Neck and back pain are among the most common reasons adults see a doctor. Most episodes come from strained muscles and ligaments, worn joints and discs, or posture and lifting habits, and they get better on their own with time and the right self-care. According to MedlinePlus, many people with acute low back pain feel better within a week, and the pain is usually gone within another four to six weeks.
That does not mean pain should simply be ignored. A small share of neck and back pain comes from something that needs prompt attention: a pinched nerve causing weakness, an infection, a fracture from thinning bones, a kidney stone, or, rarely, a tumor. Our internal medicine physicians evaluate the pain, screen for these warning signs, and put together a plan that relieves symptoms and gets you moving, with referral to spine and pain specialists when it is needed.
Common causes of neck and back pain
Muscle and ligament strain from lifting something heavy or awkwardly, a sudden twist, or a long day hunched over a desk or phone is the most frequent cause. Muscular imbalances and poor posture set the stage. Car accidents and slips and falls can injure muscles, joints or bones. Herniated or bulging discs can press on a nerve root and send pain, numbness or tingling down an arm or leg, which in the lower back is called sciatica. Arthritis of the spine and narrowing of the spinal canal (spinal stenosis) are more common with age and can cause stiffness or leg pain with walking. Scoliosis and other spinal irregularities also contribute.
Some back pain does not come from the spine at all. Pain in the flank, the side of the back just below the ribs, can come from the kidneys, especially a kidney stone, which typically causes severe, cramping pain that comes in waves and may spread toward the groin, sometimes with blood in the urine or nausea. A kidney infection causes flank pain with fever and urinary symptoms. Because our group includes urology, we can evaluate and treat these causes within the practice. In older adults, a sudden onset of back pain after a minor strain can be a compression fracture from osteoporosis, which is why bone health is part of the conversation. Rarely, back pain comes from an abdominal aortic aneurysm, pancreatitis or gynecologic conditions.
How we evaluate neck and back pain at NYMD Center
The evaluation starts with the story of the pain: when and how it began, where it is and where it travels, what makes it better or worse, and whether you have numbness, tingling or weakness in an arm or leg. We ask specifically about red flags: fever, a history of cancer, unexplained weight loss, significant trauma, steroid use, osteoporosis, and any change in bladder or bowel control or numbness in the groin or buttocks.
The exam checks posture, range of motion, tenderness, and the nerves to your arms and legs through strength, reflexes and sensation. When flank pain or urinary symptoms suggest the kidneys, we check a urine sample and can arrange ultrasound. Blood tests are added when infection, inflammation or other medical causes are possible.
For most new back pain without red flags, X-rays and MRI are not needed at first. MedlinePlus notes that spine imaging is usually not ordered at the first visit, or for four to six weeks, unless specific warning signs are present. Early imaging often shows age-related disc and joint changes that are common in people without pain, which can lead to worry and unnecessary treatment without helping recovery. We order imaging when red flags are present, when there are neurologic findings, or when pain persists despite treatment.
Treatment options, least invasive first
Staying active and self-care
Staying as active as you comfortably can speeds recovery. MedlinePlus cautions that staying in bed for more than a day or two can make back pain worse. Ice in the first couple of days and heat afterward, gentle walking, and gradually resuming normal activity while avoiding heavy lifting and twisting are the foundation of care.
Medication
Over-the-counter anti-inflammatory medicines such as ibuprofen or naproxen, or acetaminophen, relieve pain for many people. These are not right for everyone: anti-inflammatories can affect the stomach, kidneys and blood pressure, and acetaminophen can affect the liver in higher doses, so we tailor the choice to your health. Muscle relaxants or prescription pain medication may help for a short time in some patients, but they cause drowsiness and other side effects, and we use them sparingly.
Physical therapy
A physical therapist can teach exercises that restore motion, strengthen the core and neck muscles, correct posture and lower the chance of recurrence. We refer to physical therapy, or to a chiropractor when appropriate, for pain that is not improving or that keeps returning.
Specialist referral
Pain that persists for months, significant nerve symptoms, or findings on imaging may call for referral to a spine specialist, pain management physician or surgeon. Options such as injections or surgery help selected patients, but they carry more risk and are reserved for those who need them.
What to expect at your visit
Expect a detailed conversation and a hands-on exam, with a urine test or blood work if the pain could be coming from the kidneys or another organ. Bring your medication list and any prior X-rays, MRIs or reports. Most patients leave with a working diagnosis, a self-care and medication plan, and a clear idea of what should prompt a return visit. If you are due for a checkup, we can pair the visit with your annual exam, and for women over 65 or anyone with risk factors, we can discuss osteoporosis screening.
When to seek care urgently
Go to the emergency room for back pain with new loss of bladder or bowel control, numbness in the groin, buttocks or inner thighs, or rapidly worsening weakness in the legs, which can signal compression of the nerves at the base of the spine. Seek urgent care for back pain after a serious fall or accident, back pain with fever, severe flank pain with vomiting or fever, or sudden severe pain in the back or abdomen, especially in older adults. Contact us promptly for pain with unexplained weight loss, a history of cancer, or pain that is worse at night or not improving after a few weeks.
Questions patients ask
Do I need an MRI for my back pain?
Usually not at first. Most new back pain improves within weeks, and early imaging often shows age-related changes that are common even in people without pain. We order X-rays or MRI when there are red flags such as fever, cancer history, trauma, weight loss or new weakness or numbness, or when pain is not improving with treatment.
How long does back pain usually last?
Many people with acute low back pain feel better within about a week, and most recover within four to six weeks. Staying active, heat, and over-the-counter pain relievers where safe help recovery. Pain that lasts longer than that, keeps returning, or comes with nerve symptoms deserves a closer look.
Could my back pain be a kidney stone?
It can be. Kidney stones typically cause severe, cramping pain in the flank, below the ribs on one side, that comes in waves and may spread toward the groin, sometimes with nausea or blood in the urine. Muscle pain usually changes with movement. Because our group includes urology, we can test your urine, arrange imaging and treat stones within the practice.
Should I rest in bed when my back hurts?
No. A day or two of taking it easy is fine, but longer bed rest tends to slow recovery. Gentle walking and gradually returning to normal activities, while avoiding heavy lifting and twisting for a few weeks, usually help the most. Heat and over-the-counter medication where safe can make movement more comfortable.
When is back pain an emergency?
Go to the emergency room for back pain with new loss of bladder or bowel control, numbness in the groin or buttocks, or rapidly worsening leg weakness. Seek urgent care after a serious fall or accident, with fever, or with severe flank pain and vomiting. These signs can point to nerve compression, infection, fracture or a kidney problem.