The Longevity Podcast: Optimizing HealthSpan & MindSpan

Back Pain Decoded: Real Clues, Red Flags & Fast Relief

• Dung Trinh

Share episode

Send us a text

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

Follow for daily longevity and wellness episodes.

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.

Never miss an episode—subscribe on your favorite podcast app!

SPEAKER_01:

Welcome back to the deep dive. Today we are taking on a topic that is statistically pretty much guaranteed to affect every single person listening at some point.

SPEAKER_00:

Oh, definitely.

SPEAKER_01:

Back pain. It is just so incredibly common. But when it happens to you, the sheer confusion about, you know, what's actually wrong can be completely overwhelming.

SPEAKER_00:

Aaron Powell It really can. It's the most common reason for disability globally, and I think the mystery surrounding it is half the battle. For this deep dive, we pulled a really detailed review from Harvard Health Publishing.

SPEAKER_01:

Okay.

SPEAKER_00:

And this source, it just cuts through the noise and helps us categorize the type of pain we're experiencing.

SPEAKER_01:

Aaron Powell Right. So let's unpack this. Our mission today feels pretty critical. We want to move beyond just that, you know, generalized discomfort and give you the knowledge to understand the specific clues your body is sending. Trevor Burrus, Jr.

SPEAKER_00:

From the totally benign strain to the rare but critical red flag symptoms.

SPEAKER_01:

Trevor Burrus The goal here is actionable, realistic steps you can actually take for prevention and treatment.

SPEAKER_00:

Aaron Powell And we have to start with a crucial and I think slightly unsettling fact from the source. A lot of the time, when someone goes to the doctor with back pain, even after a bunch of tests, a specific anatomical source-like a clear structural reason for the pain, it just can't be identified.

SPEAKER_01:

Aaron Powell So wait, you're saying the pain is very real, but the diagnostic process doesn't always point to a clear physical why.

SPEAKER_00:

That's exactly right. And that's why the history, the symptom profile, is just so important. But when we do find a cause, we categorize it. We look at pain that comes directly from the back itself. Trevor Burrus, Jr.

SPEAKER_01:

The mechanical stuff.

SPEAKER_00:

Aaron Powell Yeah, the mechanical pain, muscles, bones, nerves. And then we look at what's called referred pain.

SPEAKER_01:

Aaron Powell, which is pain from somewhere else entirely.

SPEAKER_00:

Trevor Burrus, Jr.: Right. An issue with an organ, for example, that just manifests as back pain.

SPEAKER_01:

Yeah.

SPEAKER_00:

And making that distinction is, well, it's fundamental.

SPEAKER_01:

So let's start there with the most likely scenario for our listeners. What are the common culprits? What's the reason their back just decides to revolt?

SPEAKER_00:

Aaron Powell It's almost always muscular or uh related to overload. The classic back sprain or strain. 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 be things like obesity or even the temporary chronic overload you see in late-stage pregnancy. Trevor Burrus, Jr.

SPEAKER_01:

That's the classic I spend all Saturday lifting heavy boxes, I shouldn't have injury.

SPEAKER_00:

Precisely. But you know, pain isn't just about an acute injury. Sometimes it's structural wear and tear.

SPEAKER_01:

Like arthritis.

SPEAKER_00:

Exactly. Degenerative arthritis is extremely common. It's that age-related genetic, you know, wear and tear process in the joints of the spine. We also have to think about fractures.

SPEAKER_01:

From an accident.

SPEAKER_00:

Either from trauma? Sure, or from osteoporosis, the bone thinning disease.

SPEAKER_01:

And we should probably pause on osteoporosis. The source emphasizes it's really common in postmenopausal women, but it affects older men too. So what's the mechanism there? Is it the disease itself that hurts or something else?

SPEAKER_00:

That's a great question. It's the resulting fractures. When bones get porous, really simple things, minor falls, even a strong cough sometimes, can cause what are called compression fractures in the vertebrae.

SPEAKER_01:

And that would be incredibly painful.

SPEAKER_00:

Extremely painful. And it's obviously a structural issue that needs intervention.

SPEAKER_01:

Okay, let's get to the thing I think everyone dreads. Nerve issues. We hear terms like slipped disc all the time. Can you sort of clarify the two main nerve problems?

SPEAKER_00:

Sure. So first we look at the disc. That's the fibrous cushion that sits 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 that radiates down a limb. The other major issue is spinal stenosis. Which means it literally means narrowing. The space inside the spinal canal where all the nerves travel, it gets narrower, and that puts pressure on the spinal cord and nerves.

SPEAKER_01:

Okay, so that's the mechanical breakdown. But you mentioned non-spinal causes. Before we get into symptoms, what kind of organ issues can fool us into thinking it's our back?

SPEAKER_00:

The most common examples of this referred pain are kidney stones or a kidney infection, which is called pylonephritis.

SPEAKER_01:

Why the kidneys?

SPEAKER_00:

Just because of where they're located. They're up high in the flank area, protected by your lower ribs, so any problems there are felt really intensely in the back. People often think they've just pulled a muscle.

SPEAKER_01:

And just to round out the picture, what are those rare but really important causes we should know about?

SPEAKER_00:

Well, these are always screened for, even if they're rare, just because of how serious they are. Certain types of inflammatory arthritis like ankle losing spondylitis, an infection in the disc space or bone.

SPEAKER_01:

Which you said is rare.

SPEAKER_00:

Rare but urgent, yes. And crucially, a tumor, either a primary spinal tumor or cancer that has spread or metastasized to the bone.

SPEAKER_01:

Aaron Powell Okay. That sets the stage perfectly for decoding the pain itself. This is where it gets really interesting because the type of pain is often a better diagnostic tool than an initial x-ray, right?

SPEAKER_00:

Aaron Powell Oh, absolutely. And we have to start with the critical red flags. These are the symptoms that, you know, they override everything else and demand immediate medical attention. We're talking an emergency room visit.

SPEAKER_01:

Aaron Powell So what are these non-negotiable red flags?

SPEAKER_00:

Aaron Powell It's a pretty focused list. Any back pain that comes with a high fever or shaking chills, that suggests infection.

SPEAKER_01:

Okay.

SPEAKER_00:

Pain that follows a recent significant trauma, a car accident, a bad fall, unexplained, unintentional weight loss, especially when it's combined with that consistent back pain.

SPEAKER_01:

Aaron Powell A history of cancer, too, I imagine.

SPEAKER_00:

Aaron Powell A known history of cancer is a big one. And finally, any new neurological symptoms. So sudden or increasing numbness, rapid muscle weakness, difficulty walking, or, and this is the most critical, one new onset of incontinence.

SPEAKER_01:

So losing control of your bladder or bowel.

SPEAKER_00:

Exactly. If you have any of those, you do not wait. You go.

SPEAKER_01:

That provides some really necessary caution. So now let's go back to the more common stuff. How do I tell if my ache is just a simple strain or if I've actually messed up a disc?

SPEAKER_00:

Aaron Powell A simple sprain or strain, what we call a lumbosacral strain. It's predictable. The pain typically begins the day after the heavy exertion or the twisting.

SPEAKER_01:

Oh, so it's delayed.

SPEAKER_00:

It's a delayed inflammation, yeah. You feel this localized soreness, stiffness, and the back is tender right when you press on the muscle, but it pretty much stays contained to your back.

SPEAKER_01:

So if the pain doesn't really kick in until I wake up the next morning, that's a pretty good sign. It's just a muscle strain.

SPEAKER_00:

It is a very strong indicator, yes. Now contrast that with a protruding disc. If that disc is big enough to press on a nerve, which often leads to sciatica. Right. The pain is severe in the lower back, but the signature symptom is that it shoots down one leg, sometimes all the way to your foot.

SPEAKER_01:

And what makes that worse?

SPEAKER_00:

Bending, twisting, sometimes even just sitting. Because those movements all put internal pressure on the disc, making that protrusion worse.

SPEAKER_01:

So that radiating pain, that's the real hallmark of nerve involvement, not just a tight muscle.

SPEAKER_00:

Precisely. Now compare that radiating pain to spinal stenosis, the narrowing of the canal. Stenosis has this incredible diagnostic profile.

SPEAKER_01:

How so?

SPEAKER_00:

The pain, the numbness, the weakness in the back and the legs, it gets dramatically worse when you stand or walk. But, and here's the massive clue it is reliably relieved by sitting down or leaning forward.

SPEAKER_01:

Why does leaning forward help so much? That feels like the opposite of what you'd want to do for a backache.

SPEAKER_00:

It does, but when you lean forward, you slightly flex your lumbar spine. And that action physically opens up the spinal canal just a little bit. It gives the compressed nerves more room.

SPEAKER_01:

Ah, so it's a mechanical relief.

SPEAKER_00:

It's the aha moment. If leaning on a shopping cart or a bicycle relieves your pain, stenosis is very, very likely.

SPEAKER_01:

That's a perfect contrast. Okay, what about other categories of pain? Like chronic issues versus inflammatory ones. How does something like fibromyalgia present?

SPEAKER_00:

Aaron Powell Fibromyalgia is different again. It's more of a generalized gnawing ache. It's not localized to one spot and it's often worse than the morning. Key features beyond just pain are feeling profoundly tired and having these specific spots called tender points that are acutely painful when you press them.

SPEAKER_01:

So it's a whole body pain and fatigue thing.

SPEAKER_00:

Aaron Powell It's a widespread pain and fatigue syndrome, yes.

SPEAKER_01:

Aaron Powell Now for that paradox we mentioned earlier, inflammatory arthritis, like ankle losing spondylitis. What makes its pain profile so unique?

SPEAKER_00:

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 a strained muscle or a worn joint that hates movement.

SPEAKER_01:

This pain gets better with exercise.

SPEAKER_00:

It actually improves with exercise, yes.

SPEAKER_01:

Aaron Powell, so if a listener has stiffness that lasts, say more than an hour after they wake up, but it gets better the more they move around, that's a huge distinction. Why does movement help?

SPEAKER_00:

With these inflammatory conditions, the fluid in the joints and the soft tissues, they get kind of sticky and stiff overnight. It's a process sometimes called gelling.

SPEAKER_01:

Gelling.

SPEAKER_00:

Yeah. And exercise breaks up that gelling, and that reduces the inflammatory pain and the stiffness. It tells a doctor immediately they're looking at something autoimmune or inflammatory, not just simple wear and tear.

SPEAKER_01:

Okay, finally, let's revisit those more serious issues. What about cancer in the spinal bones? What makes that pain stand out?

SPEAKER_00:

Cancer pain in the spine is often described as consistent. It's not something that hurts when you lift something and then stops when you sit down. It's it's just there.

SPEAKER_01:

And it gets worse.

SPEAKER_00:

Sometimes progressively worsening, and crucially, it may actually get worse when you're lying down at night. That combination persistent, non-mechanical pain that disturbs your sleep, that is a definite red flag.

SPEAKER_01:

And the referred kidney pain, pylonephritis, how do we tell that apart from a normal backstream?

SPEAKER_00:

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 down toward the groin or abdomen.

SPEAKER_01:

It's not just pain.

SPEAKER_00:

Never. It comes with systemic illness. High fever, shaking chills, nausea, and changes in urination burning, urgency, cloudy urine. That high fever with that specific flank pain means kidney infection until proven otherwise.

SPEAKER_01:

This whole symptom decoding process really proves that understanding the context of the pain, when it starts, what makes it better, what other symptoms are there, that is really the deep dive here.

SPEAKER_00:

Absolutely. It is.

SPEAKER_01:

Okay, let's move into diagnosis and timeline. If you take this pain profile to your doctor, what happens next? And you know, how long should you expect this thing to last?

SPEAKER_00:

Aaron Powell Well, the initial diagnosis is like 80% reliant on your medical history and the physical exam.

SPEAKER_01:

Aaron Powell So just talking and a few simple tests.

SPEAKER_00:

Exactly. The doctor will ask about all the things we just discussed and then do specific tests. For example, the straight leg raise test, where they raise your straightened leg while you lie flat that can reproduce the pain that radiates down the leg.

SPEAKER_01:

Aaron Powell Which suggests a disc problem.

SPEAKER_00:

Strongly suggests a disc problem, yes. So they're confirming those symptomatic clues physically.

SPEAKER_01:

Got it.

SPEAKER_00:

This is another point of comfort, I think. For most minor cases, a muscle strain, pain from obesity or pregnancy, you usually won't need immediate x-rays or complex imaging. The initial plan is conservative care.

SPEAKER_01:

So when do they start ordering the big tests then?

SPEAKER_00:

Testing, like x-rays, MRIs, blood work. It's generally reserved for two scenarios. First, if the doctor suspects one of those red flag causes we talked about. Of course. Or second, if the back pain just persists for longer than 12 weeks. That's the benchmark for chronic pain. If it's truly persistent, they need to look deeper.

SPEAKER_01:

And if they do need to look deeper, what's on the menu, so to speak?

SPEAKER_00:

Uh, standard imaging would be X-rays, MRI, or CT scans. They might order blood or urine tests if they suspect an infection or inflammation. If nerve compression is a question, nerve conduction studies can actually measure how fast signals are traveling through the nerves.

SPEAKER_01:

And for specific cases.

SPEAKER_00:

Right. If the patient has a history of cancer, they might use specialized imaging like a bone scan or a PE scan to look for any metastasis.

SPEAKER_01:

I think setting expectations for recovery is so vital for morale. What are the typical timelines people should have in mind?

SPEAKER_00:

For the most common issue, a simple strain or overexertion, the symptoms usually subside over days or a few weeks. You just have to gradually return to activity.

SPEAKER_01:

What about pregnancy-related pain?

SPEAKER_00:

Oh, that, thankfully, resolves almost universally after delivery. For infections like pylonephritis, you feel better within days of starting antibiotics, but you absolutely must complete the full course.

SPEAKER_01:

And for those tougher structural or nerve issues like stenosis or a persistent disc problem.

SPEAKER_00:

Those are the challenges. If the cause is structural or involves nerve compression, the pain can be persistent. It could last for months or even years. And this is why addressing the biomechanics through things like physical therapy becomes so critical.

SPEAKER_01:

Which brings us perfectly to our last section: taking control. Given that the prognosis is so good for most people with just conservative care, what are the most effective, actionable steps we can implement now to prevent this in the first place?

SPEAKER_00:

Prevention really boils down to respecting your spine's natural alignment. Good posture is just foundational, sitting or standing.

SPEAKER_01:

And sleeping.

SPEAKER_00:

When you sleep, if you're a back sleeper, put a pillow under your knees. It helps flatten the lumbar curve, eases the strain. Side sleepers should put a pillow between their knees to keep the hips and spine aligned.

SPEAKER_01:

We hear strengthen your core constantly. Why is that the magic phrase for back health?

SPEAKER_00:

Because your core acts like a natural corset for your entire torso. Strong abdominal muscles stabilize the spine from the front, and that takes pressure off the muscles and ligaments in the back.

SPEAKER_01:

So what's a good exercise for that?

SPEAKER_00:

Simple abdominal crunches are key. And for the lower back itself, low-impact movements like walking or swimming are just excellent for building endurance without a lot of stress.

SPEAKER_01:

Okay, let's nail down lifting technique. This is where so many people go wrong. What is the single most critical rule?

SPEAKER_00:

Always. Always lift objects from a squatting position. Use your hips and your legs, the strongest muscles in your body, to power the lift. But the most dangerous combination, the recipe for a disc injury, is lifting, twisting, and bending at the same time.

SPEAKER_01:

So you have to avoid that rotation while you're holding something heavy.

SPEAKER_00:

You must avoid that rotational stress while under load. If you have to turn, move your feet, not your torso.

SPEAKER_01:

That makes the mechanics really clear. Okay, something else in the source was footwear. Why does the height of my shoe heel matter?

SPEAKER_00:

It sounds so minor, doesn't it? But footwear dramatically affects your spinal alignment. High heels, even moderate ones, they tilt your pelvis forward.

SPEAKER_01:

Which increases the curve in your lower back.

SPEAKER_00:

Immensely. It puts a huge strain on the spinal joints and muscles. The recommendation is soft-soled shoes with heels less than one and a half inches high. It just minimizes that unnatural tilt.

SPEAKER_01:

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 to fractures?

SPEAKER_00:

Preventing osteoporosis is a lifelong strategy. Getting enough calcium and vitamin D every day is just non-negotiable. And routine weight bearing, exercise walking, lightweights, whatever helps maintain bone density.

SPEAKER_01:

And the lifestyle stuff.

SPEAKER_00:

Avoiding smoking and limiting alcohol intake are also essential.

SPEAKER_01:

And a quick reminder on screening for that.

SPEAKER_00:

Screening is recommended for all postmenopausal women and for men aged 70 and older. Early detection lets you make changes that can prevent serious fractures down the road.

SPEAKER_01:

Okay, finally, let's wrap up treatment for that acute minor strain. If I wake up with pain and it's not a red flag, what should I do?

SPEAKER_00:

Focus on conservative care. A little bit of bed rest is okay, but no more than two days. Movement is key for healing.

SPEAKER_01:

And for the pain.

SPEAKER_00:

Over-the-counter pain relief, like acetaminophin or anti-inflammatories like ibuprofen, hot or cold compresses can help soothe muscle spasms. The key is just managing the discomfort enough to allow a gradual return to normal activity.

SPEAKER_01:

So we've established that back pain is complex, but the prognosis is actually excellent for the vast majority of people.

SPEAKER_00:

It is overwhelmingly positive. More than 90% of people with back pain get better with conservative care alone. Only about 5% have symptoms that last longer than that 12-week benchmark.

SPEAKER_01:

And even then, it's usually not something life-threatening.

SPEAKER_00:

Exactly. The underlying cause is still usually not that serious.

SPEAKER_01:

That encouraging statistic really underscores why knowing those critical red flags is so important. So let's just review the absolute when to call a professionalist one last time.

SPEAKER_00:

Okay. If the pain is severe and incapacitating, if it followed a significant fall or accident, if a mild pain is just getting worse and it sticks around for more than a week or two, or if you notice any new neurological issues.

SPEAKER_01:

The numbness, weakness, loss of control.

SPEAKER_00:

Right. You need a professional evaluation.

SPEAKER_01:

Yeah.

SPEAKER_00:

And always, always disclose a history of cancer if you have persistent back pain.

SPEAKER_01:

So what does this all mean then? Back pain isn't some mysterious curse. It's a series of highly specific signals. The clues are right there. What makes it better, what makes it worse, and they help you figure out if you need an ice pack or if you need immediate medical attention.

SPEAKER_00:

And that leads right to our final provocative thought for you. Given that the solution for most back pain is preventative care and simple conservative treatment, well, it means the power is largely in your hands. So what small, often overlooked daily ritual is it checking the height of your shoe heels? Is it changing your sleeping position? Is it consciously pausing to use the squat lift technique? What one thing could you adopt today to move yourself out of that small minority that struggles with persistent trouble? Often the solution isn't a silver bullet. It's just consistent, minor adjustments to your daily biomechanics. And that's the most powerful preventative medicine of all.