Do I need an MRI for low back pain?

Usually not in the first 6 weeks. NICE NG59 and the American College of Physicians guidance both advise against early imaging for non-specific low back pain because scans frequently show disc bulges, degenerative changes, and protrusions in people with no pain at all. Imaging becomes useful when there are red flags, progressive neurological loss, or when symptoms have not responded to a reasonable trial of conservative care and a scan would actually change the plan.

Should I rest or stay active?

Stay active within tolerance. Bed rest beyond a day or two slows recovery and deconditions you.

How long does low back pain usually take to settle?

Most acute episodes improve meaningfully in 2 to 6 weeks. The Lancet Low Back Pain Series describes a pattern of rapid early improvement followed by a slower tail, with many people experiencing some residual or recurring symptoms. Recurrence does not mean your back is getting worse. It usually reflects load, sleep, stress, and training history more than structural change.

What position should I sleep in?

The position that lets you sleep. There is no single correct posture. Side-lying with a pillow between the knees and back-lying with a pillow under the knees are the two setups that work for most people in the acute phase. If a position wakes you up sore, try the other.

Is it safe to keep exercising or lifting weights?

Often yes, with short-term modifications. Completely stopping training tends to make things worse, not better. What I usually adjust first is deadlift volume, heavy loaded flexion, and deep morning bending, while keeping most of your programme intact. Pain during exercise up to about 3 or 4 out of 10 that settles within 24 hours is generally safe, and is closer to what the JOSPT 2021 low back pain CPG describes as appropriate loaded progression.

Why does my back feel worse in the morning?

Discs rehydrate overnight, which makes the lumbar spine slightly taller and stiffer first thing, and mechanically more sensitive to bending in the first hour. Avoiding deep forward flexion (tying shoes bent over, loaded rowing, sit-ups) for 30 to 60 minutes after waking often takes the edge off. Prolonged, dramatic morning stiffness that lasts more than an hour and improves through the day, especially in a younger person, is a pattern I flag for inflammatory back pain screening.

My MRI showed disc degeneration. Is my back damaged?

Probably not in the way that report sounds. Brinjikji and colleagues (AJNR 2015) pooled imaging findings in pain-free adults and showed disc degeneration in around 37% of 20 year olds and 96% of 80 year olds, with disc bulges present in roughly 30% and 84% respectively. Those changes are part of a normal aging spine, not a structural diagnosis. I treat the clinical picture, not the scan.

When should I be worried about back pain?

Seek urgent care for loss of bladder or bowel control, numbness in the saddle area, rapidly progressing leg weakness, or foot drop. These can signal cauda equina syndrome. Also see your physician promptly for unexplained weight loss, fever with back pain, severe unrelenting night pain, or a history of cancer, rather than starting physiotherapy first.

Low Back Pain Treatment in Burlington | Kareem Hassanein Physiotherapy

Low Back Pain

acute and chronic, mechanical, disc-related

Treating low back pain at my Burlington clinic. Convenient for Waterdown and Flamborough residents.

Important: When to seek immediate medical attention

New or progressive weakness in legs

Seek urgent medical assessment - possible nerve compression

Loss of bladder or bowel control with back pain

Go to emergency department immediately

Unexplained weight loss with back pain

See your physician for investigation

Fever with severe back pain

Seek medical assessment same day

Pathophysiology and contributing factors.

Inside Overview

The Science of Low Back Pain

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Mechanical low back pain typically involves dysfunction of the intervertebral discs, facet joints, sacroiliac joints, or surrounding musculature. The disc starts to lose its hydration and load distribution capabilities, which leads to increased stress on surrounding structures. The deep stabilizing muscles like multifidus and transverse abdominis often show delayed activation patterns, compromising segmental stability. Over time, this can lead to movement pattern changes that perpetuate the problem. When pain persists beyond 3 months, changes in the nervous system can amplify pain perception, making previously non-painful movements uncomfortable. When disc dysfunction progresses significantly, it may lead to disc herniation with potential nerve root compression (sciatica). Similarly, when facet joints become primary pain generators, this can develop into facet joint syndrome, while sacroiliac joint dysfunction may become a distinct condition requiring specific treatment approaches.

Low Back Pain

The Science of Low Back Pain

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