PATIENT EDUCATION
Spine / Back
Back problems are extremely common and most are not caused by serious disease. Select the symptom that most closely describes what you are experiencing to learn about common causes, initial measures and when medical assessment may be needed.
A Note on Treatment — Before You Read Further
Fear of surgery keeps many people away from the clinic for months or years with back pain. That fear is worth setting aside, because it doesn't reflect how back problems are actually treated.
The large majority are managed entirely without an operation — through staying active, physiotherapy and structured exercise, medication and, in selected cases, a targeted injection. Injections tend to be most useful where pain is travelling down the leg from a compressed nerve, rather than for general back ache.
Surgery is reserved for a small minority: mainly significant or progressive nerve compression, the emergency features described below, or symptoms that haven't settled after a genuine trial of conservative treatment.
Seeing someone early usually improves your chances of staying on the non-surgical path. Early problems respond well to simple measures, whereas nerve compression left for a long time becomes harder to reverse.
Coming in early is not the first step toward an operation. More often, it's what prevents one.
Select a symptom below to view more information.
Low Back Pain
What you'll notice or feel
- Aching or stiffness across the lower back, sometimes spreading into the buttocks.
- Pain that worsens with prolonged sitting, standing or bending.
- Difficulty straightening up after being bent over.
- Muscle tightness or spasm across the lower back.
Common causes
- Muscle or ligament strain, often from lifting, twisting or an awkward movement.
- Age-related wear of the discs and small joints of the spine.
- Prolonged poor posture or sustained positions.
- Deconditioning of the core and back muscles.
What it could be
- Ordinary mechanical back pain from muscle and ligament strain — by far the most common cause and usually improving within weeks.
- Age-related disc and joint wear (lumbar spondylosis).
- Irritation of the small joints at the back of the spine (facet joint pain), often worse when leaning backward.
- A vertebral compression fracture, particularly in older adults or people with weak bones.
- Rarely, infection, inflammatory disease or a spinal lesion.
Initial self-care
- Stay active — prolonged bed rest tends to slow recovery rather than help.
- Gentle movement and walking within comfort.
- Apply heat to tight muscles.
- Use over-the-counter pain relief if appropriate, as per the label.
- Gradually return to normal activity rather than waiting for complete pain resolution.
When to see a doctor urgently
- Difficulty controlling your bladder or bowels, or numbness around the saddle area.
- New leg weakness or difficulty walking.
- Back pain following significant trauma, or even a minor fall in someone with known weak bones.
- Back pain with fever, unexplained weight loss or night sweats.
- Severe unrelenting pain that is not eased by any position, particularly at night.
When to see a doctor
- Pain persisting beyond 4–6 weeks despite staying active and self-care.
- Pain that keeps recurring.
- Pain limiting work or normal daily function.
Leg Pain Radiating From the Back (Sciatica)
What you'll notice or feel
- Pain travelling from the lower back or buttock down the back or side of the leg.
- Pain following a defined line down the leg rather than being diffuse.
- Pain that may extend below the knee and sometimes into the foot.
- Coughing, sneezing or straining may sharply worsen the pain.
Common causes
- A bulging or herniated disc pressing on a nerve root.
- Bony narrowing around the nerve exit points from wear and tear.
- Narrowing of the spinal canal.
- Muscle tightness in the buttock irritating the nerve in some cases.
What it could be
- Lumbar radiculopathy or sciatica — usually from a disc bulge and often improving over weeks to months.
- Spinal stenosis, often producing leg symptoms while walking that improve with sitting or leaning forward.
- Irritation of the nerve as it passes through the buttock muscles.
- Referred pain from the hip or sacroiliac joint, which can mimic sciatica.
Initial self-care
- Stay as active as comfort allows — complete rest generally isn't helpful.
- Find positions that ease the pain and use them for temporary relief.
- Prefer gentle walking and movement to prolonged sitting.
- Use over-the-counter pain relief if appropriate, as per the label.
When to see a doctor urgently
- Bladder or bowel control problems, or numbness around the saddle area.
- New or progressive leg weakness, foot drop or difficulty walking.
- Pain affecting both legs simultaneously.
- Severe, unrelenting pain not eased by any position.
When to see a doctor
- Leg pain persisting beyond 4–6 weeks.
- Pain significantly disturbing sleep.
- Numbness that remains persistent even if it is not worsening.
Leg Numbness, Tingling or Weakness
What you'll notice or feel
- Pins-and-needles or numbness in part of the leg or foot.
- A specific pattern following a line down the leg rather than involving the whole leg.
- Difficulty lifting the front of the foot, causing it to slap or catch when walking.
- Weakness climbing stairs, standing from a chair or pushing off when walking.
Common causes
- Nerve-root compression in the lower back from a disc or bony narrowing.
- Narrowing of the spinal canal affecting multiple nerve roots.
- Nerve compression further down the leg, at the knee or ankle.
- Generalised nerve damage from diabetes or other metabolic causes.
What it could be
- Nerve-root compression affecting sensation and muscle power.
- Spinal stenosis, producing leg heaviness or numbness during walking that improves with sitting or leaning forward.
- Compression of a nerve near the outer knee causing difficulty lifting the foot.
- Peripheral neuropathy from diabetes or another metabolic condition.
- Rarely, cauda equina syndrome — a surgical emergency.
Initial self-care
- Note exactly which part of the leg or foot is affected and whether it is improving, static or worsening.
- Avoid activities that would be unsafe with a weak leg or foot.
- Genuine weakness should not simply be monitored at home for a prolonged period — arrange medical assessment.
When to see a doctor urgently
- Any bladder or bowel control change, or saddle-area numbness.
- New or progressive leg weakness, or a foot that drags or slaps when walking.
- Numbness affecting both legs.
- Rapidly worsening symptoms.
When to see a doctor
- Numbness persisting beyond a couple of weeks.
- Numbness that is stable but affecting daily function.
- Symptoms during walking that consistently improve with sitting.
Stiffness / Reduced Range of Motion
What you'll notice or feel
- Difficulty bending forward, arching backward or twisting.
- Stiffness that is worst in the morning and eases as the day progresses.
- Trouble putting on socks or picking things up from the floor.
- A feeling that the back does not move as freely as it once did.
Common causes
- Age-related wear of the discs and small spinal joints.
- Muscle tightness and deconditioning.
- An underlying inflammatory spinal condition, particularly in younger adults.
- Stiffness following a previous injury or period of reduced activity.
What it could be
- Age-related spinal wear (spondylosis).
- Muscle tightness and deconditioning.
- An inflammatory spinal condition such as ankylosing spondylitis, particularly with prolonged morning stiffness, younger age at onset and improvement with exercise rather than rest.
- Stiffness following a previous vertebral fracture or injury.
Initial self-care
- Regular gentle mobility exercises through a comfortable range.
- Heat before activity to ease stiffness.
- Core and back strengthening once acute pain settles.
- Avoid prolonged sitting — regular changes of position are generally more helpful than rest.
When to see a doctor urgently
- Sudden marked loss of movement with severe pain.
- Stiffness associated with fever or feeling generally unwell.
- Stiffness following significant trauma.
When to see a doctor
- Morning stiffness lasting more than an hour, particularly in a younger adult.
- Stiffness persisting beyond a few weeks and limiting daily tasks.
- Progressive loss of spinal movement over time.
⚠ Bladder / Bowel Change or Saddle Numbness — URGENT
What you'll notice or feel
- Difficulty starting or stopping urination, or not being able to tell when your bladder is full.
- Loss of bladder or bowel control, or new incontinence.
- Numbness around the inner thighs, buttocks, genitals or back passage — the area that would contact a saddle.
- Back pain accompanied by symptoms affecting both legs.
- Sometimes new sexual dysfunction.
Common causes
- Compression of the bundle of nerves at the base of the spine, most commonly from a large disc herniation.
- Less commonly, a spinal lesion, infection or bleeding compressing these nerves.
- Severe narrowing of the spinal canal.
What it could be
- Cauda equina syndrome — compression of the nerve bundle at the base of the spine. This is a surgical emergency because delayed treatment can result in permanent bladder, bowel, sexual or neurological problems.
- Spinal cord or nerve compression from a lesion or infection.
- Other rare causes of acute nerve compression.
What you should do
- There is no appropriate self-care or wait-and-see period for these symptoms.
- Do not wait for a routine appointment and do not wait until the following morning.
- Go to an emergency department immediately.
YOUR CONSULTATION
What to Expect at Your Visit
- The doctor will ask how the pain started, where it travels, what makes it better or worse, and will specifically ask about warning symptoms including bladder and bowel function.
- You'll be examined for spinal movement and tenderness and, if there are leg symptoms, leg strength, reflexes, sensation and nerve-tension signs.
- Your hips and walking pattern may also be assessed because hip problems can sometimes mimic back-related leg pain.
- Imaging is often unnecessary for ordinary mechanical back pain during the first few weeks. When warning features, persistent nerve symptoms or lack of improvement make imaging appropriate, MRI is usually the main investigation. X-rays may be useful when fracture or alignment problems are suspected.
- Management ranges from staying active, physiotherapy and structured exercise to medication and selected injections. Surgical referral is required only for a minority with significant nerve compression, emergency features or selected persistent structural problems.
* IMPORTANT: A Note Before You Go
Most episodes of back pain improve without surgery. The presence of pain — even significant pain — does not by itself mean that an operation will be necessary.
This page covers common patterns of back and spine symptoms and cannot replace an individual medical assessment. New weakness, bladder or bowel changes, saddle-area numbness or rapidly worsening neurological symptoms require urgent medical assessment.