When should I see a doctor for lower back pain?

Written by: Mr Jonathan Bull
Edited by: Cameron Gibson-Watt

Low back pain is a very common cause for visits to the doctor and affects around 70% of the population at least once in their lifetime. Furthermore, roughly 20% of people are expected to experience it in the space of just one year.


We asked Mr Jonathan Bull, a leading neurosurgeon and spinal surgeon based in London, what are the main causes of low back pain and how a specialist might diagnose and treat this problem.



What are the most common causes of lower back pain?

Low back pain is a very self-limiting condition. Some of the most common causes of low back pain include:

  • Muscular strains
  • Wear and tear in the lumbar spine
  • Arthritis
  • Sciatica
  • Disc injury
  • Long periods of sitting or standing (common with office workers)


Arthritis is a common cause that triggers inflammation of the joints. It usually happens gradually over time, with patients finding it to be worse in the morning and during the cold winter weather.


Inactivity can also make your back pain worse: During long periods of inactivity, the back becomes stiff, weak and deconditioned. Usually, as pain in the back increases, patients tend to reduce their physical activity that often results in even more pain and begins a cycle of more pain and inactivity. Because of this, normal activity should be continued and you should avoid lying in bed during the day for long periods.


When can a doctor help me with lower back pain?

When pain is persistent for several weeks, you should visit your GP or physiotherapist.


Your doctor will likely request a complete medical history and perform a physical examination to find out exactly where the pain is.


Is lower back pain ever an emergency?

Rarely, however, there is a condition known as cauda equina syndrome which usually requires surgery. The symptoms include severe low back pain, loss of sensation and pain in the legs and problems with bladder or bowel function.


Cauda equina syndrome

Cauda equina syndrome is caused by something compressing on the spinal nerve roots, and if left untreated, can lead to incontinenceparalysis of the legs and a loss of sensation of sexual organs. This type of low back pain requires immediate medical care and is considered an emergency.


Unfortunately, there is a lack of awareness of cauda equina syndrome however, if people were more aware of this condition they would recognise the signs and seek the correct treatment quickly. The consequences of not treating this condition properly can be most unfortunate especially when patients can make a full recovery when given the right treatment.


How would a doctor diagnose the cause of the back pain?

After doing a physical examination, your doctor will likely check your reflexes and responses to certain sensations. The doctor will also need to know if there’s any shooting pain in the legs, any strange foot sensations or accompanying weakness anywhere in your legs or feet.

It’s also important for the doctor to understand what makes the pain worse and if there’s anything you know that alleviates it.


Unless you have severe and concerning symptoms, then the doctor will monitor your pain over the course of a couple of weeks and advise you on home treatments.


If your back pain is not responding to home treatments, your doctor may want to do some additional imaging tests such as X-raysCT scans and MRIs. There is a particular test - 20 minutes long – which is undertaken in an open MRI scanner for people who suffer from claustrophobia.


What treatments would a doctor offer me?

Generally speaking, the first step for the doctor is to offer advice and reassurance to the patient. This will usually be followed by ideas to alleviate the pain and how to manage it when it occurs.


Treatment depends on the cause of the lower back pain but can include:

  • a therapeutic injection
  • physiotherapy
  • osteopathic or chiropractic treatment
  • steroid injections that are done under sedation and X-ray guidance
  • surgical intervention


Unless the condition is a medical emergency, surgical intervention is only considered if the pain is unmanageable and chronic and all other treatments have failed.



If you would like to see Mr Jonathan Bull about your lower back pain, visit his profile and book a consultation online.

By Mr Jonathan Bull

Mr Jonathan Bull is a consultant neurosurgeon and spinal surgeon. He treats a full range of brain and spinal disorders which cause pain and dysfunction in the spine and the limbs with both simple and complex procedures.

He studied neurophysiology and medicine at Cambridge University before qualifying in 2000.

Mr Bull completed initial surgical training at St Mary’s campus, Imperial College, followed by higher surgical training in neurosurgery under the tutelage of Henry Marsh in the south Thames Programme. Alongside this, he achieved a Doctor of Medicine (MD Res) at University College London (UCL) specialising in MRI imaging of paediatric brain tumours.

He then undertook two specialist fellowships in complex spine surgery, initially as the Sir Victor Horsley Complex Spine fellow between the Royal National Orthopaedic Hospital, Stanmore and the National Hospital for Neurology and Neurosurgery (Queen Square). He was subsequently awarded a European Association of Neurosurgical Societies (EANS) fellowship at University Hospital Klinikum rechts der Isar. He became a Fellow of the Royal College of Surgeons in 2011.

Mr Bull joined the Barts Health Trust as a Consultant in 2012; his NHS practice is based in the Trust’s Royal London Hospital.

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