Lower back pain: common causes, red flags and which doctor to see

Lower back pain is one of the most common health problems in the world. It can feel frightening, especially when it comes on suddenly. Most of the time, though, it is not caused by anything serious and gets better within a few weeks. This article explains the common causes, the warning signs that mean you need care quickly, and which kind of doctor can help.

What is lower back pain?

The World Health Organization (WHO) describes low back pain as pain between the lower edge of the ribs and the buttocks. It can be a dull ache or a sharp pain. It can also spread into the legs, cause stiffness, and affect sleep and mood.

Doctors often group back pain by how long it has lasted:

Acute (short-term) pain lasts from a few days to a few weeks.
Chronic (long-term) pain lasts more than 3 months.

How common is it?

According to WHO, low back pain affected about 619 million people worldwide in 2020. It is the leading cause of disability in the world. Most people get it at least once in their life.

In Bangladesh, a national survey of adults carried out in 2015 (published in BMJ Open in 2022) found that about 18.5% of adults had low back pain. It was more common in women (about 27%) than in men (about 14%).

Common causes

WHO says that about 90% of low back pain is non-specific. This means doctors cannot find a particular disease or problem in the spine that explains the pain. Even so, this kind of pain is real, and for most people it gets better.

Everyday causes

Muscle or ligament strain: a pulled muscle, or a stretched or torn ligament (the tough tissue that holds bones together). This can happen after a sudden movement or injury.
Stress, anxiety and low mood, which can play a part in back pain.

Problems in the spine

Slipped (herniated) disc: a problem with one of the soft cushions between the bones of the spine, which can press on nerves.
Sciatica: pain from an irritated or trapped nerve, which can spread down the leg.
Spinal stenosis: narrowing of the space inside the spine.
Ankylosing spondylitis: an inflammatory condition that affects the spine.

Pain coming from somewhere else

WHO notes that sometimes pain felt in the lower back is spreading from another part of the body. This is one reason a doctor may need to examine you.

Rare but serious causes

Very rarely, back pain is a sign of a serious problem such as a broken bone in the spine, an infection, or cancer. NHS clinical guidance says a serious spinal cause is found in around 1 in 100 doctor visits for back pain.

Warning signs: get urgent care

Go to a hospital emergency department straight away if you have back pain together with any of these:

New difficulty passing urine, or leaking urine or stool without control.
Numbness or tingling around the genitals, anus or buttocks. For example, you cannot feel the toilet tissue properly when you clean yourself.
Pain, tingling, numbness or weakness in both legs, or new difficulty walking.
Changes in sexual function, such as loss of feeling or new trouble getting an erection.
Back pain that started after a serious fall, road accident or other injury.
Back pain together with chest pain.

Do not drive yourself. Ask someone to take you, or call an ambulance.

The first four signs can point to cauda equina syndrome. This is a rare but serious condition in which the nerves at the bottom of the spine are squeezed. It needs emergency care to prevent permanent damage. Do not wait to see if it gets better.

Get an urgent doctor’s appointment (the same day if you can) if you have back pain and:

fever, chills or you feel generally unwell
severe pain that started suddenly or is getting worse quickly

See a doctor soon if you have back pain and:

pain that does not get better with rest, or is worse at night
weight loss without trying
a lump or swelling on your back, or your back has changed shape
a past history of cancer or tuberculosis (TB), or a condition or treatment that weakens your immune system
it is your first episode of back pain and you are under 20 or over 55

When to see a doctor for less urgent pain

Book a normal appointment if the pain:

has not improved after a few weeks of looking after yourself
stops you doing your daily work or household tasks
spreads down one leg, with numbness or pins and needles
is making you worried, or you are struggling to cope

What you can do in the meantime

If you have none of the warning signs above, health services such as the NHS and MedlinePlus advise:

Stay as active as you can. Bed rest is not recommended. You may need to cut down your activity for the first couple of days, then slowly return to your usual activities.
Gentle activity such as walking can help.
Heat or cold packs may ease the pain. Do not put them directly on the skin.
Avoid heavy lifting and twisting while the pain settles.
Ask a pharmacist or doctor before taking any painkiller. Some painkillers are not suitable for everyone, for example people who are pregnant or who have asthma or a stomach ulcer.

How doctors assess and treat back pain

The doctor will ask about your pain, such as where it is, how often it happens and how bad it is, and will examine you, including checking the nerves in your legs. Most people do not need an X-ray or MRI scan. Scans often do not show the cause of the pain. A scan may be needed if the doctor suspects a serious problem. For example, suspected cauda equina syndrome needs an emergency MRI scan.

Treatment depends on the cause, and your doctor will decide what suits you. For long-term back pain that is not caused by another disease, WHO’s 2023 guideline recommends care that does not involve surgery, such as:

education and advice
structured exercise programmes
some physical (hands-on) therapies, such as massage or spinal manipulation
psychological therapies, and in some cases certain medicines

WHO also advises against some treatments as routine care for long-term back pain, including opioid painkillers. The NHS says that sometimes surgery may be needed.

Which doctor should you see?

Situation	Who to see
New back pain, no warning signs	A general practitioner (GP) or medicine doctor, who can assess you and refer you if needed
Pain that lasts or keeps coming back, stiffness, trouble moving	A physical medicine and rehabilitation specialist (physiatrist), or a physiotherapist for an exercise plan
Injury, fracture, disc or bone problems	An orthopaedic surgeon (bone and joint specialist)
Leg weakness, numbness or nerve pain (sciatica)	A neurologist, or a neurosurgeon or spine surgeon if there may be nerve compression
Possible ankylosing spondylitis or other inflammatory arthritis	A rheumatologist (specialist in arthritis and inflammatory joint conditions)
Fever or feeling generally unwell with back pain	A medicine doctor, urgently
Back pain in pregnancy	A gynaecologist and obstetrician
Any emergency warning sign	The emergency department of the nearest hospital, immediately

Getting advice by phone in Bangladesh

The government health call centre, Shasthyo Batayon (16263), run under the Ministry of Health and Family Welfare, gives health advice from doctors, 24 hours a day. If you have any of the emergency warning signs above, do not wait on the phone. Go straight to a hospital.

Preventing back pain

Exercise regularly, including exercises that strengthen your stomach and core muscles.
Lift carefully: bend your knees, keep the load close to your body, do not bend forward as you stand up, and get help with heavy or awkward items.
Do not sit for too long. Change position regularly and take breaks to walk around.
Keep a healthy weight and stop smoking.
Find ways to relax, such as yoga.

This article is for general information only and does not replace advice from a doctor who has examined you.

Find a doctor

Browse Orthopedic doctors in Bangladesh on ratings.com.bd, with chambers and, where listed, visiting hours and phone numbers.

Sources

This article is general information, not medical advice. It was written by AI from the sources above. It did not pass the automatic check, and an administrator chose to publish it; no doctor or editor has reviewed it. For a diagnosis or treatment, see a registered doctor.