recent study showed that when back pain is not treated, it may go away temporarily but will most likely return. The study demonstrated that in more than 33% of the people who experience low-back pain, the pain lasts for more than 30 days. Only 9% of the people who had low-back pain for more than 30 days were pain free 5 years later.1
Another study looked at all of the available research on the natural history of low-back pain. The results showed that when it is ignored, back pain does not go away on its own.2 Those studies demonstrate that low-back pain continues to affect people for long periods after it first begins.
What Can I Do to Prevent Long-Term Back Pain?
If your back pain is not resolving quickly, visit your doctor of chiropractic. Your pain will often result from mechanical problems that your doctor of chiropractic can address. Many chiropractic patients with relatively long-lasting or recurring back pain feel improvement shortly after starting chiropractic treatment.3 The relief they feel after a month of treatment is often greater than after seeing a family physician.4
Chiropractic spinal manipulation is a safe and effective spine pain treatment. It reduces pain, decreases medication, rapidly advances physical therapy, and requires very few passive forms of treatment, such as bed rest.5
How Can I Prevent Back Pain?

  • Don’t lift by bending over. Instead, bend your hips and knees and then squat to pick up the object. Keep your back straight, and hold the object close to your body.
  • Don’t twist your body while lifting.
  • Push, rather than pull, when you must move heavy objects.
  • If you must sit for long periods, take frequent breaks and stretch.
  • Wear flat shoes or shoes with low heels.
  • Exercise regularly. An inactive lifestyle contributes to lower-back pain.
  • What Should I Tell My Doctor of Chiropractic?
    Before any treatment session, tell your doctor of chiropractic if you experience any of the following:

  • Pain goes down your leg below your knee.
  • Your leg, foot, groin, or rectal area feels numb.
  • You have fever, nausea, vomiting, stomach ache, weakness, or sweating.
  • You lose bowel control.
  • Your pain is caused by an injury.
  • Your pain is so intense you can’t move around.
  • Your pain doesn’t seem to be getting better quickly.
  • 1. Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C. The course of low-back pain in a general population. Results from a 5-year prospective study. J Manipulative Physiol Ther 2003 May;26(4):213-9.
    2. Hestbaek L, Leboeuf-Yde C, Manniche C. Low-back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 2003 Apr;12(2):149-65.
    3. Stig LC, Nilsson O, Leboeuf-Yde C. Recovery pattern of patients treated with chiropractic spinal manipulative therapy for long-lasting or recurrent low back pain. J Manipulative Physiol Ther 2001 May;24(4):288-91.
    4. Nyiendo J, Haas M, Goodwin P. Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study. J Manipulative Physiol Ther 2000 May;23(4):239-45.
    5. Time to recognize value of chiropractic care? Science and patient satisfaction surveys cite usefulness of spinal manipulation. Orthopedics Today February 2003;23(2):14-15.
    Lawrence H. Wyatt, DC, DACBR, Professor, Division of Clinical Science, Texas Chiropractic College,
    Writer Nataliya Schetchikova, PhD, Editor

When Back Pain Won’t Go Away

A frequently misdiagnosed condition may be to blame

Nearly everyone experiences low back pain at one time or another. For many people, the pain is brought on by heavy lifting, a bad sleep position or twisting the wrong way. For others, it may be age-related osteoarthritis.

But for a significant number of back pain sufferers, the pain becomes chronic (occurring daily for months to years) and can be due to a condition known as ankylosing spondylitis (AS), a form of arthritis that causes painful inflammation of the spinal joints (vertebrae). Less often, pain also occurs in other parts of the body, such as the shoulders and hips — or even the jaw or small joints of the hands.

AS — most often referred to simply as spondylitis — is typically diagnosed before the age of 40, but the condition may go undetected or misdiagnosed until the patient is much older.

If spondylitis progresses, the inflammation can lead to new bone formation that causes the spine to fuse (a condition known as ankylosis) in a forward-stooped position. This occurred in Pope John Paul II, who suffered from AS.

Why do so many cases of spondylitis escape notice? For some patients, the back pain and stiffness caused by spondylitis are so mild or intermittent that the condition doesn’t become a problem until later in life. For example, I recently diagnosed a man in his 70s who had spondylitis, but his back pain had become severe only recently.

Spondylitis also can go undiagnosed because most patients — as well as many health-care professionals — are unfamiliar with the condition. Few people know that back pain (often accompanied by fatigue and morning back stiffness that gets better with activity) can be due to spondylitis, but estimates show that the condition affects at least one in every 500 adults, making it nearly as common as rheumatoid arthritis.

What you need to know…


The chronic inflammation caused by spondylitis can lead to other potentially serious complications. For example, up to 40% of people with spondylitis suffer from inflammation of the eye (iritis), which can result in pain and sensitivity to light. The condition is treated with corticosteroid eyedrops to ease the inflammation.

In addition, some people with spondylitis develop inflammation just below the aortic valve (the aorta transports blood from the heart to the rest of the body). This chronic inflammation can interfere with the heart’s rhythm and/or cause the aortic valve to become leaky (aortic ­insufficiency), a condition that may require surgical valve replacement.

Recent research: Patients with spondylitis have more aortic stiffness (due to inflammation) than those without the back condition, according to a recent study. Stiffness in an artery raises the risk for high blood pressure and blood vessel damage.

In other spondylitis cases, the cartilage around the ribs may become inflamed, causing a painful condition known as costochondritis. The ribs may eventually fuse to the spine, which limits the chest’s ability to expand and may aggravate an existing lung disease, such as asthma or bronchitis, and raise the risk for spinal fracture.


Spondylitis is difficult to diagnose — primarily because it progresses so slowly. It often takes up to 10 years from the time a patient first feels the twinges of back pain before the inflammation shows up on an X-ray.

Ask your doctor about: Getting a magnetic resonance imaging (MRI) scan if spondylitis is suspected. A telltale sign of spondylitis is inflammation of the sacroiliac joints, located in the low back. But X-rays do not always detect this inflammation in the early stages of the condition.

Spondylitis is primarily caused by hereditary factors, especially a genetic marker known as HLA-B27, which is present in more than 90% of people who have spondylitis. However, only about one in 20 people with HLA-B27 develop spondylitis or a related disease.

Certain gastrointestinal conditions, such as Crohn’s disease and ulcerative colitis, also have been associated with spondylitis.

Although no cure is yet available, recent advances in treatment have been successful in reducing the pain and inflammation associated with the disease.


Many people with spondylitis are able to control the pain with over-the-counter nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil) or naproxen (Aleve). Others may require the use of a prescription drug known as a TNF-alpha inhibitor, such as infliximab (Remicade), etanercept (Enbrel) or adalimumab (Humira).

Caution: The FDA recently issued a warning about increased risk for fungal infection in people who take these TNF-alpha inhibitors.

These medications, which often are used for rheumatoid arthritis, can eliminate the inflammation of spondylitis but won’t prevent the spinal fusion associated with ankylosis.

Latest treatment advances: The FDA recently approved the use of golimumab (Simponi), another TNF-alpha inhibitor, for the treatment of spondylitis. Studies show that the drug works at least as well as other TNF-alpha inhibitors, and it is taken less often than those other drugs. Certolizumab (Cimzia), another drug in the same class, was recently approved for treatment of rheumatoid arthritis and is expected to be studied as a treatment for spondylitis.


Daily exercise — even if it’s only five to 10 minutes of gentle stretching — is crucial in the treatment of spondylitis. Many studies have shown that spondylitis patients who exercise regularly experience less pain and better functioning than patients who do not get regular exercise.

Best types of exercise include…

Conditioning. Aerobic workouts, such as swimming, are especially effective at decreasing pain and stiffness.

Helpful: If you have trouble turning your head to breathe while swimming, try a snorkel and mask.

Spinal extension. These exercises loosen up the spine and prevent stiffness.

One to try: While on all fours, arch your back like a cat and hold until you feel a good stretch. Then let your back sway or sag downward toward the floor, while lifting up your head and buttocks. Repeat three to five times daily.

Range-of-motion for the neck. Moving the neck can help guard against the stiffness caused by spondylitis.

What to do: Pull in your chin and shift your gaze to your chest. Return to the starting position, then tip your head backward as far as you comfortably can. Repeat three to five times daily.

The Surprising Reason Why Your Low Back Pain Won’t Go Away

Have you ever wondered why your low back pain just keeps sticking around even after you have faithfully seen a physical therapist, chiropractor, or massage therapist? Most of the time, these professionals are addressing the spine and sometimes even the hips. But why do we neglect the very foundation of the spine? Your spine begins at your tailbone, which is one of the three bones of the pelvis. Muscles that attach to and support your pelvis and tailbone include back muscles, abdominal muscles, glutes and other hip muscles, as well as a small set of muscles at the base called your pelvic floor. If your pelvic floor is not getting assessed and treated, you are missing a huge piece of the puzzle that is low back pain.

As pelvic floor physical therapists, we’ve always known there is a close relationship between the pelvic floor and low back pain. For many of our patients, one of the first symptoms they notice is sciatica or other low back pain; often, they don’t realize it might be related to their pelvic floor until their initial evaluation. Recent research has shown this is even more prevalent that we realized.

Of women with low back pain, more than 95% had pelvic floor dysfunction as well!

This included pelvic tenderness (71%), weakness (66%) and even pelvic organ prolapse (41%). Other research has tied low back pain to urinary incontinence, with nearly 80% of women with chronic back pain reporting at least occasional incontinence.

The Chicken or the Egg?

It’s not always clear which comes first. A major role of the pelvic floor is to help stabilize the core and lower back, so when the back is in pain, the pelvic floor muscles may tighten to try and protect the sensitive area. This can overwork the pelvic floor, causing trigger points to form in the muscles and creating additional symptoms (see graph below). In other cases, the pelvic floor dysfunction may have come first and altered the spine’s mobility and stability, thus triggering low back pain. Either way, there is a feedback loop where low back pain and pelvic floor dysfunction reinforce each other. Both must be addressed for full resolution of symptoms.

Resolving Chronic Low Back Pain

This is why it’s so important to address both the internal and external causes. A traditional orthopedic physical therapist will address the common causes of low back pain and prescribe some stretching and strengthening exercises for the low back. However, many patients will find that the treatment doesn’t ‘stick’ – they feel better for a few days, but lasting relief is elusive. In these cases, the pelvic floor dysfunction isn’t being addressed, so the low back regresses and gets pulled back into dysfunction.

The same issues arise when only the internal pelvic floor muscles are treated. Even if the trigger points in the pelvic floor are cleared out and a strengthening program put in place to resolve weakness, if the lower back isn’t addressed the pelvic floor dysfunction will simply reoccur. For true healing to occur, both the pelvic floor and low back must be addressed together.


So what does this mean for the treatment of low back pain? Our philosophy is that complex low back and pelvic floor patients need at least an hour of hands-on physical therapy with a pelvic PT who can address both the internal and external aspects of the issue. However, it can be difficult to find this kind of hands-on treatment philosophy in today’s medical world. Some patients do well when working with both a skilled orthopedic and pelvic floor physical therapist concurrently, treating both components of the problem at once. A massage therapist can also be a valuable tool in conjunction with a traditional, internal-only pelvic floor physical therapist. The massage can focus on the glutes, low back, and hamstrings while the pelvic PT resolves internal trigger points.

For sustained relief of lower back pain, often both the pelvic floor and lower back must be looked at together.

Additional Resources

Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County’s premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole’s clinic.

Lower back pain

Whether you spend your day moving furniture or sitting in an office chair, you’re probably no stranger to back pain. According to the Mayo Clinic, four out of five Americans suffer back pain at some point in their lives. It’s an expensive proposition, costing the United States an estimated $100 billion a year.

Although problems can arise anywhere in the spine, the lower back is Pain Central. Low back pain is a major cause of disability and missed workdays. It’s also among the most frequent complaints that send people to the doctor.

But even if your back is causing you excruciating pain, try not to despair. You shouldn’t have to put up with the agony too long. Most acute back pain gets a lot better within a couple of weeks and goes away completely within a couple of months. With a little extra care, your back has an excellent chance to heal quickly.

What causes back pain?

To a large extent, modern medicine still hasn’t solved the riddle of low back pain. In fact, doctors can determine a specific cause of back pain only about 15 percent of the time, according to two back pain experts writing in the New England Journal of Medicine in 2001. In most cases, a doctor could order multiple tests and still not be able to pinpoint a cause.

Most backaches are chalked up either to sprains or to strains in muscles or ligaments. These injuries — often caused by heavy lifting or twisting — won’t show up on an x-ray or any other imaging technology, but the pain is no less real. A muscle spasm in the back — caused by disk, joint, or muscle injury — can also cause waves of intense pain.

Another common cause of back pain is osteoarthritis, which often causes pain after the cartilage that protects the joints between the vertebrae is worn down. Bearing heavy loads may result in bone spurs that press on a spinal nerve, and nerves in the disks themselves may also become irritated and cause pain.

Both osteoarthritis and excessive strain can also result in herniated disks, another possible source of back pain. Disks are flexible cushions that have a jellylike center and fit in between vertebrae to help absorb shocks. With advancing age or excessive strain, the cushions can wear thin. Eventually, the jellylike center of one or more disks can start to ooze out. This is called a herniated or “slipped” disk. In some cases, the center spreads out and presses against a nerve, causing considerable pain. However, most herniated disks are harmless. In fact, many people with no back pain have this condition and never know it.

Other causes of back pain are spinal stenosis (a narrowing of the tissue that covers the spinal column), spinal deformities, and fractures caused by osteoporosis. For a tiny minority of patients, back pain may signal a serious disease such as cancer, a bone infection, or a rare type of inflammatory arthritis. Finally, for some people, chronic back pain — in the absence of any serious underlying disease or disorder — may be linked to stress.

Is there a link between back pain and the emotions?

Yes, according to many researchers. In 2001 two German researchers interested in the connection combed through 900 studies on back and neck pain in a literature review and analyzed 37 in detail. Their conclusion: There’s ample evidence of a link between back pain and the emotions. Not only were factors such as depression, dissatisfaction with work, and overall distress in daily life clearly associated with the onset of back and neck pain, but the same factors — along with chronic stress — were linked with back pain that turned into chronic pain and disability. Although these findings are controversial among some doctors, others are investigating the relationship between chronic tension and back pain.

“I have never seen a patient with pain in the neck, shoulders, back, or buttocks who didn’t believe that the pain was due to an injury, a ‘hurt’ brought on by some physical activity,” writes John Sarno, MD, professor of clinical rehabilitation medicine at New York University School of Medicine and an outspoken champion of a link between back pain and the emotions. He quoted a typical patient: “Ten years ago I was involved in a hit-from-behind auto accident and I have had recurrent back pain ever since.” What this means, Sarno continued, is that “the idea that pain means injury or damage is deeply ingrained. But this is nothing less than a catastrophe for the American public, which now has an army of semi-disabled men and women whose lives are significantly restricted by the fear of doing further damage or bringing on the dreaded pain again.”

Based on nearly 20 years of treating patients with chronic back and neck pain, Sarno has come to believe that most cases result from nervous tension, which temporarily constricts blood vessels and makes it hard for the cells to get enough oxygen. According to Sarno, chronic tension results in actual physiological changes in certain muscles, nerves, tendons, and ligaments, resulting in a “harmless but potentially very painful disorder” that he calls Tension Myositis Syndrome (TMS). According to Sarno, highly conscientious and self-motivated people are particularly prone to back pain, and anxiety and repressed anger can trigger muscle spasms. By unearthing and treating the sources of the tension and anxiety — from job and marital troubles to caring for an ailing parent — Sarno says, he has successfully treated patients who had previously suffered for decades from “intractable” back pain.

Who is at higher risk for back pain?

At least 80 percent of people will suffer from back pain at some point in their lives, so in some sense we’re all at risk. Anything that causes wear and tear on the muscles, ligaments, bones, and disks of the back can bring on pain. People who constantly lift heavy objects or do a lot of bending or twisting often suffer as a result. At the other end of the spectrum, people who rarely get any exercise are also vulnerable to back pain, especially when they suddenly get a wild notion to move a couch or shovel snow from the driveway.

“In my experience, most of the time back injuries happen to the busy person who is out of shape and overworked and not paying attention to what he or she is doing,” says Michael Potter, MD, of UCSF Medical Center. “If the pain turns into chronic pain, people are at risk of getting into a vicious cycle in which pain leads to depression, which in turn can make the pain worse and more difficult to treat. That is why it’s important not to let pain fester for too long before getting some help — and why doctors need to take pain seriously.”

Besides strain and injury, other factors can increase the risk of back pain. Age also takes a toll — most people first notice back pain after age 30. People in unfulfilling jobs or with unhappy home lives are also prime candidates for pain; according to Sarno, highly motivated individuals with repressed anger and anxiety — often from shouldering overwhelming responsibilities — fit into this category as well. And according to a report from the University of California at Davis, smokers are especially likely to develop back pain, possibly because cigarette smoking slows down circulation.

How can I control my back pain?

The good news about back pain is that most people quickly get better. Roughly one-third of all patients with a sudden episode of lower back pain improve greatly within one week, and two-thirds feel much better after seven weeks, according to a report in the New England Journal of Medicine.

For most people, the key to recovery is staying active — within limits, of course. You may need to rest for a day or two, but lying around too long can weaken your muscles and increase your pain. Most people who try to return to their normal lives as soon as possible find that their ache gradually fades. Of course, some common sense is in order: If your job requires heavy lifting or other strenuous activity, you may have to take some time off to give your back a chance to heal.

While waiting for your back to recover, you may be able to ease the pain with aspirin, ibuprofen, or other over-the-counter pain relievers. A combination of cold and heat can also help. To reduce pain and inflammation, the Mayo Clinic recommends putting a store-bought ice pack (which can be used and refrozen over and over) or a home-made cold pack (a bag of ice wrapped in a cloth) on the sore spot soon after the pain first arises. Try the cold pack several times a day, 20 minutes at a time. When the pain starts to fade, 20 minutes with a heating pad can help loosen muscles and speed relief.

When should I see a doctor?

Most people with back pain can wait several weeks before they see a doctor, according to the Mayo Clinic. For many of them, the pain will probably disappear before they ever have to make an appointment. However, some people shouldn’t wait that long. Lingering numbness or tingling in your limbs, for example, could be a sign of nerve damage.

In addition, if your pain doesn’t show any signs of improving after 72 hours of rest, applying cold and hot packs, and taking pain relievers, it’s time to see a doctor, according to the Mayo Clinic. If pain is treated in its early stages, it probably won’t linger as long.

You should also see your doctor if you’ve had trouble with your back before, if you have a history of cancer or osteoporosis, if you’ve experienced unexplained weight loss of more than 10 pounds in the last six months, or if you’re over 50.

Contact a doctor immediately if, along with your back pain, you show these signs of a serious medical problem:

  • a high fever that lasts for more than 48 hours
  • constant or intense pain (especially at night)
  • pain that spreads down one or both legs
  • loss of bladder or bowel control
  • stomach pain
  • weakness in the limbs or numbness and tingling in one or both legs

What kind of tests will my doctor order?

Your doctor can learn a lot about your condition simply by examining your back and asking about symptoms. If your pain has lasted for several weeks — or if you show signs of a serious problem — your doctor may need to take a closer look. Regular x-rays are not routinely used by doctors, because they can’t show herniated disks and many other sources of back pain. If you show signs of nerve damage or have very severe symptoms that don’t respond to physical therapy, anti-inflammatories, or other standard treatments, your doctor may order a high-tech imaging test such as a magnetic resonance image (MRI) or a computed tomography (CT) scan.

What is the treatment for back pain?

If your pain just won’t go away, talk to your doctor about your treatment options. For mild to moderate cases, your doctor may prescribe muscle relaxants or prescription painkillers to help you feel more comfortable. If you have a herniated disk, he or she may suggest an injection of corticosteroids to calm inflammation of the nerves.

If back pain is a nagging problem, your doctor may also recommend specific exercises to ease your back pain and prevent future flare-ups. Exercise doesn’t seem to help soothe sudden bouts of back pain, but it can definitely help control chronic cases, and it may be able to help prevent future injuries. According to recent studies, massage therapy, acupuncture, physical therapy, and chiropractic treatment can help as well. As always, it’s best to take a new workout program slowly and let your body set the limits. You may also want to explore the research on the connection between back pain and chronic tension.

Back surgery has been overprescribed in the past, but it may still be the best remedy for a small minority of patients. If you have a herniated disk, if the pain shoots down to your legs, and if the pain has lingered for at least four to six weeks, your doctor may request an MRI to see what’s going on. Based on those findings, he or she may recommend an operation to remove part of your damaged disk. Surgery may be necessary if you have a herniated disk accompanied by signs of nerve damage such as weakness and numbness. Surgery can also be used to remove a bone spur or correct a case of spinal stenosis, or narrowing. Be sure to discuss all of the pros and cons of surgery and all of your other options before agreeing to an operation.

What about chiropractors and physical therapists?

To rule out certain diseases or disorders that require medical care, the Mayo Clinic recommends seeing a regular doctor before trying chiropractic. For people who have a herniated disk or compression fracture, for example, manipulation of the spine could make things worse. If you get the go-ahead to try a chiropractor, find one who’s willing to work with your doctor. That said, a chiropractor’s hands-on approach may help relieve run-of-the-mill back pain, at least for the short term. The biggest barrier to chiropractic care is that it often isn’t covered by health insurance.

For patients with low back pain, studies have shown that physical therapy is slightly more effective than medical care alone for reducing disability. One added benefit is that therapists emphasize what you can do to take care of yourself after the pain has been relieved.

How can I prevent back pain?

Once you’ve had an episode of back pain, the pain is likely to occur again. Your job is to make sure the attacks are as brief and as far apart as possible. If you lift heavy objects, let your legs, not your back, do the work. Get regular exercise, stretch before engaging in sports, and ask your doctor about exercises that can strengthen your back muscles. Avoid standing or working in the same position for too long — try shifting postures at least every 20 minutes — and keep your posture straight but relaxed. Sleep on a comfortable mattress. And if you smoke, stop. Finally, here’s a recommendation from none other than the National Institutes of Health: Cut down on emotional stress that causes muscle tension.

Your back may hurt again, and it may not. Either way, it’s up to you to keep your back as strong and healthy as possible. Back pain may be a fact of life, but it doesn’t have to become a way of life.

Further Resources

American Chronic Pain Association (ACPA), P.O. Box 850. Rocklin, CA 95677 800-533-3231

Deyo, R.A. and J.N. Weinstein. Primary care: Low back pain. New England Journal of Medicine. February 1, 2001. 344 (5) 363-370.

Mayo Clinic. Back pain. April 15, 2002.

NINDS Back Pain Information Page. National Institute of Neurological Disorders and Stroke, National Institutes of Health. www.ninds.nih.gove/health_and_medical/disorders/backpain_doc.htm

Sarno, John, MD. Mind Over Back Pain. Penguin Putnam, 1982.

Sarno, John, MD. Healing Back Pain: The Mind-Body Connection. Warner Books, 1992.

University of California at Davis. What are the lifestyle risk factors for low back pain? 2001.

Assessment and management of acute low back pain. American Family Physician. November 15, 1999.

Spinal Stenosis online factsheet, American Academy of Orthopaedic Surgeons

Hurwitz, E.L. A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study. Spine 2002, October 15; 27 (20): 2193-204.

Andersson, Gunnar B.J., “Epidemiological features of chronic low-back pain,” Lancet 1999; 354 (9178): 581-585

Cherkin, Daniel C., Eisenberg, David, et al., “Randomized Trial Comparing Traditional Chinese Medical Acupuncture, Therapeutic Massage, and Self-care Education for Chronic Low Back Pain,” Archives of Internal Medicine, 2001;161:1081-1088.

Ernst, E., “Massage therapy for low back pain: a systematic review.” Journal of Pain Symptom Management 1999;17:65-9.

Keeping Your Back Healthy at Work.

Why Low Back Pain May Not Go Away

Low back pain is one of the most common aches and pains that causes people to see their physical therapist. Low back pain comes in different levels, from a simple achy, stiff back in the morning, to a severe and debilitating condition. By receiving treatment sooner, you can lessen the long-term damage that may result in your spine.

What causes low back pain? Typically, there are 4 main factors at work here:

  1. Poor spinal and abdominal muscle support
  2. Poor posture and alignment of the spine
  3. Limited movement of the spinal joints
  4. Lack of proper coordination of the spinal muscles

In order for your spine to be healthy and to work properly, you need to have strength, flexibility and coordination. While medications and injections can help to relieve the inflammation caused by a malfunctioning spine, they don’t fix the root cause of the problem.

Physical therapy is the ideal solution to improve spinal strength, coordination and flexibility. Best of all, once your spine is working better, we teach you how to maintain your spinal health so you don’t have to continue to suffer with low back pain. Call Fleming Physical Therapy today to discover how we can help you relieve your back pain and get back to doing the activities you love.

Low back pain – chronic

Your back pain may not go away completely, or it may get more painful at times. Learn to take care of your back at home and how to prevent repeat episodes of back pain. This can help you continue with your normal activities.

Your provider may recommend measures to reduce your pain, including:

  • A back brace to support your back
  • Cold packs and heat therapy
  • Traction
  • Physical therapy, involving stretching and strengthening exercises
  • Counseling to learn ways to understand and manage your pain

These other health care providers may also help:

  • Massage therapist
  • Someone who performs acupuncture
  • Someone who does spinal manipulation (a chiropractor, osteopathic physician, or physical therapist)

If needed, your provider may prescribe medicines to help with your back pain:

  • Aspirin, naproxen (Aleve), or ibuprofen (Advil), which you can buy without a prescription
  • Low doses of prescription medicines
  • Narcotics or opioids when the pain is severe

If your pain does not improve with medicine, physical therapy, and other treatments, your provider may recommend an epidural injection.

Spinal surgery is considered only if you have nerve damage or the cause of the back pain does not heal after a long time.

In some patients, a spinal cord stimulator can help reduce back pain.

Other treatments that may be recommended if your pain does not improve with medicine and physical therapy include:

  • Spinal surgery, only if you have nerve damage or the cause of your pain does not heal after a long time
  • Spinal cord stimulation, in which a small device sends an electric current to the spine to block pain signals

Some people with low back pain may also need:

  • Job changes
  • Job counseling
  • Job retraining
  • Occupational therapy

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