Back pain, most of it ordinary and some of it not

Back pain is one of the most common reasons people see a doctor of any kind. Most of it is musculoskeletal, meaning it comes from the muscles, joints and discs of the back, and most of it settles. A small but important share is something else entirely, and a few kinds of back pain are emergencies.

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When is back pain an emergency?

Most back pain isn't urgent. These are the exceptions, and they're the part of this page to read first.

Seek emergency care now (call 911 or go to an emergency room), not an appointment with us, if back pain comes with any of the following:

• any new change in bladder function: difficulty starting or stopping the stream, difficulty emptying, not being able to urinate, not feeling the need to go, or leaking without knowing it
• loss of control of your bowels, or any new numbness in the area that would contact a saddle
• new loss of sexual function
• weakness in one or both legs that is getting worse
• sudden severe tearing pain in the back or abdomen, particularly if you are older or have a known aneurysm

Don't wait for these to become obvious. Early bladder changes are easy to explain away. They can signal pressure on the nerves, and when they do, how quickly you're assessed is what matters.

Get a prompt medical assessment instead of starting manual care if you have:

• fever alongside back pain, or back pain following a recent infection or procedure
• a weakened immune system, injecting drug use, or a long course of steroids, each of which raises the risk of spinal infection
• back pain after a fall or collision, and after even a minor injury if you have osteoporosis or are older
• a history of cancer, unexplained weight loss, or pain that is worse at night and does not ease with a change of position

None of these is a reason to panic. Each one is a reason to see the right person first, and if you mention one to us, that's exactly what we'll tell you.

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Could your back pain be coming from somewhere else?

Some pain that feels like back pain doesn't come from the muscles and joints at all. Kidney stones and urinary tract infections are the common examples: both can cause pain in the flank or lower back that feels like a back problem.

Stone pain is often described as coming in waves. A urinary infection often brings burning when you urinate, or needing to go more often. These pictures overlap with each other and with ordinary mechanical back pain, and none of them is something to sort out on your own. Blood in the urine, and especially fever or chills with pain in the flank, need a prompt medical assessment, not an appointment with us.

We don't treat kidney stones or urinary tract infections. Part of examining anyone with back pain is working out if the problem looks like a muscle-and-joint one. When it doesn't, the right answer is a referral for a medical evaluation, not an adjustment, and that's what we'll give you.

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What causes most back pain?

A bulging or herniated disc. The discs between your vertebrae have a tough outer ring and a softer center. A bulging disc spreads broadly past its normal edge. A herniated disc is one where disc material has pushed out through the outer ring. They are different findings, and the words aren't interchangeable. Either one may press on a nerve root, and then pain can travel into the buttock and leg, sometimes with pins and needles or numbness. A scan finding doesn't, on its own, show what's causing your pain. Bulges and herniations turn up on scans of people with no back pain at all, which is why imaging has to be read against the exam. Our disc injury page goes into more detail.

Restricted spinal joints. When chiropractors say subluxation, they generally mean a perceived dysfunction in a spinal motion segment: a joint in the spine that isn't moving well. Medical doctors use the same word differently, closer to a partial dislocation, and practitioners don't all use it the same way either, so it can mean something different depending on where you read it.

Sprains and strains. Ligament sprains and muscle or tendon strains usually happen during something unfamiliar, or a lift with a twist in it. Pain, swelling and bruising are typical. For uncomplicated acute low back pain, clinical guidelines encourage staying as active as you can manage and advise against bed rest. How long recovery takes varies a lot from one person to the next.

Muscle tension that comes with stress. Long stretches of stress tend to go along with long stretches of muscle tension, often across the upper back and neck, and tender spots in tight bands of muscle are a common exam finding. The stress behind that tension is its own problem, and an adjustment won't make it go away.

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Do you need an X-ray or MRI for back pain?

Not automatically. For an uncomplicated episode, NICE, which writes the clinical guidelines for England's NHS, recommends against routine imaging in a non-specialist setting, with specialist imaging considered when the result is likely to change management.

For an ordinary episode of back pain, what matters is specific to you: which movements to keep, which loads to ease off for a while, and how to build activity back up. The same guideline supports continued normal activity and exercise fitted to each person's needs and capabilities. It doesn't prescribe one stretch, or a fixed number of visits, for everyone.

What does chiropractic care for back pain involve here?

Your first visit for low back pain starts with a detailed history. You'll sit down with Dr. Jeff, Dr. Cindy or Dr. Ali and go over your health history, your symptoms, your concerns and your goals, such as sitting through a meeting, walking the dog, lifting at work or sleeping more comfortably. Then comes a full evaluation, with full-spine X-rays when they're clinically appropriate. After we've gone over the findings, we'll recommend a plan built around your condition and those goals.

Our manual care for back pain is aimed at three things: pain, stiffness and how well your back moves.

The risks, as plainly as we can put them. Manual treatment of the spine isn't risk-free. The effects reported most often are short-lived soreness or stiffness afterward. Serious events are reported rarely. Rarely reported isn't the same as rare. There's no systematic reporting system for adverse events after manual therapy, so published counts show what's been written up, not everything that's happened, and the true rate is not known.

The other options are real, and some are strong. Staying active, graded exercise and strength work, and time itself account for a great deal of recovery from an ordinary episode of back pain, and they're the best-supported first line. Medical management can address pain well enough to let you move. Physical therapy adds supervised exercise and progression. For the small number of people whose pain is driven by something a scan and a surgeon need to see, a surgical assessment is the route that answers it. Manual care can sit alongside any of these, or not, and that comes down to your back and what the exam finds. There's no blanket answer.

We'll tell you what we find, including when what we find isn't something we treat. If we are not able to help you with your problem or are unable to reduce your pain levels, we will make sure to give you a recommendation to another experienced provider.

If none of the warning signs above fit and your back just won't loosen up, a first visit in Clarksville is where we start working out what's behind it.