What it is
Low back pain is extraordinarily common and usually self-limiting. It arises from discs, facet joints, muscles, ligaments or the sacroiliac joints, and in most episodes no single structure can be identified with confidence — which is not a failure of investigation, it is the nature of the problem.
The useful question is not "what does the MRI show" but "does what the MRI shows explain what you are actually feeling".
Symptoms
- Aching, stiffness or spasm across the lower back
- Pain worse with prolonged sitting, bending or lifting
- Morning stiffness that eases with movement
- Pain that stays in the back, rather than traveling below the knee
Red flags that warrant prompt assessment: pain following significant trauma, fever, unexplained weight loss, a history of cancer, night pain that wakes you, or any change in bladder or bowel control.
How it is diagnosed
History and examination first. Imaging is not automatically helpful early on — for uncomplicated back pain it frequently shows findings that are present in people without symptoms and can push treatment in unhelpful directions. X-rays showing alignment and movement, and MRI where there is leg pain, neurological change or a red flag.
Non-surgical treatment
This is where the great majority of low back pain is treated, and treated well. Staying active, structured physical therapy focused on the trunk and hips, weight and conditioning work, anti-inflammatories, and targeted injections where a specific pain generator has been identified.
When surgery is considered
For back pain alone, rarely. Surgery is considered where there is nerve compression causing leg symptoms, instability, deformity, or a structural problem that explains the pain and has not responded to sustained non-operative care. Dr. Long would rather tell you an operation is unlikely to help than perform one that disappoints you.