December 6, 2025 • 17 mins
This episode decodes back pain with practical, clinically aligned clues that help you separate simple strains from disc issues, stenosis, referred kidney pain, and the rare but serious conditions that need urgent care. Instead of guessing, we map a clear framework for diagnosing patterns, avoiding unnecessary imaging, and using daily biomechanics to speed recovery and prevent recurrence.
We start by distinguishing mechanical vs. referred pain, then break down the most common causes: muscular strains from overload or poor lifting technique; arthritis and fractures in older adults or those with osteoporosis risk; hallmark signs of disc protrusion and sciatica; and the classic pattern of spinal stenosis, often relieved by leaning forward. We also highlight when back pain signals something outside the spine—such as kidney infections marked by fever and flank pain, or fibromyalgia and inflammatory back pain that follow distinct profiles.
You’ll learn the essential red flags that require immediate medical attention, when imaging actually matters, and realistic timelines for conservative recovery. We close with a prevention blueprint built on posture, sleep, core strength, proper lifting technique, supportive footwear, and long-term bone health.
High-volume keywords used: back pain, sciatica, spinal stenosis, disc injury, red flags, osteoporosis, biomechanics, recovery
Listener Takeaways
- How to distinguish mechanical vs. referred back pain
- Clues for strains, disc issues, stenosis, and kidney-related pain
- Red flags that require urgent evaluation
- When imaging helps—and when it doesn’t
- Daily biomechanics that prevent trouble and speed recovery
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This podcast is created by Ai for educational and entertainment purposes only and does not constitute professional medical or health advice. Please talk to your healthcare team for medical advice.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:00):
Welcome back to the deep dive.
Today we are taking on a topicthat is statistically pretty
much guaranteed to affect everysingle person listening at some
point.
SPEAKER_00 (00:09):
Oh, definitely.
SPEAKER_01 (00:10):
Back pain.
It is just so incredibly common.
But when it happens to you, thesheer confusion about, you know,
what's actually wrong can becompletely overwhelming.
SPEAKER_00 (00:20):
Aaron Powell It really can.
It's the most common reason fordisability globally, and I think
the mystery surrounding it ishalf the battle.
For this deep dive, we pulled areally detailed review from
Harvard Health Publishing.
SPEAKER_01 (00:33):
Okay.
SPEAKER_00 (00:34):
And this source, it just cuts through the noise and
helps us categorize the type ofpain we're experiencing.
SPEAKER_01 (00:39):
Aaron Powell Right.
So let's unpack this.
Our mission today feels prettycritical.
We want to move beyond justthat, you know, generalized
discomfort and give you theknowledge to understand the
specific clues your body issending.
Trevor Burrus, Jr.
SPEAKER_00 (00:51):
From the totally benign strain to the rare but
critical red flag symptoms.
SPEAKER_01 (00:55):
Trevor Burrus The goal here is actionable,
realistic steps you can actuallytake for prevention and
treatment.
SPEAKER_00 (01:01):
Aaron Powell And we have to start with a crucial and
I think slightly unsettling factfrom the source.
A lot of the time, when someonegoes to the doctor with back
pain, even after a bunch oftests, a specific anatomical
source-like a clear structuralreason for the pain, it just
can't be identified.
SPEAKER_01 (01:18):
Aaron Powell So wait, you're saying the pain is
very real, but the diagnosticprocess doesn't always point to
a clear physical why.
SPEAKER_00 (01:25):
That's exactly right.
And that's why the history, thesymptom profile, is just so
important.
But when we do find a cause, wecategorize it.
We look at pain that comesdirectly from the back itself.
Trevor Burrus, Jr.
SPEAKER_01 (01:35):
The mechanical stuff.
SPEAKER_00 (01:36):
Aaron Powell Yeah, the mechanical pain, muscles,
bones, nerves.
And then we look at what'scalled referred pain.
SPEAKER_01 (01:41):
Aaron Powell, which is pain from somewhere else
entirely.
SPEAKER_00 (01:43):
Trevor Burrus, Jr.: Right.
An issue with an organ, forexample, that just manifests as
back pain.
SPEAKER_01 (01:47):
Yeah.
SPEAKER_00 (01:48):
And making that distinction is, well, it's
fundamental.
SPEAKER_01 (01:50):
So let's start there with the most likely scenario
for our listeners.
What are the common culprits?
What's the reason their backjust decides to revolt?
SPEAKER_00 (01:58):
Aaron Powell It's almost always muscular or uh
related to overload.
The classic back sprain orstrain.
Right.
It's purely mechanical.
It comes from sudden stress,twisting the wrong way, lifting
something improperly.
That's short-term overload.
Then there's chronic overload.
Aaron Powell, which would bethings like obesity or even the
temporary chronic overload yousee in late-stage pregnancy.
(02:20):
Trevor Burrus, Jr.
SPEAKER_01 (02:20):
That's the classic I spend all Saturday lifting heavy
boxes, I shouldn't have injury.
SPEAKER_00 (02:24):
Precisely.
But you know, pain isn't justabout an acute injury.
Sometimes it's structural wearand tear.
SPEAKER_01 (02:30):
Like arthritis.
SPEAKER_00 (02:31):
Exactly.
Degenerative arthritis isextremely common.
It's that age-related genetic,you know, wear and tear process
in the joints of the spine.
We also have to think aboutfractures.
SPEAKER_01 (02:42):
From an accident.
SPEAKER_00 (02:43):
Either from trauma?
Sure, or from osteoporosis, thebone thinning disease.
SPEAKER_01 (02:47):
And we should probably pause on osteoporosis.
The source emphasizes it'sreally common in postmenopausal
women, but it affects older mentoo.
So what's the mechanism there?
Is it the disease itself thathurts or something else?
SPEAKER_00 (03:00):
That's a great question.
It's the resulting fractures.
When bones get porous, reallysimple things, minor falls, even
a strong cough sometimes, cancause what are called
compression fractures in thevertebrae.
SPEAKER_01 (03:13):
And that would be incredibly painful.
SPEAKER_00 (03:15):
Extremely painful.
And it's obviously a structuralissue that needs intervention.
SPEAKER_01 (03:19):
Okay, let's get to the thing I think everyone
dreads.
Nerve issues.
We hear terms like slipped discall the time.
Can you sort of clarify the twomain nerve problems?
SPEAKER_00 (03:30):
Sure.
So first we look at the disc.
That's the fibrous cushion thatsits between your vertebrae.
If it protrudes or bulges out,the slipped disc.
Right, that's the common term.
It can press on a spinal nerve,and that causes intense pain
locally, but also pain thatradiates down a limb.
The other major issue is spinalstenosis.
Which means it literally meansnarrowing.
(03:50):
The space inside the spinalcanal where all the nerves
travel, it gets narrower, andthat puts pressure on the spinal
cord and nerves.
SPEAKER_01 (03:57):
Okay, so that's the mechanical breakdown.
But you mentioned non-spinalcauses.
Before we get into symptoms,what kind of organ issues can
fool us into thinking it's ourback?
SPEAKER_00 (04:06):
The most common examples of this referred pain
are kidney stones or a kidneyinfection, which is called
pylonephritis.
SPEAKER_01 (04:13):
Why the kidneys?
SPEAKER_00 (04:15):
Just because of where they're located.
They're up high in the flankarea, protected by your lower
ribs, so any problems there arefelt really intensely in the
back.
People often think they've justpulled a muscle.
SPEAKER_01 (04:25):
And just to round out the picture, what are those
rare but really important causeswe should know about?
SPEAKER_00 (04:30):
Well, these are always screened for, even if
they're rare, just because ofhow serious they are.
Certain types of inflammatoryarthritis like ankle losing
spondylitis, an infection in thedisc space or bone.
SPEAKER_01 (04:42):
Which you said is rare.
SPEAKER_00 (04:43):
Rare but urgent, yes.
And crucially, a tumor, either aprimary spinal tumor or cancer
that has spread or metastasizedto the bone.
SPEAKER_01 (04:53):
Aaron Powell Okay.
That sets the stage perfectlyfor decoding the pain itself.
This is where it gets reallyinteresting because the type of
pain is often a betterdiagnostic tool than an initial
x-ray, right?
SPEAKER_00 (05:02):
Aaron Powell Oh, absolutely.
And we have to start with thecritical red flags.
These are the symptoms that, youknow, they override everything
else and demand immediatemedical attention.
We're talking an emergency roomvisit.
SPEAKER_01 (05:11):
Aaron Powell So what are these non-negotiable red
flags?
SPEAKER_00 (05:13):
Aaron Powell It's a pretty focused list.
Any back pain that comes with ahigh fever or shaking chills,
that suggests infection.
SPEAKER_01 (05:21):
Okay.
SPEAKER_00 (05:21):
Pain that follows a recent significant trauma, a car
accident, a bad fall,unexplained, unintentional
weight loss, especially whenit's combined with that
consistent back pain.
SPEAKER_01 (05:33):
Aaron Powell A history of cancer, too, I
imagine.
SPEAKER_00 (05:35):
Aaron Powell A known history of cancer is a big one.
And finally, any newneurological symptoms.
So sudden or increasingnumbness, rapid muscle weakness,
difficulty walking, or, and thisis the most critical, one new
onset of incontinence.
SPEAKER_01 (05:48):
So losing control of your bladder or bowel.
SPEAKER_00 (05:51):
Exactly.
If you have any of those, you donot wait.
You go.
SPEAKER_01 (05:54):
That provides some really necessary caution.
So now let's go back to the morecommon stuff.
How do I tell if my ache is justa simple strain or if I've
actually messed up a disc?
SPEAKER_00 (06:03):
Aaron Powell A simple sprain or strain, what we
call a lumbosacral strain.
It's predictable.
The pain typically begins theday after the heavy exertion or
the twisting.
SPEAKER_01 (06:13):
Oh, so it's delayed.
SPEAKER_00 (06:14):
It's a delayed inflammation, yeah.
You feel this localizedsoreness, stiffness, and the
back is tender right when youpress on the muscle, but it
pretty much stays contained toyour back.
SPEAKER_01 (06:24):
So if the pain doesn't really kick in until I
wake up the next morning, that'sa pretty good sign.
It's just a muscle strain.
SPEAKER_00 (06:30):
It is a very strong indicator, yes.
Now contrast that with aprotruding disc.
If that disc is big enough topress on a nerve, which often
leads to sciatica.
Right.
The pain is severe in the lowerback, but the signature symptom
is that it shoots down one leg,sometimes all the way to your
foot.
SPEAKER_01 (06:45):
And what makes that worse?
SPEAKER_00 (06:47):
Bending, twisting, sometimes even just sitting.
Because those movements all putinternal pressure on the disc,
making that protrusion worse.
SPEAKER_01 (06:54):
So that radiating pain, that's the real hallmark
of nerve involvement, not just atight muscle.
SPEAKER_00 (07:00):
Precisely.
Now compare that radiating painto spinal stenosis, the
narrowing of the canal.
Stenosis has this incrediblediagnostic profile.
SPEAKER_01 (07:09):
How so?
SPEAKER_00 (07:10):
The pain, the numbness, the weakness in the
back and the legs, it getsdramatically worse when you
stand or walk.
But, and here's the massive clueit is reliably relieved by
sitting down or leaning forward.
SPEAKER_01 (07:24):
Why does leaning forward help so much?
That feels like the opposite ofwhat you'd want to do for a
backache.
SPEAKER_00 (07:29):
It does, but when you lean forward, you slightly
flex your lumbar spine.
And that action physically opensup the spinal canal just a
little bit.
It gives the compressed nervesmore room.
SPEAKER_01 (07:40):
Ah, so it's a mechanical relief.
SPEAKER_00 (07:41):
It's the aha moment.
If leaning on a shopping cart ora bicycle relieves your pain,
stenosis is very, very likely.
SPEAKER_01 (07:48):
That's a perfect contrast.
Okay, what about othercategories of pain?
Like chronic issues versusinflammatory ones.
How does something likefibromyalgia present?
SPEAKER_00 (07:57):
Aaron Powell Fibromyalgia is different again.
It's more of a generalizedgnawing ache.
It's not localized to one spotand it's often worse than the
morning.
Key features beyond just painare feeling profoundly tired and
having these specific spotscalled tender points that are
acutely painful when you pressthem.
SPEAKER_01 (08:13):
So it's a whole body pain and fatigue thing.
SPEAKER_00 (08:15):
Aaron Powell It's a widespread pain and fatigue
syndrome, yes.
SPEAKER_01 (08:17):
Aaron Powell Now for that paradox we mentioned
earlier, inflammatory arthritis,like ankle losing spondylitis.
What makes its pain profile sounique?
SPEAKER_00 (08:27):
This is where we shift from mechanical pain to
inflammatory pain.
With ankle losing spondylitis,you get lower back pain combined
with severe morning stiffness.
But the paradox is, unlike astrained muscle or a worn joint
that hates movement.
SPEAKER_01 (08:42):
This pain gets better with exercise.
SPEAKER_00 (08:44):
It actually improves with exercise, yes.
SPEAKER_01 (08:46):
Aaron Powell, so if a listener has stiffness that
lasts, say more than an hourafter they wake up, but it gets
better the more they movearound, that's a huge
distinction.
Why does movement help?
SPEAKER_00 (08:54):
With these inflammatory conditions, the
fluid in the joints and the softtissues, they get kind of sticky
and stiff overnight.
It's a process sometimes calledgelling.
SPEAKER_01 (09:02):
Gelling.
SPEAKER_00 (09:03):
Yeah.
And exercise breaks up thatgelling, and that reduces the
inflammatory pain and thestiffness.
It tells a doctor immediatelythey're looking at something
autoimmune or inflammatory, notjust simple wear and tear.
SPEAKER_01 (09:14):
Okay, finally, let's revisit those more serious
issues.
What about cancer in the spinalbones?
What makes that pain stand out?
SPEAKER_00 (09:22):
Cancer pain in the spine is often described as
consistent.
It's not something that hurtswhen you lift something and then
stops when you sit down.
It's it's just there.
SPEAKER_01 (09:30):
And it gets worse.
SPEAKER_00 (09:31):
Sometimes progressively worsening, and
crucially, it may actually getworse when you're lying down at
night.
That combination persistent,non-mechanical pain that
disturbs your sleep, that is adefinite red flag.
SPEAKER_01 (09:43):
And the referred kidney pain, pylonephritis, how
do we tell that apart from anormal backstream?
SPEAKER_00 (09:48):
The kidney pain is sudden and intense, and it's
located high up in the flank,just under the ribs and the
back, and it travels often downtoward the groin or abdomen.
SPEAKER_01 (09:56):
It's not just pain.
SPEAKER_00 (09:57):
Never.
It comes with systemic illness.
High fever, shaking chills,nausea, and changes in urination
burning, urgency, cloudy urine.
That high fever with thatspecific flank pain means kidney
infection until provenotherwise.
SPEAKER_01 (10:12):
This whole symptom decoding process really proves
that understanding the contextof the pain, when it starts,
what makes it better, what othersymptoms are there, that is
really the deep dive here.
SPEAKER_00 (10:24):
Absolutely.
It is.
SPEAKER_01 (10:25):
Okay, let's move into diagnosis and timeline.
If you take this pain profile toyour doctor, what happens next?
And you know, how long shouldyou expect this thing to last?
SPEAKER_00 (10:34):
Aaron Powell Well, the initial diagnosis is like
80% reliant on your medicalhistory and the physical exam.
SPEAKER_01 (10:40):
Aaron Powell So just talking and a few simple tests.
SPEAKER_00 (10:42):
Exactly.
The doctor will ask about allthe things we just discussed and
then do specific tests.
For example, the straight legraise test, where they raise
your straightened leg while youlie flat that can reproduce the
pain that radiates down the leg.
SPEAKER_01 (10:54):
Aaron Powell Which suggests a disc problem.
SPEAKER_00 (10:56):
Strongly suggests a disc problem, yes.
So they're confirming thosesymptomatic clues physically.
SPEAKER_01 (11:01):
Got it.
SPEAKER_00 (11:02):
This is another point of comfort, I think.
For most minor cases, a musclestrain, pain from obesity or
pregnancy, you usually won'tneed immediate x-rays or complex
imaging.
The initial plan is conservativecare.
SPEAKER_01 (11:14):
So when do they start ordering the big tests
then?
SPEAKER_00 (11:17):
Testing, like x-rays, MRIs, blood work.
It's generally reserved for twoscenarios.
First, if the doctor suspectsone of those red flag causes we
talked about.
Of course.
Or second, if the back pain justpersists for longer than 12
weeks.
That's the benchmark for chronicpain.
If it's truly persistent, theyneed to look deeper.
SPEAKER_01 (11:37):
And if they do need to look deeper, what's on the
menu, so to speak?
SPEAKER_00 (11:41):
Uh, standard imaging would be X-rays, MRI, or CT
scans.
They might order blood or urinetests if they suspect an
infection or inflammation.
If nerve compression is aquestion, nerve conduction
studies can actually measure howfast signals are traveling
through the nerves.
SPEAKER_01 (11:57):
And for specific cases.
SPEAKER_00 (11:58):
Right.
If the patient has a history ofcancer, they might use
specialized imaging like a bonescan or a PE scan to look for
any metastasis.
SPEAKER_01 (12:06):
I think setting expectations for recovery is so
vital for morale.
What are the typical timelinespeople should have in mind?
SPEAKER_00 (12:12):
For the most common issue, a simple strain or
overexertion, the symptomsusually subside over days or a
few weeks.
You just have to graduallyreturn to activity.
SPEAKER_01 (12:21):
What about pregnancy-related pain?
SPEAKER_00 (12:23):
Oh, that, thankfully, resolves almost
universally after delivery.
For infections likepylonephritis, you feel better
within days of startingantibiotics, but you absolutely
must complete the full course.
SPEAKER_01 (12:35):
And for those tougher structural or nerve
issues like stenosis or apersistent disc problem.
SPEAKER_00 (12:42):
Those are the challenges.
If the cause is structural orinvolves nerve compression, the
pain can be persistent.
It could last for months or evenyears.
And this is why addressing thebiomechanics through things like
physical therapy becomes socritical.
SPEAKER_01 (12:56):
Which brings us perfectly to our last section:
taking control.
Given that the prognosis is sogood for most people with just
conservative care, what are themost effective, actionable steps
we can implement now to preventthis in the first place?
SPEAKER_00 (13:09):
Prevention really boils down to respecting your
spine's natural alignment.
Good posture is justfoundational, sitting or
standing.
SPEAKER_01 (13:15):
And sleeping.
SPEAKER_00 (13:16):
When you sleep, if you're a back sleeper, put a
pillow under your knees.
It helps flatten the lumbarcurve, eases the strain.
Side sleepers should put apillow between their knees to
keep the hips and spine aligned.
SPEAKER_01 (13:26):
We hear strengthen your core constantly.
Why is that the magic phrase forback health?
SPEAKER_00 (13:33):
Because your core acts like a natural corset for
your entire torso.
Strong abdominal musclesstabilize the spine from the
front, and that takes pressureoff the muscles and ligaments in
the back.
SPEAKER_01 (13:44):
So what's a good exercise for that?
SPEAKER_00 (13:46):
Simple abdominal crunches are key.
And for the lower back itself,low-impact movements like
walking or swimming are justexcellent for building endurance
without a lot of stress.
SPEAKER_01 (13:56):
Okay, let's nail down lifting technique.
This is where so many people gowrong.
What is the single most criticalrule?
SPEAKER_00 (14:03):
Always.
Always lift objects from asquatting position.
Use your hips and your legs, thestrongest muscles in your body,
to power the lift.
But the most dangerouscombination, the recipe for a
disc injury, is lifting,twisting, and bending at the
same time.
SPEAKER_01 (14:16):
So you have to avoid that rotation while you're
holding something heavy.
SPEAKER_00 (14:19):
You must avoid that rotational stress while under
load.
If you have to turn, move yourfeet, not your torso.
SPEAKER_01 (14:25):
That makes the mechanics really clear.
Okay, something else in thesource was footwear.
Why does the height of my shoeheel matter?
SPEAKER_00 (14:32):
It sounds so minor, doesn't it?
But footwear dramaticallyaffects your spinal alignment.
High heels, even moderate ones,they tilt your pelvis forward.
SPEAKER_01 (14:40):
Which increases the curve in your lower back.
SPEAKER_00 (14:43):
Immensely.
It puts a huge strain on thespinal joints and muscles.
The recommendation is soft-soledshoes with heels less than one
and a half inches high.
It just minimizes that unnaturaltilt.
SPEAKER_01 (14:54):
That's a great example of a non-obvious daily
adjustment.
Speaking of long-term health,what about preventing the bone
density issues that lead tofractures?
SPEAKER_00 (15:02):
Preventing osteoporosis is a lifelong
strategy.
Getting enough calcium andvitamin D every day is just
non-negotiable.
And routine weight bearing,exercise walking, lightweights,
whatever helps maintain bonedensity.
SPEAKER_01 (15:14):
And the lifestyle stuff.
SPEAKER_00 (15:15):
Avoiding smoking and limiting alcohol intake are also
essential.
SPEAKER_01 (15:19):
And a quick reminder on screening for that.
SPEAKER_00 (15:21):
Screening is recommended for all
postmenopausal women and for menaged 70 and older.
Early detection lets you makechanges that can prevent serious
fractures down the road.
SPEAKER_01 (15:30):
Okay, finally, let's wrap up treatment for that acute
minor strain.
If I wake up with pain and it'snot a red flag, what should I
do?
SPEAKER_00 (15:39):
Focus on conservative care.
A little bit of bed rest isokay, but no more than two days.
Movement is key for healing.
SPEAKER_01 (15:47):
And for the pain.
SPEAKER_00 (15:48):
Over-the-counter pain relief, like acetaminophin
or anti-inflammatories likeibuprofen, hot or cold
compresses can help soothemuscle spasms.
The key is just managing thediscomfort enough to allow a
gradual return to normalactivity.
SPEAKER_01 (16:02):
So we've established that back pain is complex, but
the prognosis is actuallyexcellent for the vast majority
of people.
SPEAKER_00 (16:08):
It is overwhelmingly positive.
More than 90% of people withback pain get better with
conservative care alone.
Only about 5% have symptoms thatlast longer than that 12-week
benchmark.
SPEAKER_01 (16:19):
And even then, it's usually not something
life-threatening.
SPEAKER_00 (16:21):
Exactly.
The underlying cause is stillusually not that serious.
SPEAKER_01 (16:24):
That encouraging statistic really underscores why
knowing those critical red flagsis so important.
So let's just review theabsolute when to call a
professionalist one last time.
SPEAKER_00 (16:34):
Okay.
If the pain is severe andincapacitating, if it followed a
significant fall or accident, ifa mild pain is just getting
worse and it sticks around formore than a week or two, or if
you notice any new neurologicalissues.
SPEAKER_01 (16:47):
The numbness, weakness, loss of control.
SPEAKER_00 (16:50):
Right.
You need a professionalevaluation.
SPEAKER_01 (16:52):
Yeah.
SPEAKER_00 (16:53):
And always, always disclose a history of cancer if
you have persistent back pain.
SPEAKER_01 (16:58):
So what does this all mean then?
Back pain isn't some mysteriouscurse.
It's a series of highly specificsignals.
The clues are right there.
What makes it better, what makesit worse, and they help you
figure out if you need an icepack or if you need immediate
medical attention.
SPEAKER_00 (17:11):
And that leads right to our final provocative thought
for you.
Given that the solution for mostback pain is preventative care
and simple conservativetreatment, well, it means the
power is largely in your hands.
So what small, often overlookeddaily ritual is it checking the
height of your shoe heels?
Is it changing your sleepingposition?
Is it consciously pausing to usethe squat lift technique?
(17:33):
What one thing could you adopttoday to move yourself out of
that small minority thatstruggles with persistent
trouble?
Often the solution isn't asilver bullet.
It's just consistent, minoradjustments to your daily
biomechanics.
And that's the most powerfulpreventative medicine of all.
Welcome back to the deep dive.
Today we are taking on a topicthat is statistically pretty
much guaranteed to affect everysingle person listening at some
point.
SPEAKER_00 (00:09):
Oh, definitely.
SPEAKER_01 (00:10):
Back pain.
It is just so incredibly common.
But when it happens to you, thesheer confusion about, you know,
what's actually wrong can becompletely overwhelming.
SPEAKER_00 (00:20):
Aaron Powell It really can.
It's the most common reason fordisability globally, and I think
the mystery surrounding it ishalf the battle.
For this deep dive, we pulled areally detailed review from
Harvard Health Publishing.
SPEAKER_01 (00:33):
Okay.
SPEAKER_00 (00:34):
And this source, it just cuts through the noise and
helps us categorize the type ofpain we're experiencing.
SPEAKER_01 (00:39):
Aaron Powell Right.
So let's unpack this.
Our mission today feels prettycritical.
We want to move beyond justthat, you know, generalized
discomfort and give you theknowledge to understand the
specific clues your body issending.
Trevor Burrus, Jr.
SPEAKER_00 (00:51):
From the totally benign strain to the rare but
critical red flag symptoms.
SPEAKER_01 (00:55):
Trevor Burrus The goal here is actionable,
realistic steps you can actuallytake for prevention and
treatment.
SPEAKER_00 (01:01):
Aaron Powell And we have to start with a crucial and
I think slightly unsettling factfrom the source.
A lot of the time, when someonegoes to the doctor with back
pain, even after a bunch oftests, a specific anatomical
source-like a clear structuralreason for the pain, it just
can't be identified.
SPEAKER_01 (01:18):
Aaron Powell So wait, you're saying the pain is
very real, but the diagnosticprocess doesn't always point to
a clear physical why.
SPEAKER_00 (01:25):
That's exactly right.
And that's why the history, thesymptom profile, is just so
important.
But when we do find a cause, wecategorize it.
We look at pain that comesdirectly from the back itself.
Trevor Burrus, Jr.
SPEAKER_01 (01:35):
The mechanical stuff.
SPEAKER_00 (01:36):
Aaron Powell Yeah, the mechanical pain, muscles,
bones, nerves.
And then we look at what'scalled referred pain.
SPEAKER_01 (01:41):
Aaron Powell, which is pain from somewhere else
entirely.
SPEAKER_00 (01:43):
Trevor Burrus, Jr.: Right.
An issue with an organ, forexample, that just manifests as
back pain.
SPEAKER_01 (01:47):
Yeah.
SPEAKER_00 (01:48):
And making that distinction is, well, it's
fundamental.
SPEAKER_01 (01:50):
So let's start there with the most likely scenario
for our listeners.
What are the common culprits?
What's the reason their backjust decides to revolt?
SPEAKER_00 (01:58):
Aaron Powell It's almost always muscular or uh
related to overload.
The classic back sprain orstrain.
Right.
It's purely mechanical.
It comes from sudden stress,twisting the wrong way, lifting
something improperly.
That's short-term overload.
Then there's chronic overload.
Aaron Powell, which would bethings like obesity or even the
temporary chronic overload yousee in late-stage pregnancy.
(02:20):
Trevor Burrus, Jr.
SPEAKER_01 (02:20):
That's the classic I spend all Saturday lifting heavy
boxes, I shouldn't have injury.
SPEAKER_00 (02:24):
Precisely.
But you know, pain isn't justabout an acute injury.
Sometimes it's structural wearand tear.
SPEAKER_01 (02:30):
Like arthritis.
SPEAKER_00 (02:31):
Exactly.
Degenerative arthritis isextremely common.
It's that age-related genetic,you know, wear and tear process
in the joints of the spine.
We also have to think aboutfractures.
SPEAKER_01 (02:42):
From an accident.
SPEAKER_00 (02:43):
Either from trauma?
Sure, or from osteoporosis, thebone thinning disease.
SPEAKER_01 (02:47):
And we should probably pause on osteoporosis.
The source emphasizes it'sreally common in postmenopausal
women, but it affects older mentoo.
So what's the mechanism there?
Is it the disease itself thathurts or something else?
SPEAKER_00 (03:00):
That's a great question.
It's the resulting fractures.
When bones get porous, reallysimple things, minor falls, even
a strong cough sometimes, cancause what are called
compression fractures in thevertebrae.
SPEAKER_01 (03:13):
And that would be incredibly painful.
SPEAKER_00 (03:15):
Extremely painful.
And it's obviously a structuralissue that needs intervention.
SPEAKER_01 (03:19):
Okay, let's get to the thing I think everyone
dreads.
Nerve issues.
We hear terms like slipped discall the time.
Can you sort of clarify the twomain nerve problems?
SPEAKER_00 (03:30):
Sure.
So first we look at the disc.
That's the fibrous cushion thatsits between your vertebrae.
If it protrudes or bulges out,the slipped disc.
Right, that's the common term.
It can press on a spinal nerve,and that causes intense pain
locally, but also pain thatradiates down a limb.
The other major issue is spinalstenosis.
Which means it literally meansnarrowing.
(03:50):
The space inside the spinalcanal where all the nerves
travel, it gets narrower, andthat puts pressure on the spinal
cord and nerves.
SPEAKER_01 (03:57):
Okay, so that's the mechanical breakdown.
But you mentioned non-spinalcauses.
Before we get into symptoms,what kind of organ issues can
fool us into thinking it's ourback?
SPEAKER_00 (04:06):
The most common examples of this referred pain
are kidney stones or a kidneyinfection, which is called
pylonephritis.
SPEAKER_01 (04:13):
Why the kidneys?
SPEAKER_00 (04:15):
Just because of where they're located.
They're up high in the flankarea, protected by your lower
ribs, so any problems there arefelt really intensely in the
back.
People often think they've justpulled a muscle.
SPEAKER_01 (04:25):
And just to round out the picture, what are those
rare but really important causeswe should know about?
SPEAKER_00 (04:30):
Well, these are always screened for, even if
they're rare, just because ofhow serious they are.
Certain types of inflammatoryarthritis like ankle losing
spondylitis, an infection in thedisc space or bone.
SPEAKER_01 (04:42):
Which you said is rare.
SPEAKER_00 (04:43):
Rare but urgent, yes.
And crucially, a tumor, either aprimary spinal tumor or cancer
that has spread or metastasizedto the bone.
SPEAKER_01 (04:53):
Aaron Powell Okay.
That sets the stage perfectlyfor decoding the pain itself.
This is where it gets reallyinteresting because the type of
pain is often a betterdiagnostic tool than an initial
x-ray, right?
SPEAKER_00 (05:02):
Aaron Powell Oh, absolutely.
And we have to start with thecritical red flags.
These are the symptoms that, youknow, they override everything
else and demand immediatemedical attention.
We're talking an emergency roomvisit.
SPEAKER_01 (05:11):
Aaron Powell So what are these non-negotiable red
flags?
SPEAKER_00 (05:13):
Aaron Powell It's a pretty focused list.
Any back pain that comes with ahigh fever or shaking chills,
that suggests infection.
SPEAKER_01 (05:21):
Okay.
SPEAKER_00 (05:21):
Pain that follows a recent significant trauma, a car
accident, a bad fall,unexplained, unintentional
weight loss, especially whenit's combined with that
consistent back pain.
SPEAKER_01 (05:33):
Aaron Powell A history of cancer, too, I
imagine.
SPEAKER_00 (05:35):
Aaron Powell A known history of cancer is a big one.
And finally, any newneurological symptoms.
So sudden or increasingnumbness, rapid muscle weakness,
difficulty walking, or, and thisis the most critical, one new
onset of incontinence.
SPEAKER_01 (05:48):
So losing control of your bladder or bowel.
SPEAKER_00 (05:51):
Exactly.
If you have any of those, you donot wait.
You go.
SPEAKER_01 (05:54):
That provides some really necessary caution.
So now let's go back to the morecommon stuff.
How do I tell if my ache is justa simple strain or if I've
actually messed up a disc?
SPEAKER_00 (06:03):
Aaron Powell A simple sprain or strain, what we
call a lumbosacral strain.
It's predictable.
The pain typically begins theday after the heavy exertion or
the twisting.
SPEAKER_01 (06:13):
Oh, so it's delayed.
SPEAKER_00 (06:14):
It's a delayed inflammation, yeah.
You feel this localizedsoreness, stiffness, and the
back is tender right when youpress on the muscle, but it
pretty much stays contained toyour back.
SPEAKER_01 (06:24):
So if the pain doesn't really kick in until I
wake up the next morning, that'sa pretty good sign.
It's just a muscle strain.
SPEAKER_00 (06:30):
It is a very strong indicator, yes.
Now contrast that with aprotruding disc.
If that disc is big enough topress on a nerve, which often
leads to sciatica.
Right.
The pain is severe in the lowerback, but the signature symptom
is that it shoots down one leg,sometimes all the way to your
foot.
SPEAKER_01 (06:45):
And what makes that worse?
SPEAKER_00 (06:47):
Bending, twisting, sometimes even just sitting.
Because those movements all putinternal pressure on the disc,
making that protrusion worse.
SPEAKER_01 (06:54):
So that radiating pain, that's the real hallmark
of nerve involvement, not just atight muscle.
SPEAKER_00 (07:00):
Precisely.
Now compare that radiating painto spinal stenosis, the
narrowing of the canal.
Stenosis has this incrediblediagnostic profile.
SPEAKER_01 (07:09):
How so?
SPEAKER_00 (07:10):
The pain, the numbness, the weakness in the
back and the legs, it getsdramatically worse when you
stand or walk.
But, and here's the massive clueit is reliably relieved by
sitting down or leaning forward.
SPEAKER_01 (07:24):
Why does leaning forward help so much?
That feels like the opposite ofwhat you'd want to do for a
backache.
SPEAKER_00 (07:29):
It does, but when you lean forward, you slightly
flex your lumbar spine.
And that action physically opensup the spinal canal just a
little bit.
It gives the compressed nervesmore room.
SPEAKER_01 (07:40):
Ah, so it's a mechanical relief.
SPEAKER_00 (07:41):
It's the aha moment.
If leaning on a shopping cart ora bicycle relieves your pain,
stenosis is very, very likely.
SPEAKER_01 (07:48):
That's a perfect contrast.
Okay, what about othercategories of pain?
Like chronic issues versusinflammatory ones.
How does something likefibromyalgia present?
SPEAKER_00 (07:57):
Aaron Powell Fibromyalgia is different again.
It's more of a generalizedgnawing ache.
It's not localized to one spotand it's often worse than the
morning.
Key features beyond just painare feeling profoundly tired and
having these specific spotscalled tender points that are
acutely painful when you pressthem.
SPEAKER_01 (08:13):
So it's a whole body pain and fatigue thing.
SPEAKER_00 (08:15):
Aaron Powell It's a widespread pain and fatigue
syndrome, yes.
SPEAKER_01 (08:17):
Aaron Powell Now for that paradox we mentioned
earlier, inflammatory arthritis,like ankle losing spondylitis.
What makes its pain profile sounique?
SPEAKER_00 (08:27):
This is where we shift from mechanical pain to
inflammatory pain.
With ankle losing spondylitis,you get lower back pain combined
with severe morning stiffness.
But the paradox is, unlike astrained muscle or a worn joint
that hates movement.
SPEAKER_01 (08:42):
This pain gets better with exercise.
SPEAKER_00 (08:44):
It actually improves with exercise, yes.
SPEAKER_01 (08:46):
Aaron Powell, so if a listener has stiffness that
lasts, say more than an hourafter they wake up, but it gets
better the more they movearound, that's a huge
distinction.
Why does movement help?
SPEAKER_00 (08:54):
With these inflammatory conditions, the
fluid in the joints and the softtissues, they get kind of sticky
and stiff overnight.
It's a process sometimes calledgelling.
SPEAKER_01 (09:02):
Gelling.
SPEAKER_00 (09:03):
Yeah.
And exercise breaks up thatgelling, and that reduces the
inflammatory pain and thestiffness.
It tells a doctor immediatelythey're looking at something
autoimmune or inflammatory, notjust simple wear and tear.
SPEAKER_01 (09:14):
Okay, finally, let's revisit those more serious
issues.
What about cancer in the spinalbones?
What makes that pain stand out?
SPEAKER_00 (09:22):
Cancer pain in the spine is often described as
consistent.
It's not something that hurtswhen you lift something and then
stops when you sit down.
It's it's just there.
SPEAKER_01 (09:30):
And it gets worse.
SPEAKER_00 (09:31):
Sometimes progressively worsening, and
crucially, it may actually getworse when you're lying down at
night.
That combination persistent,non-mechanical pain that
disturbs your sleep, that is adefinite red flag.
SPEAKER_01 (09:43):
And the referred kidney pain, pylonephritis, how
do we tell that apart from anormal backstream?
SPEAKER_00 (09:48):
The kidney pain is sudden and intense, and it's
located high up in the flank,just under the ribs and the
back, and it travels often downtoward the groin or abdomen.
SPEAKER_01 (09:56):
It's not just pain.
SPEAKER_00 (09:57):
Never.
It comes with systemic illness.
High fever, shaking chills,nausea, and changes in urination
burning, urgency, cloudy urine.
That high fever with thatspecific flank pain means kidney
infection until provenotherwise.
SPEAKER_01 (10:12):
This whole symptom decoding process really proves
that understanding the contextof the pain, when it starts,
what makes it better, what othersymptoms are there, that is
really the deep dive here.
SPEAKER_00 (10:24):
Absolutely.
It is.
SPEAKER_01 (10:25):
Okay, let's move into diagnosis and timeline.
If you take this pain profile toyour doctor, what happens next?
And you know, how long shouldyou expect this thing to last?
SPEAKER_00 (10:34):
Aaron Powell Well, the initial diagnosis is like
80% reliant on your medicalhistory and the physical exam.
SPEAKER_01 (10:40):
Aaron Powell So just talking and a few simple tests.
SPEAKER_00 (10:42):
Exactly.
The doctor will ask about allthe things we just discussed and
then do specific tests.
For example, the straight legraise test, where they raise
your straightened leg while youlie flat that can reproduce the
pain that radiates down the leg.
SPEAKER_01 (10:54):
Aaron Powell Which suggests a disc problem.
SPEAKER_00 (10:56):
Strongly suggests a disc problem, yes.
So they're confirming thosesymptomatic clues physically.
SPEAKER_01 (11:01):
Got it.
SPEAKER_00 (11:02):
This is another point of comfort, I think.
For most minor cases, a musclestrain, pain from obesity or
pregnancy, you usually won'tneed immediate x-rays or complex
imaging.
The initial plan is conservativecare.
SPEAKER_01 (11:14):
So when do they start ordering the big tests
then?
SPEAKER_00 (11:17):
Testing, like x-rays, MRIs, blood work.
It's generally reserved for twoscenarios.
First, if the doctor suspectsone of those red flag causes we
talked about.
Of course.
Or second, if the back pain justpersists for longer than 12
weeks.
That's the benchmark for chronicpain.
If it's truly persistent, theyneed to look deeper.
SPEAKER_01 (11:37):
And if they do need to look deeper, what's on the
menu, so to speak?
SPEAKER_00 (11:41):
Uh, standard imaging would be X-rays, MRI, or CT
scans.
They might order blood or urinetests if they suspect an
infection or inflammation.
If nerve compression is aquestion, nerve conduction
studies can actually measure howfast signals are traveling
through the nerves.
SPEAKER_01 (11:57):
And for specific cases.
SPEAKER_00 (11:58):
Right.
If the patient has a history ofcancer, they might use
specialized imaging like a bonescan or a PE scan to look for
any metastasis.
SPEAKER_01 (12:06):
I think setting expectations for recovery is so
vital for morale.
What are the typical timelinespeople should have in mind?
SPEAKER_00 (12:12):
For the most common issue, a simple strain or
overexertion, the symptomsusually subside over days or a
few weeks.
You just have to graduallyreturn to activity.
SPEAKER_01 (12:21):
What about pregnancy-related pain?
SPEAKER_00 (12:23):
Oh, that, thankfully, resolves almost
universally after delivery.
For infections likepylonephritis, you feel better
within days of startingantibiotics, but you absolutely
must complete the full course.
SPEAKER_01 (12:35):
And for those tougher structural or nerve
issues like stenosis or apersistent disc problem.
SPEAKER_00 (12:42):
Those are the challenges.
If the cause is structural orinvolves nerve compression, the
pain can be persistent.
It could last for months or evenyears.
And this is why addressing thebiomechanics through things like
physical therapy becomes socritical.
SPEAKER_01 (12:56):
Which brings us perfectly to our last section:
taking control.
Given that the prognosis is sogood for most people with just
conservative care, what are themost effective, actionable steps
we can implement now to preventthis in the first place?
SPEAKER_00 (13:09):
Prevention really boils down to respecting your
spine's natural alignment.
Good posture is justfoundational, sitting or
standing.
SPEAKER_01 (13:15):
And sleeping.
SPEAKER_00 (13:16):
When you sleep, if you're a back sleeper, put a
pillow under your knees.
It helps flatten the lumbarcurve, eases the strain.
Side sleepers should put apillow between their knees to
keep the hips and spine aligned.
SPEAKER_01 (13:26):
We hear strengthen your core constantly.
Why is that the magic phrase forback health?
SPEAKER_00 (13:33):
Because your core acts like a natural corset for
your entire torso.
Strong abdominal musclesstabilize the spine from the
front, and that takes pressureoff the muscles and ligaments in
the back.
SPEAKER_01 (13:44):
So what's a good exercise for that?
SPEAKER_00 (13:46):
Simple abdominal crunches are key.
And for the lower back itself,low-impact movements like
walking or swimming are justexcellent for building endurance
without a lot of stress.
SPEAKER_01 (13:56):
Okay, let's nail down lifting technique.
This is where so many people gowrong.
What is the single most criticalrule?
SPEAKER_00 (14:03):
Always.
Always lift objects from asquatting position.
Use your hips and your legs, thestrongest muscles in your body,
to power the lift.
But the most dangerouscombination, the recipe for a
disc injury, is lifting,twisting, and bending at the
same time.
SPEAKER_01 (14:16):
So you have to avoid that rotation while you're
holding something heavy.
SPEAKER_00 (14:19):
You must avoid that rotational stress while under
load.
If you have to turn, move yourfeet, not your torso.
SPEAKER_01 (14:25):
That makes the mechanics really clear.
Okay, something else in thesource was footwear.
Why does the height of my shoeheel matter?
SPEAKER_00 (14:32):
It sounds so minor, doesn't it?
But footwear dramaticallyaffects your spinal alignment.
High heels, even moderate ones,they tilt your pelvis forward.
SPEAKER_01 (14:40):
Which increases the curve in your lower back.
SPEAKER_00 (14:43):
Immensely.
It puts a huge strain on thespinal joints and muscles.
The recommendation is soft-soledshoes with heels less than one
and a half inches high.
It just minimizes that unnaturaltilt.
SPEAKER_01 (14:54):
That's a great example of a non-obvious daily
adjustment.
Speaking of long-term health,what about preventing the bone
density issues that lead tofractures?
SPEAKER_00 (15:02):
Preventing osteoporosis is a lifelong
strategy.
Getting enough calcium andvitamin D every day is just
non-negotiable.
And routine weight bearing,exercise walking, lightweights,
whatever helps maintain bonedensity.
SPEAKER_01 (15:14):
And the lifestyle stuff.
SPEAKER_00 (15:15):
Avoiding smoking and limiting alcohol intake are also
essential.
SPEAKER_01 (15:19):
And a quick reminder on screening for that.
SPEAKER_00 (15:21):
Screening is recommended for all
postmenopausal women and for menaged 70 and older.
Early detection lets you makechanges that can prevent serious
fractures down the road.
SPEAKER_01 (15:30):
Okay, finally, let's wrap up treatment for that acute
minor strain.
If I wake up with pain and it'snot a red flag, what should I
do?
SPEAKER_00 (15:39):
Focus on conservative care.
A little bit of bed rest isokay, but no more than two days.
Movement is key for healing.
SPEAKER_01 (15:47):
And for the pain.
SPEAKER_00 (15:48):
Over-the-counter pain relief, like acetaminophin
or anti-inflammatories likeibuprofen, hot or cold
compresses can help soothemuscle spasms.
The key is just managing thediscomfort enough to allow a
gradual return to normalactivity.
SPEAKER_01 (16:02):
So we've established that back pain is complex, but
the prognosis is actuallyexcellent for the vast majority
of people.
SPEAKER_00 (16:08):
It is overwhelmingly positive.
More than 90% of people withback pain get better with
conservative care alone.
Only about 5% have symptoms thatlast longer than that 12-week
benchmark.
SPEAKER_01 (16:19):
And even then, it's usually not something
life-threatening.
SPEAKER_00 (16:21):
Exactly.
The underlying cause is stillusually not that serious.
SPEAKER_01 (16:24):
That encouraging statistic really underscores why
knowing those critical red flagsis so important.
So let's just review theabsolute when to call a
professionalist one last time.
SPEAKER_00 (16:34):
Okay.
If the pain is severe andincapacitating, if it followed a
significant fall or accident, ifa mild pain is just getting
worse and it sticks around formore than a week or two, or if
you notice any new neurologicalissues.
SPEAKER_01 (16:47):
The numbness, weakness, loss of control.
SPEAKER_00 (16:50):
Right.
You need a professionalevaluation.
SPEAKER_01 (16:52):
Yeah.
SPEAKER_00 (16:53):
And always, always disclose a history of cancer if
you have persistent back pain.
SPEAKER_01 (16:58):
So what does this all mean then?
Back pain isn't some mysteriouscurse.
It's a series of highly specificsignals.
The clues are right there.
What makes it better, what makesit worse, and they help you
figure out if you need an icepack or if you need immediate
medical attention.
SPEAKER_00 (17:11):
And that leads right to our final provocative thought
for you.
Given that the solution for mostback pain is preventative care
and simple conservativetreatment, well, it means the
power is largely in your hands.
So what small, often overlookeddaily ritual is it checking the
height of your shoe heels?
Is it changing your sleepingposition?
Is it consciously pausing to usethe squat lift technique?
(17:33):
What one thing could you adopttoday to move yourself out of
that small minority thatstruggles with persistent
trouble?
Often the solution isn't asilver bullet.
It's just consistent, minoradjustments to your daily
biomechanics.
And that's the most powerfulpreventative medicine of all.
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