Back pain, when it's worth getting checked
Almost every case of back pain I see at the clinic in Pasiano di Pordenone has one thing in common: it goes away. It shifts through the day, eases off once you start moving, and within a few weeks becomes a memory. If that sounds like you, this article is mostly here to reassure you.
There is, however, a small group of situations where waiting isn't the right move, and where the first person to speak to isn't me but your doctor. There are four of them, and they're worth knowing precisely so you can relax about all the other times.
How common back pain usually behaves
The most frequent kind of back pain is mechanical: it changes with what you do. It bothers you after half an hour sitting and lets go when you stand up, or the other way round. Your back is stiff in the morning and loosens up after ten minutes on your feet.
Pain like this usually improves with movement rather than with bed rest, and settles within two or three weeks, even if it goes up and down from one day to the next rather than fading in a straight line.
Pain that changes with movement and with your position is by far the most common picture.
Four situations where it's better to speak to your doctor first
The four situations below don't tell you what you have. They only tell you that, as a first step, the right assessment is a doctor's, not mine. They're not a list of things to be frightened of, but of cases that need a different set of eyes from mine.
1. The pain started after a significant trauma
A fall from a height or on the ice, a car or motorbike accident, a hard blow to the back. After an impact like that, a doctor should look at the pain before any treatment, even if you can walk and feel you only had a scare.
2. The pain never changes with your position
You've tried standing, sitting, lying on your side, a pillow under your knees: it stays exactly the same. Or it's worse at night when you're still than during the day when you move. Pain that doesn't respond to what you do is the case to take to your doctor.
3. The pain comes with fever, feeling generally unwell, or weight loss you can't explain
When back pain is joined by a fever that comes and goes, a tiredness that feels different from usual, or kilos lost without trying, it's no longer a question that concerns only your back. Talk to your doctor.
4. You lose strength or sensation in one leg
A foot that gives way or catches, a leg that won't hold you on the stairs, tingling or numbness running below the knee. Here what matters is speed: call your doctor straight away, not next week.
One case stands apart from all the others: if you develop difficulty controlling your bladder or bowel, or a numb area between your legs, don't call the clinic and don't wait for an appointment: go to the emergency department.
None of these four signs tells you what you have. They only tell you who should look at you first.
What I look at in an assessment
What I assess is mobility: how the vertebrae move on one another, the pelvis, the hips, the ribs and the diaphragm, the dome-shaped muscle that separates chest from abdomen and works with every breath. I watch how you walk, how you bend, where movement stops and where it compensates by working twice as hard.
The first visit starts with questions, not with hands: how long it's been going on, what makes it worse, what makes it better, how you slept. They also help work out whether yours is a case for me. When it isn't, I say so and point you to a doctor — to me that's as much part of the job as the treatment itself, not a fallback.
When to see an osteopath
If none of the four situations applies to you, and in the vast majority of cases none does, it makes sense to see me when the pain goes beyond two or three weeks without improving, when it keeps coming back in cycles despite rest, or when you notice you've changed the way you move to avoid it. In the meantime, the habits I describe in the three tips for a healthy back are still the foundation.
What you read here is not a substitute for an assessment: it's here to help you work out who to turn to first. When in doubt, ask — your doctor or me, at the clinic in Pasiano di Pordenone.