Back pain is one of the most common reasons for doctor’s visits. It affects people of all ages and is often the result of muscle strain or injury. Many episodes of back pain resolve on their own within a few weeks. However, severe or persistent back pain may be a sign of an underlying medical condition that requires treatment. This article provides guidelines on how long to wait before seeking medical care for back pain.
What are the common causes of back pain?
There are many potential causes of back pain, including:
- Muscle or ligament strain – Stretching or tearing of muscle fibers or ligaments, often due to overuse or improper lifting/bending.
- Bulging/herniated disc – Rupture of the jelly-like cushion between vertebrae, causing irritation of nearby nerves.
- Arthritis – Inflammation and wearing down of spinal joints.
- Skeletal irregularities – Abnormal curvature of the spine or bone spurs can cause irritation.
- Osteoporosis – Weakened bones that are at higher risk of compression fractures.
- Poor posture – Slouching, slumping and other postural problems place extra strain on the back.
- Obesity – Excess weight, especially around the abdomen, increases stress on back muscles and spine.
Most back pain results from muscle and ligament injuries or arthritis. Disc problems, spinal abnormalities and osteoporosis are less common sources. Understanding the origin of your pain can help determine appropriate treatment.
When should I expect back pain to go away on its own?
For otherwise healthy adults, the majority of acute back pain resolves with little intervention. This pain generally lasts for 4-6 weeks and tends to improve with rest, over-the-counter pain relievers and applying heat or ice. Gentle stretches and light activity can also aid healing. Here is the typical course of back pain without treatment:
- Week 1 – Pain is most severe, with difficulty bending or standing for long periods.
- Weeks 2-3 – Discomfort starts improving but may still cause stiffness and difficulty with daily activities.
- Weeks 4-6 – Lingering mild pain is common but most functional limitations resolve.
- After 6 weeks – Pain continues improving and most patients report feeling significantly better.
While acute back pain often resolves on its own over several weeks, prompt medical attention is advisable for severe pain or new neurological symptoms like numbness/tingling. Seek emergency care for symptoms like loss of bowel/bladder control.
Red flag symptoms that require urgent medical evaluation
Though most back pain is harmless, certain “red flag” symptoms can signal a serious problem requiring immediate medical care. Seek emergency treatment if you experience:
- Loss of bowel or bladder control
- Numbness around the groin or anal area
- Leg weakness making it difficult to stand or walk
- Fever or chills in conjunction with back pain
Call your doctor right away if you have:
- Constant or worsening pain lasting over a week
- Pain extending down the leg below the knee
- Difficulty standing up straight or walking due to stiffness
- History of cancer, steroid use or osteoporosis
These “red flag” symptoms can indicate nerve damage, an infection or, less commonly, an underlying condition like cancer. Quick treatment is needed to prevent permanent problems. Those over 50, pregnant women and people with other medical issues should have a lower threshold for seeking care.
When to see a doctor for chronic back pain
For back pain lasting over 3 months, it is important to be evaluated by a physician. Chronic pain that persists longer than expected is unlikely to completely resolve without intervention. Possible causes of chronic back pain include:
- Herniated/degenerated disc – Damaged discs don’t always heal and may worsen over time.
- Arthritis – Progressive joint damage can lead to bone spurs, inflammation and stiffness.
- Scoliosis – Spine curvature places one-sided pressure on muscles and discs.
- Osteoporosis – Collapsed vertebrae from weak bones pinch nerves.
Diagnostic tests like x-rays, MRIs and CT scans can pinpoint sources of chronic pain. Treatment options may include medication, physical therapy, steroid injections, chiropractic care or surgery. Living with chronic pain can also contribute to depression, anxiety and poor sleep – which warrant separate treatment.
What specialists treat back pain?
Depending on the nature and severity of back pain, various medical specialists may provide treatment:
- Primary care doctor – Assesses initial symptoms and performs exam to determine if specialist referral needed.
- Orthopedist – Evaluates and treats back conditions involving muscles, joints, bones and ligaments.
- Neurologist – Addresses pain arising from nerve damage or compression.
- Rheumatologist – Diagnoses and treats inflammatory back conditions like arthritis.
- Interventional pain specialist – Provides minimally invasive treatments including nerve blocks and steroid injections.
- Physical therapist – Offers noninvasive approaches to reduce pain and restore mobility.
- Neurosurgeon or orthopedic spine surgeon – Performs surgery for damaged discs and fractures if conservative treatment fails.
Depending on your symptoms, your doctor may refer you to one or more of these specialists for targeted back pain relief.
When should I go to the emergency room for back pain?
Most back pain does not require emergency care. However, immediately go to the ER if you experience:
- Sudden severe back pain, especially if combined with abdominal pain
- Pain, numbness or weakness in one or both legs
- Loss of bowel or bladder control
- Fever and immune system suppression
These alarming symptoms can result from:
- Cauda equina syndrome – Compression of nerve roots affecting bowel/bladder function and leg strength. Requires urgent surgery.
- Epidural abscess – Infection inside the spine compressing nerves. Antibiotics and possibly drainage needed.
- Aortic aneurysm – Balloon-like bulge in a major artery that can rupture. Needs immediate repair surgery.
- Spinal fracture – Broken vertebrae at high risk of nerve damage. May require braces or surgery.
Even without severe symptoms, older adults should have back pain evaluated quickly due to higher risk of dangerous spinal problems. Seek same-day medical attention if you are over 50.
What self-care can I try for back pain relief?
For milder back pain, home treatment may temporarily alleviate discomfort while waiting to recover. Self-care options include:
- Over-the-counter pain medication – Anti-inflammatories like ibuprofen or naproxen reduce swelling and pain.
- Hot/cold therapy – Applying heating pads or ice packs can decrease muscle spasms and inflammation.
- Massage – Gentle rubbing increases blood flow and relaxes tight back muscles.
- Stretching and light exercise – Yoga, walking and careful stretching maintain flexibility and strength.
- Posture correction – Sitting/standing with proper back support avoids extra strain.
Avoid extended bed rest, which may worsen back pain. Introduce normal activity gradually while avoiding movements that increase symptoms. See a doctor if self-care does not improve pain within a week or two.
When to consider surgery for back pain
Surgery for back pain has risks so doctors typically recommend it only if conservative treatment fails. Potential reasons for back surgery include:
- Herniated discs – Removal of disc fragments pressing on nerves.
- Spinal stenosis – Widening passages compressed by bone spurs or slipped vertebrae.
- Scoliosis – Rods and screws to straighten severe spine curvature.
- Spinal tumors – Removal of abnormal growths affecting spinal cord.
- Fractures/instability – Fusing unstable or collapsed vertebrae.
Symptoms that may lead your physician to consider surgery include intractable pain, inability to stand or walk, loss of bowel/bladder function and progressive leg weakness. Surgery aims to take pressure off damaged nerves causing these issues.
What alternative therapies help with back pain?
Complementary treatment approaches may provide pain relief and improve function when combined with standard medical care. Options to discuss with your provider include:
- Chiropractic – Spinal manipulation and mobilization to improve mobility.
- Acupuncture – Thin needle insertion in specific points to reduce pain.
- Massage – Hands-on deep tissue work to relax muscles.
- Yoga/tai chi – Gentle, focused movements to strengthen back and improve flexibility.
- Cognitive behavioral therapy (CBT) – Coping techniques to better manage pain.
Therapies like massage, yoga and CBT may also help treat chronic back pain related anxiety, depression and sleep issues. Acupuncture has the most evidence for effectively alleviating low back pain.
When to follow up with your doctor about back pain
You should schedule a follow-up medical appointment if:
- Symptoms last over 2 weeks with minimal improvement
- Severe pain interferes with normal daily tasks
- You experience worrying new symptoms like leg weakness
- Home treatment and over-the-counter medication do not help
- You have a history of spinal problems or osteoporosis
At your follow-up, your doctor can reassess your condition, order diagnostic imaging if needed and discuss additional pain relief options. Physical therapy or specialist referral may be recommended for certain patients based on exam findings.
Make sure to communicate how your symptoms are progressing, what makes pain better or worse and any limitations to your regular activities. This helps determine appropriate next steps.
How can I prevent back pain?
While anatomical vulnerabilities play a role, certain lifestyle factors also influence back pain risk. Steps to help avoid back problems include:
- Maintaining proper posture during sitting and standing
- Using good technique when lifting heavy objects
- Doing core-strengthening exercises like planks
- Stretching the back regularly, especially the hamstrings
- Wearing supportive, low-heeled shoes
- Quitting smoking and losing excess weight
- Treating medical conditions that affect bones and muscles
Even with preventive measures, some back pain may be unavoidable – especially as we age. Seek prompt medical care if you develop severe or prolonged symptoms.
Conclusion
Back pain is very common but also very treatable. Most acute pain resolves within several weeks using conservative self-care. See your doctor promptly for severe pain, neurological changes or other red flag symptoms. For chronic pain lasting over 3 months, pursue specialized medical evaluation and treatment to alleviate discomfort and restore function. With proper precautions and care, even serious back problems can often be managed effectively.
