Michael S. Vrana, M.D.
Orthopedic Surgeon
Overview
how the lower back worksYour lower back carries more load than any other part of the spine, which is why it is the most common source of spine-related pain. Most of it comes from the muscles, discs, and small joints, which is real pain but rarely dangerous. The key question in every visit is whether the pain is mechanical, or whether a nerve is being pinched and sending pain, tingling, or weakness down the leg.
What Usually Causes Low Back Pain
the usual suspectsMechanical low back pain
The most common back problem there is. Muscles, discs, and small joints get irritated; the pain is real, and it almost always settles.
Herniated disc
The cushion between two spine bones bulges and presses on a nerve. Back pain plus pain shooting down the leg.
Sciatica
Pain running from the buttock down the back of the leg, from a pinched nerve in the lower back.
Spinal stenosis
The nerve canal narrows with age. Legs that ache and tire with walking and feel better leaning on a grocery cart.
Spondylolisthesis
One vertebra slips forward on the one below it, which can pinch nerves and ache with standing and walking.
SI joint pain
Pain low and to one side, where the spine meets the pelvis. Often mistaken for the hip or the back.
When to Come In
most settles on its own, some does notUsually settles on its own
Most low back pain eases over days to a few weeks with staying active, over-the-counter pain relievers, and time.
Come in soon
Pain that runs down the leg with numbness or weakness, pain after a real injury, or pain with fever or unexplained weight loss.
Get emergency care
New trouble controlling your bladder or bowels, numbness in the groin, or rapidly spreading weakness. This needs same-day care.
What Care Looks Like
exam first, surgery only when it counts1
Talk and exam
Your visit starts with a conversation and a hands-on exam, including a careful check of your nerves: strength, feeling, and reflexes.
2
Imaging only if it changes the plan
Most low back pain does not need an MRI. We order one when the result would change what we do next.
3
Non-operative care first
Nearly all low back pain improves without surgery: staying active (bed rest makes it worse), a structured course of physical therapy, simple pain relievers, and time. OSI provides this first-line care.
4
Referrals when they are needed
When a pinched nerve calls for an injection, OSI refers you to a pain management specialist. When an operation is needed, for worsening nerve compression, a narrowed spinal canal that has shrunk your walking distance, or instability between spine bones, OSI refers you to a spine surgeon and stays involved in your non-operative care.
Browse non-operative care, or see how we handle neck pain.
