Back Pain Causes: What's Really Hurting

Back pain is the leading cause of disability worldwide, affecting 80% of adults at some point in their lives. The vast majority (approximately 90%) of acute back pain episodes are 'non-specific' — meaning no serious underlying cause — and resolve within 6–12 weeks with conservative management.

Common causes of low back pain include: muscle or ligament strain (most common — often from lifting, sudden movements, or poor posture), lumbar disc herniation ('slipped disc' compressing a nerve root, causing sciatica), facet joint degeneration (osteoarthritis), spinal stenosis (narrowing of the spinal canal, causing leg pain with walking), and sacroiliac joint dysfunction.

Red flags that require urgent evaluation include: pain following trauma or falls, fever with back pain (possible spinal infection or osteomyelitis), unexplained weight loss (possible malignancy), new bladder or bowel dysfunction (cauda equina syndrome — surgical emergency), saddle anesthesia (numbness around the groin), bilateral leg weakness or numbness, and cancer history with new back pain.

Evidence-based first-line treatment for non-specific low back pain: staying active (bed rest is harmful), NSAIDs for short-term pain relief, physiotherapy focused on movement and strengthening, and reassurance that most episodes resolve. Psychological factors (catastrophizing, fear-avoidance) are among the strongest predictors of chronicity and benefit from cognitive behavioral therapy.

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