Your back will get better. Here is roughly when.

Almost everybody I see with low back pain gets better. Saying so, on its own, is close to useless — because when you cannot put your socks on, "most people improve" sounds like a way of ending the conversation.

What is actually useful is a timescale, a plan, and a straight answer about the scan.

The rough shape of recovery

For a typical acute episode with no nerve involvement: the sharp, guarded, cannot-move phase is usually days rather than weeks. Most of the improvement happens in the first six weeks. A background ache that comes and goes for another two or three months after that is normal and is not a sign that something is wrong.

Where a nerve is genuinely irritated — pain travelling below the knee, pins and needles, weakness — it is slower. Think three months to substantial improvement rather than six weeks, and a proportion of people take longer. Even then, most settle without surgery.

The unhelpful thing is that nobody gives you those numbers, so every day that you are not better feels like evidence that you are the exception.

Why I will probably not send you for a scan

Because imaging early in ordinary back pain does not improve outcomes, and it frequently makes them worse.

Scan a group of adults with no back pain at all and a large share will show disc degeneration, bulges and other changes — and the proportion climbs steadily with age. These findings are close to normal ageing, like grey hair. But being handed a report that says "disc bulge at L4/5" changes how you move. People who are told this reliably move less, guard more, and take longer to recover.

I scan when the result would change what we do: significant or progressive neurological signs, a history of trauma, or red flag features. Then I arrange it quickly and tell you the cost first.

A scan answers the question "what does the picture look like". It rarely answers the question "why does this hurt".

The red flags I check every single time

• Numbness in the saddle area, or loss of bladder or bowel control
• Weakness in both legs, or rapidly progressing weakness in one
• Unexplained weight loss alongside back pain
• Fever, or a history of cancer or significant steroid use
• Pain markedly worse at night and not eased by any position

The first two are an emergency. Go to the emergency department; do not wait for an appointment with me.

What the first appointment is actually for

Forty-five minutes, and most of it is watching you move — bending, squatting, walking, standing on one leg, reaching overhead. Which movements provoke it and which relieve it tells me far more than pressing on the sore bit does.

You leave with three or four exercises written down with photographs, an explanation you can repeat to somebody else, and an estimate of how many sessions this will take. For a straightforward acute problem that estimate is usually two to four. For something long-standing, six to eight.

Rest is not the treatment

A day or two of relative rest while it is very sharp is reasonable. Beyond that, movement is the treatment. Prolonged rest reliably makes ordinary back pain last longer, and it is the single most common piece of well-meant advice I have to undo.

Walk. Keep going to work if you can, even if you modify what you do. Load the area gradually rather than avoiding it. It will feel counterintuitive and it is the thing that works.

This article is general information, not advice about your situation. If something here applies to you, book an appointment or speak to your own doctor. Ravelston Health is not an emergency service. If you need urgent help call 999, or NHS 24 on 111 when your GP practice is closed.