Everyone experiences back pain at some time in their life. In fact, it is in the top three complaints that people bring to the doctor’s office. In most cases there is soft tissue inflammation, muscle spasms, or degenerative arthritis. These respond well to conservative treatments such as anti-inflammatory medicines, stretches, and osteopathic manipulative therapy. Physical modalities such as heat or cold, massage, and acupuncture are also helpful. So when should you worry? Any loss of bowel or bladder control needs immediate attention. Surgery can release the pressure on the nerves and full function usually returns. The longer the loss of bladder or bowel control continues without treatment, the higher the risk of permanent damage. This also includes weakness of any muscles in the legs or feet. Plus you can reduce the risks of falls and fractures. Contrary to popular opinion, a thorough history, neurological and structural exams, plus basic X-rays of the spine can diagnose the problem 80-90% of the time. Expensive MRI studies certainly can be helpful looking at the cross-sections of the spine into the discs and spinal cord. But, in most cases it will not change the eventual conservative treatment anyway. Consider an MRI if surgery is likely. Certainly if there is no improvement in your symptoms after several weeks or there is worsening of your pain. Besides the obvious causes of low back pain from muscle spasms, degenerative discs and osteoarthritis, chronic structural imbalances play a major role. Wear and tear to the spine from old trauma, sports, and obesity cause the discs to lose their cushioning ability. They also may bulge or protrude backwards. Over 50 years of age almost everyone has changes I the discs loosing height and acquiring some bone spurs. However, not everyone has pain. Again, unless the nerve root coming out of the spinal cord or the spinal cord itself is squeezed, surgery will not help. Even radiating leg pain called sciatica along with numbness and tingling in the legs can go away over time with proper treatment that includes osteopathic manipulation therapy. Studies show that back pain sufferers who have surgery have no better pain relief or function than those who didn’t have surgery after five years passed. Certainly if surgery is recommended it is wise to get a second opinion.