5 Greatest Back Pain Tips from Spine Experts

Last fall I drove through Hurricane Ian to attend a spine conference. Top spine surgeons and back pain specialists from the Southeast U.S. headlined the event.

Here are the key takeaways, the 5 greatest back pain tips from spine experts.

1. Get Physical Therapy First

Physical therapy is the best 1st step for most back pain episodes, according to the spine surgeons. PT comes first before imaging (X-Rays, MRIs), and definitely prior to injections or surgery.

Time and conservative treatment resolve most back pain. Getting extra medical treatment doesn’t necessarily lead to faster pain relief. Extraneous treatment drives up medical costs and actually delays recovery in some cases.

2. Wait for an MRI

“Don’t order an MRI in the first 15 minutes.”

The most memorable quote of the conference, in my opinion.

The spine experts advised 6 weeks of conservative treatment (like physical therapy) prior to getting an MRI.

And for good reason – early MRIs correlate to worse outcomes, more aggressive interventions and higher treatment costs (Webster 2013).

Sure, immediate MRI is indicated in ultra-rare, emergency situations. But not for garden-variety back pain. And especially for acute, non-traumatic back pain that 80% of the population experiences during their lifetime.

One drawback of imaging – it’s hard to correlate symptoms and MRI (or X-Ray) findings. Learn what the research says about spinal imaging in this article: 

Why Bulging Discs Are No Big Deal (Usually)

3. Screen for Red Flags

“Red flags” don’t just tell you when your online dating match is hiding something. They also indicate when a serious medical problem is masquerading as back pain.

Sussing out serious issues is doubly important for spine physicians – to maximize patient health and reduce their medical malpractice liability.

Warning sign in red. Screen for red flags #3 back pain tips from spine experts

Some examples of red flags (for your spine, not your Tinder match): fever, chills, unrelenting pain, loss of bladder control and bilateral leg numbness.

Red flag screening is one instance when X-Rays and MRIs are valuable for back pain management. Imaging can catch the rare cases of serious medical problems masquerading as back pain.

Examples include spinal cord compression, fractures, tumors, and infection.

Wise back pain sufferers report unusual symptoms to their physician and PT, who are trained to understand when additional red flag screening is warranted.

The first 3 back pain tips from spine experts are non-invasive. And it’s no coincidence; the vast majority of spine pain resolves without injections or surgery.

4. Find the Pain Generator

Before surgery, spine surgeons aim to identify the pain-generating structure.

These experts recognize that bulging discs and arthritis are normal spinal imaging findings.

Therefore, surgeons want to ensure they operate on the correct area in the rare cases that back pain requires surgery. 

To identify the pain-generating region, spine physicians employ diagnostic injections and attempt to match MRI and X-Ray findings to the patient’s symptoms. No easy task!

Some experts believe they can identify the anatomical cause of low back pain with 10% luck, 20% skill and 15% concentrated power of will.

Other experts disagree, citing research that shows 85% of low back pain is “non-specific” and can’t be linked to a specific spinal structure. 

Identifying pain-generating activities is equally important as finding painful anatomical structures, especially during physical therapy.

By understanding what provokes your pain, your PT can prescribe a pain-relieving McKenzie exercise and optimize your exercise program.

5. The Last Resort

The last of the back pain tips from spine experts: reserve surgery for emergencies or as the last resort for severe back pain. 

Spine surgery is a legitimate option if everything else has failed. (By the way, “everything else” I don’t mean an ice pack, a tube of CBD cream and 3 random stretches from YouTube).

For non-emergency spine pain, surgery only makes sense if it hasn’t healed with time, the best PT treatments, exercise, medications, injections, nerve ablations and cognitive-behavioral therapy.


There you have it, the 5 greatest back pain tips from spine experts – get PT first, don’t rush to get an MRI, screen for red flags, identify the pain generator and consider surgery as a last resort.

For more expert health tips, join the free Facts & Physio Newsletter. Plus, get The Recovery Checklist e-book and learn 18 proven recovery strategies when you sign up.

Dr. Jacob Forsythe, PT, DPT, OCS, CMTPT

Dr. Jacob Forsythe, PT, DPT, OCS, CMTPT

Jacob failed PT multiple times, inspiring him to become a physical therapist and improve the profession. Jacob's academic background includes a Bachelor of Science in Exercise Science and Doctor of Physical Therapy. He completed an orthopedics residency program and he is a certified Orthopedic Clinical Specialist (OCS). His passions include golf, powerlifting, and empowering clients to overcome pain.

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5 Greatest Back Pain Tips from Spine Experts

Last fall I drove through Hurricane Ian to attend a spine conference. Top spine surgeons and back pain specialists from the Southeast U.S. headlined the