While all of us experience significant lower back pain at some point in our lives, most of this improves within
a few days with a little rest and with some nonsteroidal anti-inflammatory medications. I thus often get asked,
'when is it time to see a physician'?
I would recommend seeing a physician if the low back pain is not improved within a few days of rest and over-the-counter
medications. If the pain is present at rest or if the pain wakes one up from sleep then I would recommend seeing a
physician sooner rather than later, usually within a couple of weeks.
I would also recommend seeing a physician if the pain involves the buttocks and/or the legs. Pain in the lower
extremities is usually caused by nerve inflammation/irritation rather than a muscular strain of the lower back
muscles. If the legs are also noticeably weaker (in that the legs are buckling, there is a tendency to fall, or
there is difficulty with climbing stairs) then I would recommend being seen by physician within a couple of days.
This patient will likely need an MRI to assess the degree of nerve compression and/or possible disc herniation.
I would recommend an immediate evaluation - even perhaps in the emergency room - if the patient notices any bowel
or bladder changes, numbness in the genital area, and/or numbness in the perianal area. This can be the sign of a
serious condition known as cauda equina syndrome where the nerves that are innervate the lower extremities and the
nerves that inervate the bowel and bladder are compressed and the compression is severe enough to prevent these
nerves from functioning normally. This requires immediate evaluation, MRI, and possible surgical consultation.
If there are no signs of cauda equina syndrome that requires emergency evaluation, all of the remaining concerns
can be discussed with one's primary care physician or with a fellowship and orthopedic spine surgeon in the clinic.
Mir H. Ali, MD,PhD
Director - Deerpath Spine Institute
Orthopedic Spine Surgeon - Rezin Orthopedics & Sports Medicine
Dr. Ali is a board certified orthopedic spine surgeon trained in the diagnosis as well as the treatment of
non-operative and operative spinal disorders. Dr. Ali practices in the far western and southwestern
suburbs of Chicago and utilizes surgery as a last resort when all other non-operative treatments have
failed to relieve pain and/or reduce risk of nerve damage/injury. All recommendations on this site are for
general situations and a particular situation requires evaluation before specific treatment recommendations
can be made.