Common causes
- Muscle and ligament strain, often from posture, lifting, long hours at a desk or the wrong mattress
- Slip disc (disc herniation): the soft centre of a disc bulges out and can press on a nerve
- Sciatica: pain running from the back or buttock down the leg, usually from a nerve being pressed in the lower spine
- Spinal stenosis: narrowing of the spinal canal with age, causing leg pain on walking that eases on sitting or bending forward
- The same problems in the neck, with pain, tingling or weakness down the arm
Red flags
Numbness around the back passage or genitals, new difficulty passing or holding urine or stool, weakness in the legs that is getting worse, fever, unexplained weight loss, a history of cancer, or back pain after a serious fall or accident.
Treatment
Most back pain and sciatica improve within six to twelve weeks with:
- Staying active, with short rest only if needed
- Pain relief and medicines for nerve pain, as prescribed
- Physiotherapy and exercises to strengthen the core
- Correcting posture, workstation set-up and sleeping surface
An MRI is useful when pain does not settle, when there is weakness, or with any red flag. Surgery is considered when a nerve is clearly compressed on the MRI and there is weakness, or pain that has not improved despite proper treatment, or urgently when the nerves to the bladder and bowel are affected.
Dr Gupta’s advice
Dr Gupta’s clinic is a brain and spine clinic, and he talks about the everyday causes of back pain on his own videos: how a too-soft mattress or poor posture at work can be behind the pain, and what to change first. A consultation starts with your history and an examination, and the MRI only when it will change what is done.
Questions
Does a slip disc always need surgery?
No. Most slip discs and most sciatica get better without surgery within weeks to a few months. Surgery is for clear nerve compression with weakness, pain that does not settle despite proper treatment, or bladder and bowel problems.
Do I need an MRI for back pain?
Not usually at the start. An MRI is useful if pain does not improve after several weeks, if there is weakness or numbness, or with any warning sign such as bladder problems, fever or a history of cancer.
Can a mattress cause back pain?
It can contribute. A mattress that is too soft lets the spine sag through the night. Posture at work, long sitting and lack of exercise are also common causes.
About Dr Gupta
This page explains the condition in general terms and is written for patients and families. It is not a diagnosis. Decisions about treatment are made in consultation, with your scans. In an emergency, go to the nearest hospital emergency department.