Low back pain (without leg pain)
Before anything else — 5 symptoms that need urgent careReviewHide
- •Fever with back pain
- •Trauma (fall, collision)
- •Unexplained weight loss
- •History of cancer
- •IV drug use
Likely conditions
Common causes based on epidemiology alone — a physical exam and sometimes imaging are needed to identify which one applies to you.
Who to see first
Primary Care Physician
Your general physician — family medicine, internal medicine, or DO.
When to see them: First visit for most non-emergent new pain — they can coordinate PT and determine whether specialist referral is needed.
Treatment sequence
Published guidelines (NASS, AAOS, ACP, NICE) recommend a conservative-first sequence unless red flags are present. Each step below lists the evidence strength and the primary source.
- 1Week 1–2Strong evidence
Self-care and movement
Stay active within tolerance. Avoid bed rest beyond 1–2 days. Use heat or cold for comfort. Over-the-counter NSAIDs (ibuprofen, naproxen) for pain relief if no contraindications.
- 2Week 2–6Strong evidence
Structured physical therapy
Physical therapy with a focus on core stabilization, McKenzie method, or motor control exercises shows the strongest evidence for both short-term pain reduction and functional improvement. Duration typically 4–8 weeks, 2–3 sessions per week.
- 3Week 6–12Moderate evidence
Escalation: PM&R or pain management
For pain persisting beyond 6 weeks despite PT, consider a PM&R or interventional pain management consult. Diagnostic injections (facet or SI joint) can clarify pain generators. Imaging (MRI) is generally appropriate at this stage if intervention is being considered.
- 4Week 12+Moderate evidence
Multidisciplinary approach
Chronic low back pain (>12 weeks) benefits most from a multidisciplinary approach combining continued exercise, cognitive behavioral therapy where indicated, and selective interventions. Fusion surgery for non-specific low back pain has mixed evidence and is not a first-line option.
Common causes
- •Muscle or ligament strain
- •Lumbar disc degeneration without herniation
- •Facet joint arthropathy
- •Sacroiliac joint dysfunction
- •Spondylolisthesis (degenerative)
Your next steps
- 1Screen yourself for red flags. If any apply, go to an emergency department before continuing with this Guide.
- 2Start the first stage of the treatment ladder. Most new pain episodes improve significantly in the first 2–6 weeks with self-care and PT.
- 3If symptoms persist, book with the specialist above. Bring: when it started, what makes it better or worse, medications tried, any imaging you have, and the questions from our surgery decision framework.