What is chronic lower back pain?
Chronic lower back pain is pain in the lumbar spine - the lower part of your back - that lasts for 12 weeks or longer, beyond the time an initial strain or injury would normally take to settle. It is one of the most common reasons people seek medical help, and it ranges from a nagging background ache to episodes that make everyday activity difficult.
Often no single structure is clearly to blame, and the pain is described as non-specific lower back pain. When a source can be identified, it may involve the discs, the facet joints, the sacroiliac joints, or the surrounding muscles and ligaments - and sometimes several of these together.
The reassuring part: most chronic lower back pain improves with the right non-surgical care, and surgery is rarely the first or only answer. Our role is to work out what is genuinely driving your pain and guide you toward the least invasive treatment that gives a durable result.
Symptoms to look for
Chronic back pain can feel different from one person to the next. Common patterns include:
- A persistent dull ache or stiffness across the lower back that lingers over months.
- Sharper pain with bending, lifting, or twisting, sometimes triggered by a specific movement.
- Pain that worsens after sitting or standing for long periods and eases when you change position.
- Muscle tightness or spasm around the lower back and hips.
- Reduced mobility and flexibility that affects daily tasks and sleep.
CAUTION
Back pain accompanied by unexplained weight loss, fever, pain that is worse at night or at rest, new or progressive leg weakness or numbness, or any loss of bladder or bowel control needs urgent review. Treat these as an emergency and seek immediate medical attention.
What causes chronic lower back pain?
Chronic lower back pain usually builds up rather than starting with one event. Common contributors include disc wear or a herniated disc, facet joint or sacroiliac joint strain, and muscle or ligament overload. In many people, a mix of factors is at play and no single cause stands out.
Day-to-day habits matter too. Long hours seated at a desk, limited physical activity, weak core muscles, poor lifting technique, carrying extra weight, and smoking can all add to the load on the lower back. Stress and poor sleep can also make pain feel worse and harder to shift.
How we diagnose it
Diagnosis begins with a careful history and a focused physical and neurological examination to understand your pain pattern, movement, and nerve function. Imaging is not always needed early on, but where it is helpful an MRI or X-ray can show the discs, joints, and alignment, and in some cases nerve studies add useful detail.
Just as important, we match any imaging to your symptoms. Scans in healthy, pain-free people often show wear, so we treat the person - not the picture. Your assessment is led by a US board-certified neurosurgeon.
Treatment - least invasive first
We follow a measured, surgery-last approach. For the great majority of people that means non-surgical care, guided by a clear understanding of your pain.
- A clear diagnosis first. A thorough consultation helps identify what is driving your pain and rules out anything that needs urgent attention, so your plan is targeted rather than generic.
- Non-surgical care (first line for most). Staying active, physiotherapy, core strengthening, and changes to posture and daily habits are the foundation of recovery. Where appropriate, pain medication management can help you stay active while your back settles.
- Targeted injections. If a specific pain source is identified, an image-guided injection can reduce inflammation and support your return to activity without surgery.
- Surgery (rarely, and only when warranted). An operation is considered only when a specific structural problem is clearly the source of your pain and conservative care has not helped.
If you have already been told you need surgery, we are glad to give an honest second opinion on whether a less invasive path could work for you.
What to expect
Chronic back pain usually improves gradually rather than all at once, and the goal is to restore comfortable movement and daily function as much as to reduce pain. Progress often comes from consistent physiotherapy and activity over weeks to months. If a specific treatment or procedure is recommended, your surgeon will explain the likely timeline for your specific case, and the plan is built around you, with clear explanations at every step.
Common questions
When should I worry about lower back pain?
Most lower back pain is not caused by anything serious. Seek prompt medical review if your pain comes with unexplained weight loss, fever, pain that is worse at night or at rest, new leg weakness or numbness, or any change in bladder or bowel control. These 'red flag' symptoms are uncommon but need urgent assessment.
How long does chronic lower back pain last?
Chronic back pain is defined as pain lasting 12 weeks or more. The outlook varies from person to person, but many people improve significantly with the right, consistent care, and symptoms often become manageable rather than constant. Staying active and following a tailored plan gives the best chance of steady, lasting improvement.
What causes chronic lower back pain?
It can come from several structures - the discs, the facet joints, the sacroiliac joints, or the surrounding muscles and ligaments - and often more than one is involved. In many cases no single cause is found, which is called non-specific back pain. Things like inactivity, prolonged sitting, weak core muscles, and stress can all contribute.
Should I rest or stay active with chronic back pain?
Staying gently active is usually better than prolonged rest, which can stiffen the back and slow recovery. Regular movement, walking, and guided physiotherapy help maintain strength and flexibility. Short rest during a severe flare-up is fine, but the aim is to return to normal activity as comfortably and as soon as you reasonably can.
Can an MRI find the cause of my back pain?
Sometimes, but not always. Scans often show wear such as disc changes that are also common in pain-free people, so an MRI finding does not automatically explain your pain. That is why we match any imaging to your symptoms and examination, rather than treating the scan alone. Imaging is most useful when specific red flags or nerve symptoms are present.
Does chronic lower back pain mean I need surgery?
Usually not. Most chronic lower back pain is managed without an operation, using physiotherapy, activity, and where helpful, medication or targeted injections. Surgery is considered only when a specific structural problem is identified as the source and conservative care has not helped. If surgery has been suggested, an independent second opinion can help you decide.