Low back pain is the most common reason patients come to us, and most of it is mechanical: muscles, joints, discs and posture responding badly to a specific load or to years of small loads. The reassuring part is that a large share improves with time and movement. The problem is that patients often cannot tell which kind they have.
Patterns that warrant an evaluation
Pain that has lasted more than four to six weeks without meaningful improvement. Pain that keeps returning every few months in the same place. Pain that travels below the knee, or comes with numbness, tingling or weakness in a leg or foot. Pain that wakes you at night rather than easing when you lie down. Pain that appeared after a fall, a crash, or a lifting injury.
Some features need attention right away rather than an appointment next week: loss of bladder or bowel control, numbness in the groin or inner thighs, progressive leg weakness, fever with back pain, or back pain with a history of cancer. Those belong in an emergency department, not a scheduled clinic visit.
What an evaluation adds
The value of the visit is a working diagnosis and a sequence. Nerve-driven pain is treated differently from facet joint pain, which is treated differently from sacroiliac or muscular pain. Getting the category right is what stops patients from cycling through treatments that were never aimed at their problem.
The exam distinguishes those categories: straight-leg raise and neurological testing for nerve involvement, extension and rotation testing for facet-driven pain, hip assessment to catch the hip problems that masquerade as back pain, and gait observation.
What the plan may involve
Guided physical therapy is the backbone for most mechanical low back pain, because strength and movement patterns are what hold a result in place. Around that, plans may include steroid or trigger-point injections, acupuncture, laser therapy, StemWave shockwave sessions, imaging where the exam justifies it, and monitored medication management where clinically appropriate under Maryland law and CDC guidelines.
Every plan is individualized after a clinician evaluation, and no outcome is promised. What we can commit to is a clear explanation of what we found and why the plan follows from it.
Timing
Patients often wait until a flare becomes unmanageable. Earlier evaluation generally means simpler options. With appointments seven days a week and evening telehealth follow-ups, there is rarely a scheduling reason to wait for the next flare.