If you are reading this, you are probably shifting in your chair right now, trying to find a comfortable position.
You aren’t alone. Lower Back Pain (LBP) is one of the most common reasons people walk into my clinic. In fact, nearly 80% of us will experience it at some point in our lives.
The good news? The vast majority of back pain is “non-specific.” That’s doctor-speak for “a muscular strain or sprain that hurts a lot but will get better on its own.”
However, sometimes back pain is a signal that something specific is going on inside the spine. As a doctor, my job isn’t just to treat the pain; it’s to interpret what the pain is trying to tell us.
Here is how I break down lower back pain, the “Red Flags” I look for, and what your specific symptoms might mean.
🚩 The “Red Flags”
When to See a Doctor Immediately
Before we talk about mechanical causes, we need to rule out the serious stuff. Most back pain is annoying, but safe. However, if your back pain comes with any of the following, please do not ignore it.
- The Age Factor: You are younger than 20 or older than 50 when the pain starts for the first time.
- The History: You have a history of cancer or malignancy.
- The “Night” Pain: Mechanical back pain usually gets better when you lie down. Pain that gets worse at night or wakes you up from sleep is a warning sign.
- The Trauma: The pain started after a fall, a car accident, or a heavy impact.
- The “Whole Body” Signs: You feel sick generally—unexplained weight loss, fevers, or night sweats.
Decoding Your Pain
What Is Your Back Trying to Say?
1. The “Morning Stiffness”
The Scenario: You wake up feeling like the Tin Man—stiff and sore. The pain is usually deep in the lower back.
The Trigger: Standing for a long time or leaning backward (extension).
Likely Cause: Facet Joint Pain
2. The “Shopping Cart” Sign
The Scenario: You feel fine sitting down. But when you walk, you get pain, numbness, or weakness in your legs.
The Relief: Leaning forward while walking—like leaning on a shopping cart.
Likely Cause: Spinal Stenosis
3. The “Young Person’s” Backache
The Scenario: Usually affects men under 40. Chronic pain and stiffness, but resting actually makes it worse.
The Relief: Exercise! Once you get moving, the pain improves.
Likely Cause: Ankylosing Spondylitis
4. The “It’s Not Actually Your Back” Pain
The Scenario: Cramping pain in calves/thighs when walking. Stops when you rest. Returns when you walk again.
The Cause: Poor blood flow to leg muscles, especially in smokers.
Likely Cause: Peripheral Arterial Disease (PAD)
📝 Interactive Checklist
Prepare for your Doctor’s Visit
Try to answer these three questions. This is exactly what I would ask you in the clinic.
The Doctor’s Advice
If your pain sounds like simple muscular strain (no leg pain, no red flags), keep moving. The old advice of “bed rest” is outdated. Gentle movement speeds up recovery.
However, for comfort while healing, here are tools I often recommend:
Disclaimer: I am a doctor, but I am not your doctor. This article is for educational purposes and does not replace a professional consultation. If you have Red Flags, please see a professional immediately.
