Most low back pain is mechanical — it comes from the muscles, joints, and discs of the spine rather than from a disease process. Current clinical guidelines recommend starting with non-drug treatment, including spinal manipulation, exercise, and staying active, before turning to medication or imaging.
That guidance matters, because the instinct after a back injury is usually the opposite: rest, wait it out, and reach for pain relievers. This page covers what actually causes low back pain, the warning signs that need prompt medical attention, what the evidence supports, and how care works at our office in St. Peters.
What causes lower back pain?
The large majority of low back pain is mechanical in origin — strained muscles, irritated facet joints, disc problems, or the cumulative effect of poor movement patterns. Only a small percentage traces to a serious underlying condition.
The most common sources we see:
- Muscle and ligament strain — from lifting, a sudden twist, or simple overuse
- Disc problems — herniated, bulging, or degenerating discs that irritate nearby nerves
- Facet joint irritation — the small joints at the back of the spine becoming restricted or inflamed
- Sacroiliac joint dysfunction — pain at the base of the spine where it meets the pelvis
- Sciatica — nerve root irritation producing pain that travels down the leg
- Postural and workload strain — prolonged sitting, repetitive bending, or heavy physical work
- Spinal stenosis — narrowing of the spinal canal, more common with age
These frequently overlap. A disc problem changes how you move, which overloads the joints and muscles around it, which produces its own pain. Untangling the primary driver from the secondary effects is the point of a thorough examination.
When should you see a doctor for back pain?
Certain symptoms alongside back pain need prompt medical evaluation rather than conservative care. Seek urgent attention if you have:
- Loss of bladder or bowel control, or numbness in the groin or inner thighs
- Progressive weakness in one or both legs
- Back pain with fever, chills, or unexplained weight loss
- Severe pain following a significant fall or accident
- A history of cancer with new, unexplained back pain
- Pain that is severe, unrelenting, and notably worse at night
These can indicate cauda equina syndrome, infection, fracture, or other conditions that require imaging and immediate medical management. We screen for them at every evaluation and refer out without hesitation when the findings call for it.
What does the research say about chiropractic care for low back pain?
Major clinical guidelines now place non-drug treatment first for low back pain. The American College of Physicians recommends beginning with non-pharmacologic care — including spinal manipulation, exercise, heat, and massage — before medication for acute and subacute cases.
The UK’s National Institute for Health and Care Excellence reaches a similar conclusion, recommending exercise as a core treatment and supporting manual therapy as part of a package that includes exercise. Both guidelines also discourage routine imaging for uncomplicated low back pain, because X-rays and MRIs frequently show age-related changes that have little to do with the pain and can lead to unnecessary intervention.
Read the source guidelines directly: American College of Physicians guideline and NICE guideline NG59.
How do we treat lower back pain?
Care begins with an examination to identify what is actually generating your pain — joint, disc, muscle, or nerve. Treatment is then matched to that finding, typically combining chiropractic adjustments, soft-tissue therapy, and specific exercises.
Depending on what the exam shows, a plan may include chiropractic adjustments to restore joint motion, therapeutic massage for muscle tension and spasm, non-surgical spinal decompression for disc-related pain and sciatica, laser therapy for pain and tissue healing, or acupuncture as a drug-free option for persistent pain.
Nearly every plan includes exercise. Passive treatment can relieve pain, but strength and movement are what keep it from returning — so we would rather teach you two or three exercises you will actually do than hand you a sheet of twenty you will not.
What about middle and upper back pain?
Mid-back pain often presents differently from low back pain: a band of tightness between or below the shoulder blades, sometimes wrapping around the ribs. It commonly stems from the joints where the ribs meet the spine, which can become restricted and refer pain around the rib cage.
Prolonged sitting, desk work, and forward head posture are frequent contributors. Because rib-related pain can occasionally mimic other conditions — and because chest or rib pain accompanied by shortness of breath, dizziness, or radiating arm pain needs emergency evaluation — a proper examination matters here rather than assuming it is “just posture.”
How long does lower back pain take to get better?
Acute low back pain often improves substantially within a few weeks, particularly when you stay active rather than resting in bed. Pain that has persisted for three months or more is considered chronic and typically needs a longer, more structured plan.
The most reliable predictor of a slower recovery is not the severity of the initial pain — it is inactivity and prolonged waiting. Gentle movement early tends to shorten recovery. If your pain has lasted more than a few weeks without improvement, that is the point to have it examined rather than continuing to wait it out.
Lower back pain treatment in St. Peters, MO
Crosby Chiropractic & Acupuncture Centre has treated back pain in St. Peters and St. Charles County since 1995. Our four doctors bring over 130 years of combined experience, and we take a whole-body approach — looking at how you move, work, and sleep, not just where it hurts.
We are located at 331 Jungermann Road in St. Peters, serving patients from O’Fallon, Dardenne Prairie, St. Charles, Cottleville, and Weldon Spring. Call (636) 928-5588 or request an appointment online.
Frequently asked questions
Should I rest or stay active with lower back pain?
Stay active within your comfort. Extended bed rest is no longer recommended and tends to slow recovery. Gentle walking and normal daily activity, avoiding movements that clearly aggravate the pain, generally produce better outcomes than rest.
Do I need an MRI for back pain?
Usually not, at least initially. Guidelines discourage routine imaging for uncomplicated low back pain, because scans often reveal age-related changes unrelated to your symptoms. Imaging becomes appropriate when red-flag findings are present or when pain is not responding as expected.
Is chiropractic care safe for low back pain?
For most people, yes. Serious complications from spinal manipulation for the low back are rare. The most common side effect is temporary soreness, similar to post-exercise stiffness. A thorough exam first is what identifies the minority of patients for whom manipulation is not appropriate.
Can back pain be caused by sitting too much?
It certainly contributes. Prolonged sitting loads the discs and lets the muscles that support your spine become deconditioned. Position changes through the day, a workstation set up reasonably, and regular movement usually help more than any single piece of equipment.
What is the difference between lower back pain and sciatica?
Low back pain stays largely in the back. Sciatica is nerve pain that travels from the low back down through the buttock and leg, often with numbness or tingling. They frequently occur together, and the presence of leg symptoms changes the treatment approach.
How soon should I be seen for back pain?
If pain follows a significant injury, comes with any of the red-flag symptoms listed above, or has not improved after a couple of weeks, get it examined. Earlier evaluation generally means a shorter course of care than waiting for it to become chronic.
Reviewed by Dr. Jenny Crosby Wiemann, DC, President, Crosby Chiropractic & Acupuncture Centre. Read Dr. Crosby’s full bio.
Last reviewed: July 2026
This page is for general education and is not a substitute for professional medical advice, diagnosis, or treatment. If you are experiencing a medical emergency, call 911.
