At a glance
What it is
Pain in the lower back — mechanical, disc-related, or (rarely) systemic.
When to be seen
Pain lasting more than three days, or any leg pain, numbness, or weakness.
How we treat it
Assessment first, then a stepped plan: activity, physiotherapy, targeted injection, surgery only when indicated.
Why most back pain doesn't need a scan
Eight in ten people will have back pain at some point in life. In most cases the pain is mechanical — muscle, ligament, or disc origin — and resolves within days to a few weeks with movement and simple analgesia.
Imaging the low back too early is a common mistake. MRI scans find changes in almost every adult over forty; treating the scan rather than the patient leads to unnecessary procedures. The first appointment is a clinical examination — imaging is ordered only when the history or exam raises a specific concern.
When back pain is a red flag
A small subset of back pain has a serious underlying cause and needs urgent assessment. Any of the following warrants same-week evaluation: pain following significant trauma, unexplained weight loss, night pain that wakes you, fever, saddle-area numbness, difficulty passing urine, or progressive leg weakness.
Leg pain, numbness, or weakness — with or without back pain — points to nerve root involvement and shifts the assessment away from muscle-and-ligament territory towards disc or spinal stenosis.
Two common presentations
Most patients arrive with one of two patterns. The distinction shapes both the examination and the treatment plan.
Pattern 1
Mechanical low back pain
- Pain localised to the lower back, worse with movement, better with rest.
- No leg symptoms, no red flags.
- Typically settles within 2–6 weeks with activity + physiotherapy.
Pattern 2
Radicular pain (sciatica)
- Pain radiates down one leg, sometimes with numbness or weakness.
- Usually a disc herniation compressing a nerve root.
- Most improve without surgery over 6–12 weeks; injection can accelerate that.
What we see in clinic
80%
Adults affected by back pain at some point in life
90%
Resolve within six weeks with conservative care
5%
Require surgical evaluation on first review
Key facts
How it is treated
Care is stepped: start conservative, escalate on evidence, reserve surgery for defined indications. Most patients never reach the last group.
Movement first
Days 1 to 14
- Stay active; avoid prolonged bed rest
- Simple analgesia if needed
- Heat, gentle stretching
- Return to work as tolerated
Physiotherapy
Weeks 2 to 8
- Assessment of posture, movement, and core strength
- Targeted exercise programme
- Manual therapy where appropriate
- Ergonomic and work advice
Interventional pain
When conservative care stalls
- Epidural steroid injection (interlaminar or transforaminal)
- Facet joint injection
- Radiofrequency ablation for confirmed facet pain
- Sacroiliac joint injection
Surgery
Defined indications only
- Progressive neurological deficit
- Cauda equina syndrome (emergency)
- Persistent radicular pain unresponsive to 6+ weeks of care
- Instability or structural deformity
The plan is written and given to the patient and the referring clinician at the end of the first visit.
Watch the procedure
Related reading
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Widespread muscle pain that routine scans don't explain. Most of it comes from muscle and fascia, and is treatable once the source is found.
Acoustic neuroma
A slow-growing, non-cancerous tumour of the hearing and balance nerve. Treatment ranges from monitoring to microsurgery, depending on its size and effects.
Book a consultation
The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.
This page provides general information about back pain and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.