Low back pain is one of the most common reasons people see a doctor. About 8 out of 10 adults will have at least one episode at some point in their lives. The pain is usually felt along the lumbar spine and can worsen with bending, twisting, or even just sitting down. In many cases the muscles that support the back are the main source of the pain. Sometimes arthritis or a bulging disk irritates the nerve roots and that’s when patients notice symptoms like numbness, tingling, or weakness in the legs.

Sciatica is a well-known example. That’s when one of the nerve roots of the sciatic nerve is irritated, sending sharp, burning pain down the back or side of the thigh and often all the way to the ankle or foot. It may also come with numbness or tingling.

Most back pain gets better with conservative care, but there are times when patients should see a doctor right away. If someone over 70 suddenly develops back pain, if the pain persists at night even while lying down, or if it comes with weakness in the legs, loss of bladder or bowel control, unexplained fever, or weight loss, those are red flags. A history of cancer, osteoporosis, or a significant fall also raises concern. And if pain hasn’t improved at all after four weeks, it’s worth reevaluating.

Doctors usually start with a history and physical exam. Imaging tests like x-rays can pick up things such as compression fractures or alignment issues. CT or MRI scans are used when more detail is needed, especially to look at soft tissues, disks, or nerves. A bulging disk will often improve on its own over time as the body reabsorbs it, so surgery isn’t the first step unless there are severe symptoms.

Activity is important. Studies show patients recover faster when they keep moving. Staying in bed too long can actually make pain worse. Heat can ease stiffness in the first couple of weeks, and alternating ice and heat sometimes helps too. I usually encourage people to keep working if possible, but to avoid heavy lifting, prolonged standing, or twisting motions.

Medications have a role. Over-the-counter options like acetaminophen, ibuprofen, or naproxen can reduce pain and inflammation. Muscle relaxants such as cyclobenzaprine or baclofen may help in the short term, but they can cause drowsiness, so patients need to be cautious with driving or operating machinery. Narcotics are occasionally used but carry more risks and aren’t typically needed for most back pain.

Exercise is helpful once the pain begins to settle. Early stretching can sometimes aggravate symptoms, but as recovery progresses, a structured program that builds flexibility and strengthens core muscles supports long-term improvement. If pain lingers beyond four to six weeks, physical therapy is often recommended. Therapists focus on strengthening, posture, and mobility to reduce recurrences.

As an osteopathic physician, I sometimes use hands-on manipulation. By improving range of motion in restricted areas, it’s possible to break the cycle of stiffness and pain. Other approaches that can help certain patients include massage, yoga, acupuncture, injections, or even traction. Braces may be useful in select cases. Surgery is an option, but usually only when there’s severe nerve involvement or persistent symptoms that don’t respond to other treatments.

Prevention is key. Staying active, exercising regularly, and keeping the core muscles strong all help protect the back. Avoiding repetitive heavy lifting or twisting motions reduces strain. When lifting can’t be avoided, bending at the knees rather than the waist protects the spine. Stretching the hamstrings, quadriceps, piriformis, and gluteal muscles also supports spinal health.

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.