Updated
Back pain is one of the most common reasons anyone sees any clinician. Most of it is musculoskeletal, most of it settles, and a small but important fraction of it is something else entirely. This page covers all three, starting with the part that matters most.
When back pain is an emergency
Most back pain is not urgent. These are the exceptions, and they are worth knowing before you read anything else on this page.
Seek emergency care now, not an appointment, 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
Do not wait for these to become obvious. Early bladder changes are easy to explain away, and with the nerve compression they can signal, the time to assessment is what matters.
Arrange prompt medical assessment, rather than 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 are reasons to panic and all of them are reasons to be seen by the right person first. If you tell us about one of them, that is what we will say.
Back pain that is not coming from the back
Some pain that a person reasonably describes as back pain is not musculoskeletal in origin. Kidney stones and urinary tract infections are the common examples: both can produce pain in the flank or lower back that feels like a back problem.
Stone pain is often described as coming in waves. Urinary infection often brings burning on urination or needing to go more often. These pictures overlap with each other and with mechanical back pain, and none of them is something to sort out yourself. Blood in the urine, and especially fever or chills alongside pain in the flank, need prompt medical assessment rather than an appointment here.
We do not treat kidney stones or urinary tract infections. Part of examining someone with back pain is working out whether the picture looks musculoskeletal or whether it does not, and when it does not, the right answer is a referral for medical evaluation rather than an adjustment.
The common musculoskeletal sources
Disc bulge and herniation. The discs between the vertebrae have a tougher outer ring and a softer centre. A bulge, where the disc extends broadly beyond its normal margin, and a herniation, where disc material is displaced through the outer ring, are different findings and the words are not interchangeable. Either may press on a nerve root, and pain can then travel into the buttock and leg, sometimes with pins and needles or numbness. What is seen on imaging does not by itself establish what is causing your symptoms: bulges and herniations are found on scans of people with no back pain at all, which is why the imaging has to be read against the examination. Read more on our disc injury page.
Restricted spinal joints. Subluxation in chiropractic generally refers to a perceived dysfunction in a spinal motion segment. It is not the same thing as a subluxation or dislocation in medical usage, and practitioners use the word differently from one another, which is worth knowing when you read it elsewhere.
Sprains and strains. Ligament sprains and muscle or tendon strains usually happen during something unfamiliar, or a lift combined with a twist. 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 from person to person.
Muscle tension associated with stress. Sustained stress goes along with sustained muscle tension, often across the upper back and neck, and tender spots in taut bands of muscle are a common finding on examination. That is a description of what gets found, not a claim that an adjustment resolves the stress causing it.
Choosing care and tracking progress
Start with the warning signs above, then ask what an examination would change about your next step. An X-ray or MRI is not automatically needed for an uncomplicated episode: NICE recommends against routine imaging in a non-specialist setting, with specialist imaging considered when the result is likely to change management.
Before agreeing to a plan, name the everyday activity you want back: sitting through a meeting, walking the dog, lifting at work or sleeping more comfortably. Ask how progress will be checked, when the plan will be reconsidered, and what would prompt a referral. Ask which movements to keep, which loads to adjust temporarily and how to build activity back up. The same guideline supports continued normal activity and exercise tailored to the person's needs and capabilities; it does not prescribe one stretch or a fixed number of visits for everyone.
What care here involves, and what it is aimed at
A first visit begins with a detailed history, taken by Dr. Jeff, Dr. Cindy or Dr. Allie, covering your health history, symptoms, concerns and goals. It then includes a comprehensive evaluation, and full-spine X-rays when those are clinically appropriate.
Manual care for back pain is aimed at pain, stiffness and movement. That is a narrower aim than these pages often describe, and it is the one that holds up.
A realistic assessment of the risk. Manual treatment of the spine is not risk-free. The most commonly reported effects are short-lived soreness or stiffness afterwards. Serious events are reported rarely. Rarely reported is not the same as rare. There is no systematic reporting system for adverse events after manual therapy, so published counts describe what has been written up rather than what has happened, and the true rate is not known.
The alternatives 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 are 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, surgical assessment is the route that answers it. Whether manual care belongs alongside any of these is an individual question rather than a general yes.
We will tell you what we find, including when what we find is not 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 you are dealing with back pain in Clarksville TN, call our team at Source Chiropractic.
Follow the evidence
Research, with context.
Published sources behind the discussion. Read the findings alongside the limits; a study is not a diagnosis or a promise of a result.
Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians
Adults with acute, subacute or chronic low-back pain considering noninvasive management.
What it foundThe guideline prioritizes non-drug options for chronic low-back pain, including exercise. Spinal manipulation is one of several options, supported by lower-quality evidence.
What it cannot tell usA guideline synthesizes evidence rather than reporting a new experiment. It does not establish disc realignment, a universal cure or superiority over all other care.
Publication details & citation
Qaseem et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine. 2017. DOI: 10.7326/M16-2367.
Read the publication recordSystematic literature review of imaging features of spinal degeneration in asymptomatic populations
33 studies reporting imaging findings in 3,110 people without symptoms.
What it foundDegenerative findings were common in people without pain and became more frequent with age. A scan needs interpretation alongside symptoms and examination findings.
What it cannot tell usThis does not mean every disc finding is harmless or that imaging is never needed. It cannot identify the cause of an individual patient’s pain.
Publication details & citation
Brinjikji et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 2015. DOI: 10.3174/ajnr.A4173.
Read the publication record
Read our editorial policy for how sources and clinical review are identified.