Understanding Lower Back Pain and When It Becomes a Concern
Back pain is one of the most common health complaints there is — almost everyone will experience an episode of back pain at some point in their life. The good news is that the majority of cases resolve on their own, especially with the right early treatment.
In most cases, a simple back strain or facet joint strain will typically settle within a few weeks with appropriate conservative treatment — think mobilisation, good physiotherapy, and staying active. This kind of early, conservative lower back pain treatment is usually all that’s needed to get symptoms under control.
There is a smaller group of causes that don’t follow this pattern and need closer attention, including fractures, spinal deformity, and spondylolisthesis.
As a general rule, if symptoms are persisting or getting worse after six weeks of proper conservative treatment, it’s time to seek specialist input.
Common Causes of Chronic Back Pain
Most back pain isn’t sinister. Common contributors include:
- Muscle and ligament strain
- Disc injuries
- Arthritis or degeneration
- Low mood and lifestyle factors
- Posture and body weight
Signs You Should Consult a Back Pain Specialist
Certain “red flags” should prompt earlier assessment, regardless of how long the pain has been present or how it started.
Background health factors that raise concern:
- A history of cancer (raises the possibility of metastatic spread to the spine)
- Diabetes (increased risk of infection, and can mask or mimic nerve symptoms)
- Osteoporosis, or long-term steroid use (increased risk of vertebral fracture, sometimes from minimal trauma)
- Unexplained weight loss
- Fevers, night sweats, or feeling generally unwell
- Recent significant trauma, even if the pain seemed minor at the time
- A history of intravenous drug use or a recent infection elsewhere in the body (both raise the risk of spinal infection)
- Age under 20 or over 50 at first onset of significant back pain
Symptoms and signs that need urgent attention:
- Pain that is constant, worsening, and unrelated to movement or position
- Pain that is worse at night or wakes you from sleep
- Progressive weakness or numbness in the legs
- Changes in reflexes on examination
- Unsteadiness or difficulty walking
Cauda equina syndrome — a true emergency:
This is the one red flag that should prompt going straight to a hospital emergency department, not waiting for a GP or specialist appointment. Signs include:
- Numbness in the “saddle” area (inner thighs, buttocks, or around the genitals)
- New difficulty controlling the bladder or bowel, or loss of sensation when passing urine
- Sudden sexual dysfunction
- Progressive weakness or numbness affecting both legs
These occur because of significant compression of the nerves at the base of the spinal cord, and delayed treatment can lead to permanent loss of function. This always warrants immediate assessment.
None of these red flags mean something serious is definitely happening — but they’re the features that should lower the threshold for imaging and specialist review, rather than waiting out the usual six-week period of conservative treatment.
What Does a Spinal Specialist in Adelaide Do?
A spinal specialist will start with a thorough history and examination, aiming to reach an accurate diagnosis for the back pain. Particular attention is paid to radiating pain or other signs of nerve or spinal cord involvement and any concerning features in the past medical history.
From there, specific investigations may be arranged, including:
- MRI scan — to assess ligaments, discs, and bony structures
- CT scan — particularly useful for a more detailed look at arthritis or fracture
- CT-SPECT scan — helpful for identifying activity in joints or bones, including the sacroiliac joints, that may be contributing to pain
One important point worth understanding: most people will show some degree of degenerative change on MRI, even if they have no symptoms at all. Part of the specialist’s role is separating what is a normal finding for age from what is actually the source of the patient’s pain.
Lower Back Pain Treatment Options Available in Adelaide
Treatment depends heavily on the underlying cause of the back pain and what else is going on.
Surgery is reserved for a relatively small number of situations, including deformity, instability, spondylolisthesis, and fractures.
Most spinal surgery, however, is performed for nerve compression — whether that’s spinal stenosis, causing pain or numbness with walking, or disc prolapse, causing pain in a specific distribution down the leg.
For purely axial back pain — for example, from a facet joint problem, mild degeneration, or a muscular/ligamentous issue — conservative treatment remains the first choice. This typically includes:
- Physiotherapy and exercise physiology
- Hands-on treatment
- Corticosteroid injections where appropriate
Conservative management is generally tried before any surgical treatment is considered, unless red flags are present that change the urgency of the situation.
Specialist Treatment for Back Pain vs. General Physiotherapy
For most people, the first port of call should be a GP and physiotherapist, not a spine surgeon.
Pain that is improving within six weeks, is being managed with simple analgesia and exercise, and has no worrying features, should be treated conservatively in the first instance. This means normal reflexes, normal power, normal sensation, and no bladder or bowel symptoms.
Until proven otherwise, this is simple mechanical back pain, and conservative treatment is appropriate for at least the first six weeks.
If there is any neurological involvement — such as changes in reflexes, power, sensation, or bladder and bowel function — this raises the possibility of something more serious. This is the point at which imaging and referral to a specialist for more targeted, specialist treatment for back pain should be organised.
What to Expect During Your First Visit for Spinal Treatment in Adelaide
Every clinic’s process differs slightly. If you have any concerns or would like more information about what a first appointment involves, it’s best to book an appointment with your regular spinal specialist, who can talk you through what to expect based on your individual situation. Spending some time to write out symptoms and treatments in chronological order can be very useful for your specialist and avoid missing key parts of your story you wish to share.
Choosing the Right Chronic Back Pain Specialist for Your Needs
The ideal person to assess and manage spinal conditions is a fellowship-trained spinal surgeon — whether their background is in orthopaedic surgery or neurosurgery. This additional fellowship training is what ensures a patient receives a thorough assessment and access to contemporary, evidence-based treatment options.
It’s worth asking about their specific experience with your type of condition, whether they take a conservative-first approach before considering surgery, and whether they’re happy to answer your questions clearly. Feeling comfortable and informed is an important part of the process.
Frequently Asked Questions About Seeing a Spinal Specialist in Adelaide
Not covered in the original recording — suggested questions to address:
Do I need a referral to see a spinal specialist?
Patients can self refer but its advisable to obtain a referral from your GP which will include important past medical history.
Will I need surgery for my back pain?
Not necessarily. Most back pain is treated conservatively first, with surgery reserved for specific situations like spinal cord or nerve compression, instability, deformity, or fracture.
Is it normal to have “abnormal” findings on an MRI?
Yes — most people show some degree of degenerative change on MRI, even without symptoms. A specialist’s role is to determine whether a finding is actually the source of your pain, or simply a normal part of ageing.
What’s the difference between seeing a GP, a physiotherapist, and a spinal specialist?
A GP and physiotherapist are usually the right first step for straightforward back pain. A spinal specialist becomes relevant if pain persists beyond six weeks, isn’t improving, or if any red flag symptoms are present.
What should I do if I notice a red flag symptom, like loss of bladder or bowel control?
This is a medical emergency (cauda equina syndrome) and requires immediate attention at a hospital emergency department — do not wait for a GP or specialist appointment.
Book a Consultation with a Trusted Spinal Specialist in Adelaide
If you’re experiencing ongoing lower back pain, or you’re unsure whether your symptoms warrant specialist review, it’s always worth reaching out. Whether you need a second opinion or a full assessment, timely spinal treatment in Adelaide often means simpler, more effective outcomes.
You can easily book an appointment by asking your GP to refer to me or via my website