Back Pain

Back pain is one of the most common reasons people seek medical advice. It can range from a mild ache to severe pain that limits movement and daily activities. Back pain may come on suddenly after a strain, or develop gradually over time due to posture, degeneration, or underlying conditions.

Most back pain is not caused by anything serious and improves with the right combination of advice, movement and treatment. However, some symptoms require prompt assessment.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment to identify the likely cause of your back pain and recommend a clear treatment plan tailored to your needs.

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Types of Back Pain

Back pain is often grouped by where it occurs and how long it has been present:

By location

• Lower back pain (lumbar pain) – the most common type
• Mid back pain (thoracic pain)
• Upper back pain (cervical/upper thoracic region) – sometimes linked to neck and shoulder tension

By duration

• Acute back pain – lasts days to weeks
• Subacute back pain – lasts 6–12 weeks
• Chronic back pain – lasts longer than 12 weeks

Back pain with leg pain (sciatica-type symptoms)

Sometimes back pain is associated with irritation of a nerve root, causing pain that travels into the buttock, leg or foot. This is often called sciatica or radicular pain.

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Common Causes of Back Pain

Back pain can have many causes. Common examples include:

• Muscle or ligament strain (often after lifting, twisting, or sudden movement)
• Poor posture and prolonged sitting (especially desk work)
• Disc-related problems (bulging or slipped disc)
• Degenerative changes in the spine (wear and tear over time)
• Arthritis affecting the spine joints
• Spinal stenosis (narrowing of the spinal canal, more common with age)
• Sciatica / nerve root irritation
• Sacroiliac joint dysfunction
• Osteoporosis-related fractures (particularly in older adults)
• Pain referred from other areas (less common)

In a small number of cases, back pain may be linked to a more serious underlying cause, which is why assessment is important if symptoms are severe, persistent, or unusual.

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Symptoms of Back Pain

Back pain symptoms vary, but may include:

• A dull ache or stiffness in the back
• Sharp pain with movement or certain positions
• Pain that worsens after sitting or standing for long periods
• Reduced flexibility and difficulty bending or twisting
• Muscle spasms or tightness
• Pain that travels into the buttock or leg
• Numbness or tingling in the leg or foot (if a nerve is irritated)
• Pain that interferes with sleep or daily activities

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Diagnosis at Royal Buckinghamshire Hospital

Assessment aims to identify the most likely cause and rule out signs that need urgent treatment. Your consultant may:

• Discuss symptoms, triggers, activity levels and medical history
• Examine posture, movement, muscle strength and reflexes
• Assess nerve function if you have leg pain, tingling or weakness
• Recommend investigations where appropriate, such as:
  • X-ray (for bone/joint assessment)
  • MRI scan (for discs, nerves, and spinal structures)
  • Blood tests in specific circumstances

Many cases of back pain do not require imaging, but it may be recommended if symptoms are persistent, severe, or there are signs of nerve involvement.

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Treatment & Management

Treatment depends on the cause, severity and duration of your symptoms. Your consultant will recommend a plan focused on pain relief, mobility and long-term prevention.

Self-care and early management

For many patients, the most effective early steps include:

• Staying as active as possible within your comfort level
• Gentle walking and stretching
• Avoiding prolonged bed rest
• Heat packs to ease muscle tension
• Short-term activity modification while symptoms settle

Medication and pain relief

Your clinician may recommend medication to help manage pain and improve function, tailored to your situation.

Physiotherapy and rehabilitation

Physiotherapy is often key for recovery and prevention, focusing on:

• Strengthening core and back muscles
• Improving flexibility and posture
• Manual therapy where appropriate
• Advice on lifting technique and movement confidence
• A home exercise programme to reduce recurrence

Specialist treatments (when needed)

If symptoms persist or there is nerve involvement, your consultant may discuss:

• Further investigations such as MRI
• Referral to a specialist for spinal assessment
• In some cases, targeted injections or interventional pain management options

Surgery is only required in a small proportion of back pain cases, typically where there is significant nerve compression or specific structural problems.

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When to seek urgent help

Seek urgent medical advice if you experience back pain with any of the following:

• Loss of bladder or bowel control
• Numbness around the groin or buttocks (saddle numbness)
• Severe or worsening weakness in one or both legs
• Fever, unexplained weight loss, or feeling very unwell
• Severe pain after a significant fall or injury
• Back pain with a history of cancer
• Constant pain that does not improve with rest, particularly at night

These symptoms may require urgent assessment.

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If you are experiencing back pain that is persistent, affecting your mobility, or associated with nerve symptoms such as tingling or weakness, contact Royal Buckinghamshire Hospital for assessment and treatment planning. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly any costs will always be discussed.