What it is
Low back pain is one of the most common reasons adults see a doctor. It can arise from muscles and ligaments, the discs between vertebrae, the small joints of the spine, or compressed nerves — and each source calls for a different plan. The majority of episodes improve within weeks with the right conservative care.
Common symptoms
- Persistent aching or stiffness in the lower back
- Pain that worsens with movement, standing, or sitting
- Sharp pain with bending or lifting
- Pain radiating into the buttock or leg (see sciatica)
- Stiffness that improves as you move through the day
Why it happens
Common causes include muscle strain, degenerative disc changes, arthritis of the facet joints, disc herniation, spondylolisthesis (a shifted vertebra), and spinal stenosis. Age, occupation, activity level, and overall conditioning all play a role. Importantly, degenerative findings on MRI are common even in people with no pain — which is why symptoms and examination, not just the scan, drive the diagnosis.
How Dr. Pompliano evaluates it
Every evaluation starts with listening — a detailed history of your symptoms, how they behave, and how they limit your life — followed by a focused physical and neurological examination and a careful review of your imaging. The diagnosis drives the plan, not the other way around.
Treatment: conservative first
Most patients with this condition improve without surgery. Depending on your specific situation, a plan may include:
- Physical therapy & targeted exercise: the foundation of almost every back pain plan — core strengthening, mobility, and graded return to activity
- Activity modification: short-term adjustment, not bed rest — staying active speeds recovery
- Anti-inflammatory strategies: medication when appropriate, used briefly and purposefully
- Injections: targeted epidural or facet injections when a specific pain generator is identified
- Complementary approaches: yoga, strength training, acupuncture, and chiropractic care can all play a role
Surgery is recommended only when symptoms persist despite a genuine course of conservative care, or when there are signs of progressive nerve or spinal cord compromise.
When surgery makes sense
Surgery for back pain is reserved for clearly identified structural problems — instability such as spondylolisthesis, nerve compression with progressive symptoms, or deformity — after conservative care has been genuinely tried. When it's indicated, minimally invasive and motion-sparing options are considered first.
Related procedures: Microdiscectomy · Decompression · TLIF · ALIF · XLIF