It is estimated that 80 percent of individuals experience low back pain in their lifetime. At any point of time, about 15% of individuals report that they are having low back pain.

We are reminded of the saying that ‘common things occur commonly’. While it is true that back pain may be caused by sinister things like infection or tumour, generally by far the most common causes of back pain are injury or mechanical irritation of the tissues. Injury may occur as a single episode of trauma, say due to a fall or lifting of a heavy object, or more often, injury is due to repetitive stress in the form of repeated overstretching or compression. Repetitive Stress Injury (RSI) can occur due to prolonged sitting, driving and repeated lifting of even light objects. The RSI may involve muscles, tendons, ligaments, facet joints and intervertebral discs.

While it is natural that most patients and indeed doctors want to know the exact cause of back pain, it is more pertinent to approach the problem by asking the question “Is the condition likely to be self limiting or is there something more sinister causing the pain?”

I reassert that a vast majority of back pain is due to injury or mechanical irritation. In these cases, sufficient rest, a simple course of analgesics is sufficient to treat the condition. The key point is that most conditions are self limiting, and all that needs to be done is to reduce discomfort and pain while waiting it out.

However, there are certain symptoms and signs, which should alert a patient to seek medical evaluation early rather than ‘to wait it out’. These include symptoms or signs described as red flags and some of these are listed below:

1. Recent significant trauma
2. Fever
3. Loss of appetite or weight
4. Pain that wakes a patient from sleep
5. Associated pain, numbness or weakness in the legs
6. Disturbance of bladder or bowel function
7. A history of malignancy
8. An immunosuppressed patient
9. Pain that persist despite analgesia

Pain that persist more than 6 weeks duration is in itself, an indication to seek professional evaluation.

Assuming that ‘red flag symptoms’ are not present, it is reasonable for patients to just take general precautions, modify activity and take simple analgesics such as paracetamol  while waiting for symptoms to resolve. Bed rest is important in the acute phase and usually extends for a few days. When the pain reduces, the patient is advised to resume activity as tolerated. This is preferred to excessive immobilisation and rest. Activity modification would entail avoiding activities that exacerbate pain, which most commonly are lifting of heavy objects and prolonged sitting.

Looking into the ergonomics at work, and at rest can play an important part in back care especially when it comes to reducing the risk of recurrence.