Back Pain

Back pain is a common complaint by millions of individuals of all ages in North America. In fact, it is second only to headaches as the reason people miss work in the USA and San Francisco. The majority of people experience at least one episode of low back pain at least once in their life. Back pain is also one of the most common reasons why people miss work or need to see a physician. For most people with back pain, there is good news- the symptoms are short term and can be treated by simple measures. Prevention is the best method to avoid back pain. In any case, surgery is rarely needed for back pain.

Symptoms of back pain include

• muscle or joint pain
• pain that may be radiating from the lower back into the legs
• pain may be sharp or stabbing
• One may have limited range of motion
• flexibility is decreased
• difficulty standing up

 If back pain lasts for 1-3 days, it is considered acute, when pain lasts longer than 3 months, it is considered chronic.

Structural causes of Back Pain

The back is made up of complex interactions between ligaments, bone, muscles, tendons and discs. The pain may arise from any one of these structures. Back pain may occur form strained muscles and ligaments. This most commonly occurs when lifting heavy equipment or using an improper methods of lifting. In rare cases, muscle spasms may be the cause of back pain.

Ruptured discs/Herniated Discs/Bulging Discs- discs act as cushions between the vertebra and sometimes the soft jelly like material bulges out of the discs and compress the nerve. However, not everyone with a bulging disc develops back pain.

Arthritis of the back commonly causes back pain. The spinal canal can narrow or bone spurs can pinch on the nerves.

Some people are born with congenital deformities of the back that leads to an abnormal curvature of the spine. Scoliosis is a back disorder in which the spine curves to the side and often cause back pain.

In elderly people, softening of the bones or osteoporosis leads to fractures and causes pain.

Risk factors for back pain include:

• Smoking
• Age
• Obesity
• Female gender
• Performing physically demanding work
• Sedentary life style
• Stress and depression

Diagnosis of Back Pain

The diagnosis of back pain is not difficult but not everyone needs all the expensive radiological tests. If the physical exam is normal, then in most cases no testing is needed. However, if there is back pain on standing or shooting pains down the leg, then an x ray may be warranted. Besides plain x rays, MRI and bone scans are also used to determine the cause of back pain. If there is suspicion that a nerve is pinched, then nerve-conducting studies may be ordered to determine the response of muscles.


SFMMG doctor will advise treatment of back pain start to begin at home. Most people can get better with the use of over the counter pain medications and rest. A short period of bed rest is more than adequate. If the over the counter pain medications do not work, one can obtain prescription strength pain medications from our SFMMG doctors. In some cases, low doses of anti depressants can help both pain and sleep.

Once the pain has subsided, our SFMMG physical therapists and chiropractors can help strengthen the muscles and increase range of motion. Physical therapy may involve ultrasound, TENS, electrical stimulation and water therapy. Regular use of these techniques can help improve posture and ease back pain. Chiropractic may be requires to adjust the vertebrae that are out of alignment and may be causing your pain or discomfort.

Some people with more severe back pain may benefit from injection of corticosteroids in the joint. The steroid can ease inflammation but take a few weeks to work. Not all people respond to these injections. At SFMMG, our Pain Management doctors and Orthopedic physicians will work closely to determine if your back pain is responding to conservative care. If not, then we may recommend some other diagnostic tests to determine if surgery may be a solution.


Surgery for back pain is not always needed but commonly performed. Surgery is best for people who have severe nerve compression and unrelenting back pain. Surgery is usually reserved when people have failed other supportive measures. If you are recommended surgery the first time you see a physician, you need to get another doctor.

There are many types of surgery procedures for back pain including fusion, removal of discs or vertebrae. The results of surgery are mediocre at best and recurrence of back pain is common. Before you jump in line for surgery, get to know your surgeon and talk to other patients who have had surgery- you may just want to stick to physical therapy and use of pain medications.

Aternative Medicine

Because of the failure of conventional medications to help everyone with back pain, many people have been turning to alternative medicine. Other means of treating back pain include chiropractic care, acupuncture, Massage, relaxations and cognitive behavior techniques.

San Francisco Back Pain Multi-Disciplinary Approach

The San Francisco Multi-Specialty Medical Group (SFMMG) provides Full Spectrum care for your Back Pain. Our physicians and staff members represent a number of specialties including:

• Orthopedic Medicine
• Physiatry
• Chiropractic
• Podiatry
• Physical Therapy
• Acupuncture

Being able to offer appropriate, comprehensive and timely diagnosis and treatment in one place speeds recovery and reduces costs. Please call to schedule an appointment with our physicians at one of our locations.