The Back Pain That Is Not a Strain

Most back pain is mechanical, settles with sensible management, and does not need investigating. There is one presentation that is different, it is commonly missed, and recognising it matters. Sudden back pain, in an older adult, after something trivial or nothing at all. That pattern can indicate a vertebral compression fracture, and it is one of the few back pain situations where getting the diagnosis right promptly genuinely changes what happens next.

What the UK Guidance Actually Recommends for Back Pain

Most people with back pain have tried several things, been offered several more, and have no idea which of them have evidence behind them. There is a national guideline that answers this, and almost nobody outside the profession has read it. NICE published its guidance on low back pain and sciatica in over 16s, and it is unusually direct. It names what should be offered, and it names a considerable number of things that should not be. Here is the summary, in plain terms.