Lower back pain affects roughly 8 in 10 adults at some point in their lives. The vast majority of cases are mechanical — meaning they originate from the muscles, ligaments, joints, or discs of the lower back rather than from a serious underlying disease — and most resolve within four to
six weeks with basic care. The clinical work is identifying the smaller subset of cases that need imaging, the smaller still that need interventional or surgical evaluation, and the rare cases that signal something more serious. Grewal Orthopedic & Spine Care evaluates and manages lower back pain across four Long Island and Queens locations. Same-day evaluation is available at our East Meadow Urgent Care. Call (516) 743-9450.
How common is back pain, and why does it matter clinically
Lower back pain is the leading cause of disability worldwide and the most common reason for missed workdays in the United States. About 80 percent of adults experience clinically significant low back pain in their lifetime. Most episodes are self-limited and resolve within four to six weeks. A subset becomes chronic — defined as lasting longer than three months — and requires more structured management.
Two clinical realities matter for any patient. First: a specific anatomic diagnosis is often not necessary or even possible in early acute back pain, and aggressive imaging early in the course doesn’t improve outcomes. Second: certain symptom patterns require prompt evaluation because they suggest a more serious underlying process. Distinguishing these is most of what a good orthopedic and spine evaluation does.
Common causes of mechanical back pain
• Muscle and ligament strain. The most common cause of acute back pain. Often follows a specific event (lifting, twisting, prolonged poor posture) and resolves within days to weeks. • Disc-related pain. Disc herniation produces radicular pain (sciatica); degenerative disc disease produces more axial back pain.
• Facet joint pain. The small joints at the back of the spine can develop arthritis and produce localized back pain.
• Sacroiliac joint dysfunction. Pain at the joint between the spine and pelvis.
• Spinal stenosis. Narrowing of the spinal canal, more common with age.
• Spondylolisthesis. Forward slippage of one vertebra over another.
• Compression fractures. Particularly in patients with osteoporosis or after trauma. Red flags — when back pain warrants prompt evaluation • Severe pain after significant trauma, particularly in patients with osteoporosis. • Loss of bowel or bladder control, or new urinary retention. Possible cauda equina syndrome — go to an emergency room immediately.
• Progressive weakness in the legs.
• Fever, unexplained weight loss, or a history of cancer accompanying new back pain. • Pain that wakes you from sleep and isn’t relieved by any position.
• Severe pain that hasn’t improved at all after two to three weeks of conservative care. Diagnostic workup
History and physical examination are the foundation. Most acute back pain doesn’t require imaging on the first visit. Early imaging in uncomplicated acute back pain often shows incidental findings (mild disc bulges, minor degenerative changes) that don’t change management and can lead to overtreatment. Imaging is reserved for patients with red flag symptoms, those with persistent symptoms beyond four to six weeks of conservative care, those with neurologic findings, or those for whom interventional or surgical treatment is being considered.
When imaging is indicated, the choice depends on what’s being evaluated. X-rays for fracture or significant alignment concerns; MRI for disc, nerve root, and soft tissue evaluation; CT for detailed bone anatomy. The Westbury location has all four imaging modalities on site.
Conservative treatment — what actually works
• Stay active. Bed rest beyond a day or two is associated with slower recovery. • Anti-inflammatory medication during the acute phase, typically NSAIDs unless contraindicated. Acetaminophen is a less effective alternative when NSAIDs can’t be used. Opioids are not first-line and should not be used long-term.
• Heat application during the acute phase has modest evidence of benefit.
• Focused physical therapy starting within the first one to two weeks. The right physical therapy for back pain emphasizes core stabilization, hip mobility, and neutral-spine mechanics — not generic stretching.
• Address contributing factors: ergonomics at work, lifting mechanics, sleep posture, body weight when relevant.
• A structured home exercise program continued beyond the formal physical therapy course. Maintenance is what prevents recurrence.
Interventional options for persistent back pain
Patients whose back pain hasn’t responded to four to six weeks of structured conservative care, and whose imaging or examination suggests a specific procedurally-addressable diagnosis, may benefit from interventional pain management:
• For disc-related radicular pain: fluoroscopically-guided epidural steroid injections. • For facet joint pain: medial branch blocks (diagnostic) followed by radiofrequency ablation when the diagnosis is confirmed.
• For sacroiliac joint dysfunction: SI joint injections.
• For myofascial pain: trigger point injections.
Procedures are performed at the Westbury procedural suite.
When surgery becomes the right answer
For most back pain, surgery is not the answer. For specific subsets it is. Surgery is considered when conservative and interventional care have not produced meaningful improvement over an appropriate timeline (usually three to six months for non-emergent cases), when there is significant or progressive neurologic compromise, or when imaging shows a specific surgical lesion that won’t improve with non operative care.
The surgical decision is detailed and individualized. Most patients who come in for a surgical consultation leave with a recommendation other than surgery; the smaller fraction who do proceed to surgery do so with a clear understanding of why.
Lower back pain in workers’ comp and no-fault cases
A meaningful share of the practice’s lower back pain caseload involves workers’ compensation cases (lifting injuries, falls on the job, repetitive-strain conditions) and no-fault auto-injury cases. The clinical management is the same as for any back pain. The documentation requirements are different. Detailed history of the mechanism of injury at the first visit, ongoing functional capacity documentation, and clear correlation between the injury and the clinical findings are essential. The administrative team handles WCB and no-fault paperwork in-house.
Frequently asked questions
How long should I wait before seeing a doctor for back pain?
Most acute back pain improves within two to three weeks with basic care. If pain hasn’t meaningfully improved by that point, see a specialist. See a specialist sooner if there are neurologic symptoms, if pain wakes you at night, if there’s a red flag symptom, or if the pain followed a work injury or motor vehicle accident.
Should I get an MRI for my back pain?
Usually not for early acute back pain, because most cases improve before imaging would change management and abnormal findings on MRI are common in people without symptoms. MRI becomes useful when pain hasn’t improved at four to six weeks, when there are neurologic findings, or when interventional or surgical treatment is being considered.
What kind of doctor should I see for back pain?
An orthopedic spine specialist or a physiatrist specializing in spine and pain management is appropriate for most non-emergent back pain. Spine surgeons see most cases as second-line consultations after conservative care has been tried.
Will I need surgery for my back pain?
For the great majority of back pain cases, no. Surgery is considered for specific subsets where conservative and interventional care haven’t produced relief over a reasonable timeline.
Can chronic back pain be cured?
Many cases of chronic back pain are managed successfully — meaning the patient returns to a satisfying activity level with minimal pain — even if the underlying anatomic findings persist. Management is about function and quality of life.
Is back pain covered by workers’ compensation?
Yes — when it results from a work-related event or exposure. NY State Workers’ Compensation covers evaluation, imaging, conservative care, interventional procedures, and surgical care when indicated. Documentation of the mechanism of injury at the first visit is critical.
S C H E D U L E A N E V A L U A T I O N
Call (516) 743-9450. Same-day urgent care at East Meadow. On-site MRI at Westbury. Workers’ comp and no-fault paperwork handled in-house.
