Low back pain – Part 1: Causes and prevention 

When to see the doctor for low back pain

Since back pain is so common, you may wonder when to make an appointment with your family doctor. If you think you have a muscle strain, but it lasts longer than a week or happens over and over, you should call your primary care provider. If you have leg muscle weakness or numbness, numbness in the groin, or if you lose control of your bladder or, conversely, cannot urinate, you should not wait to make an appointment. Back pain can have many different causes, even infection or cancer, so don't hesitate to call for an appointment for pain that is severe, debilitating, worse when lying down, associated with fever, due to trauma (like a fall) or not getting better despite simple measures.

What happens at the primary care provider's office?

Typically, the healthcare provider will listen to your description of the pain, then examine you. He or she may feel for tenderness in the back, check the motion of your spine, test the strength and sensation in the legs as well as your reflexes at the knees and ankles, and perform some special maneuvers to verify the cause of your pain.

Sometimes, x-rays are needed, but not usually at the first visit. An MRI of the spine is needed even less often, and most doctors don't order an MRI unless a pinched nerve is suspected and you are not responding to the usual treatment regimen. A nerve conduction study is another test for a pinched nerve, which can also be helpful if pain doesn't respond to treatment.

When should I see a specialist?

Back pain that does not improve with time, medication and PT may need further evaluation or treatment by a specialist. Your primary care provider might recommend one of a few different types of specialists:

• A physiatrist or a neurologist can perform a specialized test, called a nerve conduction study, which looks for evidence of a pinched nerve.
• A pain management specialist can perform epidural steroid injections, which inject the anti-inflammatory medication into the spine, near the pinched nerve, in order to improve pain. They sometimes perform other types of injections, like trigger point injections or facet joint injections, if there is a muscle or an "arthritis" problem in the back that is causing the pain.
• A spine surgeon can operate on the spine to alleviate the symptoms.

Seeing a specialist can also be helpful if the cause of your back pain isn't clear after testing and initial treatment. After all, there are many causes of back pain other than the two that we discuss here.

Next – Part 3: Treatment and resources