Back pain is one of the commonest reasons people seek medical care, and one of the most misunderstood. The overwhelming majority of back pain improves without surgery. What matters is a correct diagnosis: identifying the small group of patients with nerve compression or a structural problem, and giving everyone else a clear, practical, non-surgical plan.
Common causes of back pain
Muscular strain and poor posture are the most frequent causes, especially with long desk hours. Other causes include disc degeneration, herniated (slipped) discs, lumbar canal stenosis, spondylolisthesis, and — rarely — infection, fracture or tumour. Each has a distinct pattern that a careful history and examination can reveal.
Red flags: when back pain needs urgent attention
Seek prompt medical attention if back pain is accompanied by leg weakness or foot drop, numbness in the inner thighs or around the buttocks, any change in bladder or bowel control, fever, unexplained weight loss, or a history of cancer or significant trauma. These red flags need urgent evaluation.
Evidence-based non-surgical treatment
For most patients the plan includes: staying active rather than bed rest, a graded physiotherapy and core-strengthening programme, posture and workstation correction, weight management, and short, sensible use of pain medication. Passive treatments alone rarely give lasting relief — active rehabilitation does.
When back pain does need a surgeon
Surgery has a role when back pain comes with clear nerve compression on MRI matching persistent symptoms — such as sciatica from a herniated disc or claudication from canal stenosis — after reasonable conservative care has failed, or when red-flag conditions are found. In those cases, minimally invasive and endoscopic options are considered first.