Understanding Back Pain: A Spine Surgeon’s Guide to Relief and Recovery

If you’re reading this, chances are you or someone you love is dealing with back pain. I want you to know: you are not alone, and there is reason to feel hopeful.

In my three decades treating patients here in the DFW area, from weekend warriors who tweaked something coaching youth baseball in Hurst to grandparents who threw out their back lifting a grandchild in Arlington, I have seen just about every kind of back pain there is. And if there is one thing I’ve learned, it is this: understanding your back pain is the single most important step toward getting better.

Back pain is one of the most common health complaints on the planet. Studies consistently show that 50% to 80% of adults will experience at least one episode of back pain during their lifetime. According to the Centers for Disease Control and Prevention, approximately 24.3% of U.S. adults reported chronic pain in 2023, with back pain being among the leading causes. Globally, roughly 619 million people experienced low back pain in 2020, and the World Health Organization has identified it as the leading cause of disability worldwide.

Those numbers can sound overwhelming. But here is the part that should give you real comfort: the vast majority of back pain is treatable, manageable, and in many cases completely resolvable without surgery. As a spine surgeon, my very first goal when a patient walks into my office in North Texas is to figure out how we can get them better without an operation. Surgery is a tool in the toolbox, but it is rarely the first one I reach for.

In this guide, I am going to walk you through everything you need to know about back pain: what causes it, when to worry, what treatments actually work, and when surgery might be the right choice. Whether you are a desk worker in Irving, a construction professional in Fort Worth, or a retiree enjoying the lake life at Eagle Mountain, this article was written with you in mind.

Let’s get started.

What Causes Back Pain? Understanding the Most Common Culprits

One of the first questions every patient asks me is, “Why does my back hurt?” The answer, as you might expect, depends on the individual. The spine is a beautifully complex structure: a column of 33 vertebrae, cushioned by gel-like discs, supported by muscles and ligaments, and threaded through with the delicate nerves of the spinal cord. When any part of this intricate system is irritated, strained, or damaged, pain is often the result.

Here are the most common causes of back pain I see in my practice:

Muscle Strains and Ligament Sprains

This is far and away the most common cause of back pain, and I see it constantly here in Texas. You spent the weekend helping a friend move. You overdid it in the garden during spring planting season. You twisted awkwardly while reaching for something in the back of your truck. Maybe you went all-out at your son’s flag football game without warming up first.

Muscle strains and ligament sprains happen when the soft tissues that support the spine get overstretched or torn. The pain can be intense, sometimes enough to take your breath away, but the good news is that these injuries almost always heal on their own within a few days to a few weeks with rest, gentle movement, and over-the-counter pain relief.

Herniated or Bulging Discs

Think of the discs between your vertebrae as little jelly doughnuts. They have a tough outer shell (the annulus fibrosus) and a soft, gel-like center (the nucleus pulposus). A bulging disc is like that doughnut getting squished so it puffs out to one side. A herniated disc is when the outer shell actually tears and some of the jelly leaks out.

When disc material presses against a nearby spinal nerve, it can cause not only back pain but also pain, numbness, or tingling that radiates down into the leg. This is one of the most common causes of sciatica, which I will discuss in detail shortly.

The spine is made up of vertebrae cushioned by intervertebral discs, with nerve roots branching out at each level.

Degenerative Disc Disease

Despite its somewhat alarming name, degenerative disc disease is not really a “disease” at all. It is the natural process of age-related wear and tear on the spinal discs. After about age 40, the discs start to lose water content and become less flexible, which can lead to stiffness, aching, and reduced mobility. Almost everyone over 60 shows some degree of disc degeneration on imaging, and many of those people have no pain at all. It is a very normal part of aging.

Spinal Stenosis

Spinal stenosis is a narrowing of the spinal canal, the bony tunnel that houses the spinal cord and nerves. This narrowing can squeeze the nerves, causing pain, numbness, and weakness, particularly in the legs. It is most common in people over 50 and often develops gradually. Patients frequently tell me, “I can walk about a block, and then my legs start going numb.” If that sounds familiar, spinal stenosis may be a factor.

Spondylolisthesis

This is a condition where one vertebra slips forward over the one below it. It can be caused by age-related degeneration, a stress fracture, or sometimes a congenital abnormality. Depending on the degree of slippage, it can cause low back pain, stiffness, and nerve compression symptoms.

Osteoarthritis of the Spine

Just as arthritis can affect your knees and hips, it can affect the small joints of the spine called facet joints. Facet joint arthritis is a very common cause of chronic low back pain, particularly in older adults. The pain tends to be worse in the morning, after sitting for long periods, or with extension movements like bending backward.

Compression Fractures

In patients with osteoporosis, particularly postmenopausal women, vertebral bodies can develop small fractures even from minimal trauma like bending over or coughing. These compression fractures can cause sudden, sharp back pain and are more common than many people realize.

Less Common Causes

While rare, back pain can also be caused by spinal infections, tumors, or inflammatory conditions such as ankylosing spondylitis. These conditions are uncommon, but they are important reasons why persistent or unusual back pain should always be evaluated by a healthcare professional.

Lifestyle Factors That Increase Back Pain Risk

Beyond structural causes, certain lifestyle factors significantly increase your risk of developing back pain:

• Obesity: Excess weight places additional stress on the lumbar spine and accelerates disc degeneration.
• Sedentary work: Sitting for prolonged periods, especially with poor posture, weakens the core muscles that support the spine. With so many DFW-area professionals working desk jobs, this is a concern I raise with patients daily.
• Smoking: This is a big one that surprises many patients. Research has shown that current smokers have a significantly higher prevalence of back pain (36.9%) compared to never-smokers (23.5%). Smoking reduces blood flow to the spinal discs, impairs healing, and accelerates degeneration.
• Poor posture: Whether you are hunched over a computer or a steering wheel during a long Texas commute, poor posture puts chronic strain on spinal structures.
• Physical inactivity: Muscles that are not regularly exercised become weak and unable to adequately support the spine.

Back Pain with Leg Pain: Understanding Radiculopathy and Sciatica

When patients come to see me and describe pain that shoots down their leg, my ears perk up. Back pain with leg pain tells a different story than back pain alone. It usually means a nerve is being compressed or irritated.

What Is Sciatica?

Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. It is typically caused by a herniated disc, bone spur, or spinal stenosis pressing on the nerve root. The hallmark of sciatica is a shooting, burning, or electric-shock-like pain that travels from the low back or buttock down the back of the leg, sometimes all the way to the foot.

Here is something that often surprises patients: with a true lumbar radiculopathy (the medical term for a compressed nerve root in the lower back), the leg pain is frequently worse than the back pain itself. Some patients have severe leg pain with very little back pain at all.

Symptoms of Nerve Root Compression

In addition to pain, a compressed nerve can cause:

• Numbness in the leg, foot, or toes
• Tingling or a “pins and needles” sensation
• Weakness in the affected leg, for example, difficulty lifting the foot (called foot drop) or rising onto your toes
• Changes in reflexes that a physician can detect during an examination

Lumbar vs. Cervical Radiculopathy

While this article focuses primarily on lower back pain, it is worth noting that nerve compression can also occur in the neck (cervical spine). Cervical radiculopathy produces similar symptoms, including pain, numbness, and tingling, but in the arms and hands rather than the legs. The principles of diagnosis and treatment are similar.

The Good News: About 90% of Patients Do Not Need Surgery

I cannot tell you how many times a patient has walked into my office terrified that they are going to need surgery, only to leave with a conservative treatment plan and a tremendous sense of relief. I became a surgeon because I love helping people in the operating room, but I get just as much satisfaction when I can help someone avoid it entirely.

The truth is, our bodies are remarkably good at healing. Many disc herniations actually shrink or reabsorb on their own over time. Inflammation around compressed nerves can resolve. Muscles that are strained can recover and grow stronger. In my three decades of practice here in the Dallas–Fort Worth area, I have seen patient after patient get better with the right combination of time, therapy, and self-care.

That is not to say you should ignore your pain. What it means is that there is very good reason to be optimistic, and that a careful, stepwise approach to treatment is almost always the best path forward.

Conservative Treatments That Work: Back Pain Relief Without Surgery

When I develop a treatment plan with a patient, we typically start with conservative, non-surgical approaches and give them a genuine chance to work. Here are the treatments with the best evidence behind them:

Physical Therapy

If I could only recommend one treatment for back pain, it would be physical therapy. Hands down. A skilled physical therapist can assess your movement patterns, identify weak or tight areas, and design a program specifically tailored to your condition. Research consistently shows that physical therapy leads to significant improvements in pain and function for the majority of back pain patients, and it reduces the overall costs of treatment substantially.

Physical therapy is not just about “doing exercises.” A good therapist will also teach you how to move safely, how to lift correctly, how to protect your spine during daily activities, and how to build the core stability that prevents future episodes.

Author

Dr. Robert Myles Board Certified Orthopedic Surgeon & Fellowship Trained Spine Surgeon