Back Pain: Causes and When to See a Doctor Skip to content

Back Pain: Causes by Location and When to See a Doctor

Pain in the lower back, between the shoulder blades or spreading down the leg is more often muscular, but sometimes it is a spine or organ problem. Here are the causes and when to see a doctor.

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When to see a doctor urgently

  • Back pain with numbness or weakness in both legs
  • Numbness around the groin and genitals, or changes in bladder or bowel control
  • Back pain after a fall, a crash or another serious injury
  • Back pain with a fever, chills or unexplained weight loss
Show all signs (8)
  • Upper back pain with chest pressure, shortness of breath or a cold sweat (call 112)
  • Pain that gets worse at night or does not depend on movement
  • Back pain with a swelling or lump on the back
  • Pain that has not gone away in several weeks or stops you walking, sleeping or working

If you have any of these signs, call 112 or go to emergency care.

What back pain is and how it varies

Back pain is one of the most common complaints: most people have it at least once in their lives. It can be dull and constant, or sharp and sudden. Pain that began recently and lasts from a few days to a few weeks is called acute, and pain that lasts longer than three months is chronic. In most cases no single cause is found, and it is called non-specific pain, linked to the muscles, ligaments and joints of the spine. In a small share of cases a specific disease is behind it: a slipped disc, inflammation or a fracture of a vertebra, or a disease of an internal organ. So it cannot be diagnosed from a description.

Lower back pain

The lower back is the most common place for pain. It is caused by muscle strain, lifting heavy things, sitting for long periods or an awkward sudden movement. The pain is often worse when bending and lifting and eases a little at rest. Risk goes up with a sedentary lifestyle, excess weight, smoking and heavy physical work. If lower back pain comes with weakness in the legs, numbness around the groin or a change in bladder and bowel control, urgent help is needed: see the warning signs above.

Back pain that spreads to the leg

When pain runs from the lower back down the back of the leg, it is called sciatica: irritation of the sciatic nerve. It usually affects one leg, the pain is sharp or burning, tingling, numbness and weakness are possible, and coughing or sneezing makes it worse. Sciatica often clears within weeks or months. If the pain does not ease, grows worse or you notice weakness in the leg, see a neurologist. Pain in both legs at once needs urgent care. For pain in the legs and joints, see Joint pain and Knee pain.

Pain between the shoulder blades and in the upper back

Pain between the shoulder blades is more often tied to muscles and posture during long desk work. But sometimes diseases of internal organs show up this way. If upper back pain comes with chest pressure, shortness of breath, a cold sweat or nausea, call 112. Pain between the shoulder blades that gets worse at night or does not depend on movement is better shown to a doctor.

Back pain and internal organs

Back pain can radiate from the kidneys, urinary tract, gallbladder, pancreas and, in women, the pelvic organs. These causes tend to produce pain that does not change with movement or body position. Pain in the side with a fever and painful urination is a reason to see a doctor urgently, see Painful urination. If your abdomen hurts too, see Abdominal pain.

Back pain in pregnancy, children and older adults

In pregnancy, lower back pain is common because of the changed load on the spine. Discuss it with the doctor overseeing the pregnancy, and report it if a fever, spotting or cramping pains appear. Back pain in a child or teenager, especially if it lasts long, disturbs sleep or comes with a fever, is better shown to a doctor. In people over 50, serious causes are more likely, so do not delay a visit for severe pain that is new.

What you can do before the visit

  • Stay active: keep walking and doing daily things as far as the pain allows. Bed rest for more than 1 or 2 days more often makes pain worse.
  • Apply heat or cold through a cloth for 15 to 20 minutes, whichever brings relief.
  • Do gentle stretches, walking or swimming. Avoid sudden movements and heavy lifting.
  • Painkillers are not the main treatment for back pain. If you decide to take one, check the choice and its safety with a doctor or pharmacist.
  • If you sit a lot, stand up and change position every 30 to 40 minutes.
  • Note when the pain began, what makes it worse or better, and whether there is numbness, weakness or fever.

How a doctor finds the cause

The doctor asks about the pain, injuries, work and other symptoms, examines the back, and checks movement, sensation and strength in the legs. In most cases imaging is not needed right away. An X-ray, MRI or CT is ordered if there are warning signs, the pain does not go away for a long time, or the examination points to a specific cause. Blood and urine tests may be needed. Treatment most often starts with staying active, exercises and physiotherapy, manual therapy and training in safe loading, and only in some cases are injections or surgery needed.

Frequently asked questions

Which doctor should I see for back pain?
A neurologist or a traumatologist. A manual therapist or physiotherapist joins as the doctor advises. With numbness in the legs, bladder problems, after an injury or with a fever, do not book a visit: get urgent care.
Why does my lower back hurt?
Most often because of muscle and ligament strain, long sitting or lifting. Less often the cause is a slipped disc, inflammation, a vertebral fracture or an internal organ disease, so the cause cannot be told from a description.
Should I stay in bed with back pain?
No: bed rest for more than 1 or 2 days more often makes the pain worse. Stay as active as the pain allows, do gentle exercises and walk.
When do I need an MRI for back pain?
Not for every back pain: imaging is usually not needed. A doctor orders it for warning signs, pain that does not go away for a long time, or when the examination points to a specific cause.
Back pain spreads to the leg: is it dangerous?
More often it is sciatica, irritation of the sciatic nerve, and it clears within weeks or months. But if the pain grows, the leg becomes weak or both legs hurt at once, see a neurologist or get urgent care.

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