Do You Have Back Pain? Here’s What To Do (and What Not To Do)
By: Brian Hoeflinger, MD
January 25, 2026 | #73
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Disclaimer: Opinions are my own. Not medical advice.
Medical Trivia of the Week
What structure acts as the “shock absorber” between the bones of your spine? (the correct answer is at the end of this email)
- A) Tendon
- B) Ligament
- C) Intervertebral disc
- D) Meniscus
The Truth About Back Pain
Most people will deal with back pain at some point.
And when it hits, your brain goes straight to worst-case scenarios:
“Did I slip a disc?”
“Do I need an MRI?”
“Am I going to need surgery?”
In my clinic, back pain is one of the most common complaints I see. Most of the time, it’s uncomfortable, but not immediately dangerous.
But sometimes it is serious. Here’s a simple roadmap for what to do.
Know someone dealing with back pain right now? Forward them this email.
Step 1: Ask “What started this?”
One of the first questions I ask patients:
What happened right before this started?
Their answers help me separate typical back pain from pain that needs urgent attention.
Most common: pain after normal activity
If your back pain started after things like:
- lifting
- yard work
- a hard workout
- a long day on your feet
…it’s often muscle strain or irritation.
More concerning: pain after trauma
If your back pain started after:
- a car accident
- a fall
- a direct hit to the back
…that changes things. Now we worry about injuries like a fracture or spinal instability.
Trauma = get evaluated sooner.
My New Podcast Episode on Back Pain
If you want the deeper dive on back pain, watch or listen to the full podcast episode I did at the links below.
YouTube: Click here
Apple Podcasts: Click here
Spotify: Click here
Step 2: If it’s “muscle-type” back pain, start simple
If your pain started after normal activity, and you don’t have red flags (we’ll cover those next), the first steps are usually conservative:
1) Rest
Avoid what clearly aggravates it. Gentle movement is often better than total shutdown. If it clearly makes pain worse, stop. If it feels okay, keep moving lightly.
2) Anti-inflammatory medications (if safe for you)
Many people do well with short-term NSAIDs like ibuprofen. Not everyone can take these safely (kidney disease, ulcers, blood thinners). If you’re unsure, ask your primary care physician.
3) Heat
A warm shower or heating pad can relax tight muscles and help stiffness.
4) Give it time
A key reality: Most non-traumatic back pain improves with conservative care. A lot of people start feeling noticeably better over days to a few weeks.
Step 3: Know when it’s no longer “just back pain”
Back pain becomes more concerning when there are signs a nerve is involved.
Watch for:
- pain shooting into the buttock and down the leg
- numbness or tingling down the leg
- weakness (leg giving out, foot drop)
Why does this matter? Because a nerve is living tissue. If it’s compressed too long, it can lead to lasting problems. This doesn’t mean you automatically need surgery, but it does mean you shouldn’t ignore it.
When Back Pain is an Emergency
Go to urgent care or the emergency room today if you have back pain plus any of the following:
- new trouble controlling bowel or bladder
- numbness in the groin area (“saddle anesthesia”)
- rapidly worsening weakness
- major trauma with severe pain
These can signal serious nerve compression that needs quick attention.
Don’t Ignore Back Pain that just Won’t Go Away
Most back pain is mechanical.
But if you have pain that:
- persists for months
- keeps getting worse
- feels deep and constant
- is worse at night
- isn’t improving with reasonable treatment
…don’t just keep “pushing through.”
Rarely, persistent back pain can be a sign of something more serious. It’s not common, but it’s one reason I tell people: If back pain doesn’t improve over time, it deserves a real evaluation.
“Do I Need Surgery?”
This surprises many people: Surgery usually isn’t great for “back pain only.” Surgery tends to help most when the problem is clearly related to nerves, like:
- pain down the leg/arm
- numbness from nerve compression
- weakness from nerve compression
If your MRI doesn’t show a clear, identifiable surgical target, then surgery often isn’t the answer. And if a surgeon tells you “no surgery,” that does not mean your surgeon doesn't care or that your pain isn’t real. It usually means that there isn’t a problem that surgery is likely to fix.
Smart Questions to Ask Your Surgeon
If you’re told you don’t need surgery, ask:
- “What do you think is causing this?”
- “What should I do next?”
- “What symptoms mean I should come back sooner?”
If you’re told you do need surgery, ask:
- “What have we tried so far that counts as conservative treatment?”
- “What are the risks?”
- “What outcome is realistic?”
- “What happens if I wait a few weeks?”
Second opinions are reasonable, especially when surgery is on the table. You must be the biggest advocate for your own health.
If You Remember Anything, Remember This
Back pain is common. And most of the time, it improves. Here are some simple rules:
- Trauma changes urgency.
- Nerve symptoms matter.
- Bowel/bladder changes are an emergency.
- Pain that won’t quit deserves a closer look.
If you’re worried, don’t sit at home trying to diagnose yourself, talk to your primary care physician. And always trust your gut if you think something is wrong.
Impactful Quote of the Week
"It is not death that a man should fear, but he should fear never beginning to live.”
- Marcus Aurelius
All my best,
Brian Hoeflinger
P.S. - if you enjoyed this newsletter, you may enjoy my book that details my life as a neurosurgeon and the loss of my oldest son, Brian (see below a synopsis) and/or my podcast where I explain topics in further detail.
If you enjoyed this newsletter or previous editions, please share it with a friend. You can use this link: https://pages.doctorhoeflinger.com/posts
Check out My Book
Life and Death . . . Two words with such opposite meaning and which inflict such contradictory emotions and yet are so closely intertwined in our lives. As parents, we bring meaning and life into this world through our children. Our lives become defined as a result. We learn the joy, hardship, and responsibility of shaping an innocent life. But a day will come when that life will be taken. For some, death will come too soon. This is the story of my son, Brian Nicholas Hoeflinger, who died unexpectedly at age 18.
https://doctorhoeflinger.com/products/the-night-he-died-the-harsh-reality-of-teenage-drinking
Check out My Podcast
The Dr. Hoeflinger Podcast is about more than medicine, it’s about living a fuller, healthier, and more meaningful life. My son, Kevin, and I discuss medicine, health, fitness, lessons learned from personal tragedy, family, and purpose. Along the way, we invite inspiring guests to bring fresh insights and perspectives. Watch or listen to the podcast below.
YouTube: Click here
Apple Podcasts: Click here
Spotify: Click here
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Medical Trivia Answer:
The correct answer is C) Intervertebral disc
*Disclaimer: This newsletter and blog is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this newsletter and blog or materials linked from this newsletter and blog is at the user’s own risk. The content of this newsletter and blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay seeking medical advice for any medical condition they may have and should consult their healthcare professionals for any such conditions.
