Back pain is the world's leading cause of disability. At some point in their lives, approximately 80% of people will experience it, and for a significant proportion, it becomes a recurring, limiting presence that affects work, sleep, sport, and the ordinary activities that make daily life worth living.
The question most patients have is not 'what is back pain?', they already know what it is. The questions they will have is more possibly: what is causing my pain, how serious is it, and what should I do about it?
Anesthesiologist and Interventional Pain Physician Dr. Nivan Loganathan answers these questions and more.
Back pain is a symptom, not a diagnosis. The same complaint, 'my back hurts', can arise from a muscle strain, an arthritic facet joint, a herniated disc pressing on a nerve, a fractured vertebra, or, in rare cases, something more serious such as a tumour or infection. The treatment for each is different. Identifying the actual pain generator is the first step — and it is where a specialist assessment makes the real difference.
“The common causes of back pain include muscle strains or sprains. It can be related to spondylosis or arthritis, which is secondary to wear and tear, and these can be contributed by poor posture or even heavy lifting,” Dr. Nivan Loganathan explains. “Some of the other pain conditions include back pain with radiation to the leg, like sciatica, and this is usually caused by a pinched nerve.”
The same complaint, 'my back hurts', can arise from a dozen different sources. Finding the actual pain generator changes everything about how it should be treated.
Some common causes of back pain include:
Most back pain is mechanical, related to structure, movement, and load, and will improve with appropriate conservative management. But a small proportion of back pain presentations are serious, and knowing the difference matters.
You should seek medical attention promptly if you notice the following signs and symptoms:
“Whenever back pain is affecting your daily activities, causing tingling or nerve-related pain like sciatica, or becomes unbearable — for example, after a fall, a sporting activity, or heavy lifting — these things point towards a more serious condition. This is when you should see a back pain specialist,” Dr. Nivan stressed.
If any of the red flags above apply to you, do not manage this with self-care alone. An urgent assessment by a pain specialist or orthopaedic surgeon is the appropriate next step.
It may feel counterintuitive. After all, when your back hurts, the instinct is to rest. To stop moving, lie flat, and wait for the pain to pass. However, prolonged bed rest is one of the most counterproductive things you can do for most back pain conditions. The evidence on this is unambiguous.
“Prolonged bed rest will actually cause you more harm than good,” Dr. Nivan states. “Maybe in the initial phases you may want to rest for a few days when you have acute pain and take some medication — but from a prolonged perspective, you might want to get into active rehabilitation. Active movements, stretching, yoga, Pilates — these things will help to improve the core muscles and will actually reduce the reliance on medication and prolonged bed rest.”
Prolonged inactivity allows the muscles supporting the spine to weaken rapidly. Within days of bed rest, core muscle strength and endurance begin to decline — and those muscles are precisely what protect the spine from the loads of daily activity. When you do eventually get up and move, a deconditioned spine is more vulnerable, not less.
Beyond the musculoskeletal consequences, extended bed rest is associated with increased depression and anxiety in back pain patients, cardiovascular deconditioning, and a higher likelihood of pain becoming chronic. The shift in evidence — from prescribing bed rest to prescribing active rehabilitation — is one of the most significant changes in back pain management over the past two decades.
For acute back pain, a day or two of relative rest is appropriate. After that, Dr. Nivan recommends beginning gentle movement. Walk and do light stretches. The goal is to resume as much normal activity as pain allows, as soon as pain allows.
If rest is not the answer, what is?
The evidence consistently supports a combination of active physical rehabilitation, targeted self-care, and — where appropriate — specialist intervention. The goal is not just to reduce pain in the short term, but to build the resilience that prevents the next episode.
Exercise is one of the most effective treatments for both acute and chronic back pain. The mechanism is straightforward: stronger core muscles provide better spinal support, reducing the load on the passive structures such as your discs, facet joints, and ligaments that are often the source of pain.
“Exercise can be incorporated into your pain management when you're having back pain,” Dr. Nivan says. “Active stretching, yoga, Pilates, posture retraining, ergonomics — these can contribute towards a more holistic pain management and get you back to your daily activities, work, sports — basically all the things you love doing.”
The most effective exercise programmes for back pain share common features: they are progressive (gradually increasing in load and complexity), they target the deep stabilising muscles of the spine (transversus abdominis, multifidus) rather than just the superficial movers, and they are consistent — two or three sessions per week, sustained over months rather than weeks.
Yoga and Pilates have both been shown in multiple randomised trials to reduce back pain and improve function. Neither is risk-free — certain poses or movements may provoke pain initially — and working with an instructor who understands your condition is important. A physiotherapist can identify which movements are appropriate and which to avoid for your specific pain source.
The relationship between back pain and overall health is bidirectional. Chronic inflammation — driven by a poor diet, poor sleep, or chronic psychological stress — worsens pain sensitivity and slows tissue healing. Addressing these factors is not peripheral to back pain management; it is part of it.
“Self-care is very important these days. Simple things like ergonomics, good posture, active stretching, watching your diet, even proper weight management can have long-lasting effects on back pain management,” Dr. Nivan notes.
Back pain is not a life sentence. Even chronic, long-standing back pain can be meaningfully improved with the right combination of accurate diagnosis, targeted treatment, and structured rehabilitation. The patients who do best are those who understand their condition, engage actively with their rehabilitation, and do not delay seeking appropriate help.
The spectrum of effective treatment has never been broader: from simple posture corrections and exercise programmes to highly targeted interventional procedures that can address the specific anatomical source of pain with minimal recovery time. Between these two poles lies a range of options that a pain specialist can match to your individual presentation.
The first step is understanding what is actually generating your pain. Everything useful follows from that.
