Chronic back and spine pain: causes, symptoms, treatment and when to act
Lower back pain, neck pain and sudden lumbago: what is common, what is a warning sign and how a doctor can help with back pain in an online consultation.
Chronic back pain is pain that lasts longer than 12 weeks; it most often affects the lumbar spine, less often the neck and upper back. It is usually caused by overload, weak muscles and a sedentary lifestyle; a serious cause is rare. Immediate help is needed, however, for problems passing urine or stool, numbness in the groin area, rapidly weakening legs, and pain after an injury or with a fever. Other problems usually improve with movement, targeted rehabilitation, adjusting your workload and short-term medication. In an online consultation, a doctor assesses your symptoms, rules out warning signs and recommends further tests or a specialist.
Definition and types
When back pain becomes chronic
Back pain is called chronic when it lasts longer than 12 weeks. Acute pain lasts less than 6 weeks, subacute pain up to 12 weeks.
The lower back hurts most often, the neck less often and the upper back least often; a Czech medical review gives a ratio of roughly 4 : 2 : 1. For pain arising from the spine and surrounding structures (muscles, small joints, intervertebral discs and nerve roots), Czech medicine often uses the term vertebrogenic pain syndrome.
- Non-specific pain. The most common type. It is linked to muscle imbalance and overload, with no serious underlying cause.
- Slipped disc. A disc presses on a nerve root; the pain radiates into the leg or arm and may come with tingling.
- Degenerative changes. Wear of the discs and small joints of the spine, or narrowing of the spinal canal (stenosis).
- Inflammatory pain. Typical of spondyloarthritis, which includes ankylosing spondylitis: gradual onset usually before age 45, pain at night and in the morning, morning stiffness and improvement after warming up.
Source: H. Ciferská, J. Vachek: Differential diagnosis of back pain, Vnitřní lékařství 2022.
Statistics
Back pain in Czechia in numbers
Back problems are among the most common health problems of working-age people in Czechia and one of the main reasons for sick leave.
- 295 thousand people aged 15–64 named back or neck problems as their main long-term health problem (ČSÚ, 2011).
- 1.34 million people aged 15–64 had long-term health problems (ČSÚ, 2011).
- 69.6 days was the average length of one case of sick leave for musculoskeletal diseases (ÚZIS, 2013).
- 93% of general nurses in a Masaryk University Faculty of Medicine survey said they had back pain.
Sources: ČSÚ, Statistika&My 5/2012 (Labour Force Survey 2011); MPSV 2016, with ÚZIS ČR data (J. Jann, Aktuální informace 20/2014); Masaryk University Faculty of Medicine, press release of May 2024.
According to ČSÚ, the share of people with long-term problems rises sharply after the age of thirty. According to ÚZIS, in 2013 musculoskeletal diseases accounted for just under 18% of sick-leave cases but 28.5% of all days of sick leave; the most common diagnosis was back pain (dorsalgia).
Work: The Occupational Safety Research Institute (VÚBP) reports that degenerative spinal disease is the second most common cause of sick leave in Czechia and that lumbar spine problems in workers worsen on average after 10–12 years of exposure to risk. Since 1/1/2023, chronic lumbar spine disease caused by long-term overload from heavy physical work has also been on the list of occupational diseases. Recognition has strict conditions, including sick leave for this diagnosis totalling at least 12 months over the last 3 years.
Health workers: In a survey by Prof. Andrea Pokorná's team at the Masaryk University Faculty of Medicine, among more than five hundred respondents, 93% of general nurses reported back pain. Two thirds of them consider it at least partly a result of their work.
Children: Doctors at the Department of Rehabilitation and Sports Medicine of University Hospital Ostrava warn that back pain in children, mainly in the lower back, is becoming more common. Most cases are functional: they are caused by muscle imbalance and long-term overload, mainly due to an unhealthy lifestyle.
Sources: VÚBP, Policy Brief 1/2024; Masaryk University Faculty of Medicine (2024); I. Chmelová et al.: Back pain in children, Pediatrie pro praxi 2023;24(4):245–248, DOI 10.36290/ped.2023.064.
Risk factors
Why your back hurts: causes and risk factors
Back pain is rarely caused by one thing alone; usually several factors come together.
- Sedentary work and long hours sitting in an office, behind the wheel or on a production line weaken the muscles that support the spine.
- Lack of exercise and a weak core: the deep stabilising muscles, abdominal and gluteal muscles.
- Overweight and obesity, which put extra load on the spine.
- Physically demanding work: lifting loads, frequent bending and twisting, awkward working positions and vibration.
- Degenerative changes with age: discs, small joints, narrowing of the spinal canal.
- Injuries, osteoporosis and vertebral fractures, poor exercise technique.
- Stress, poor sleep and smoking, which worsen both pain perception and healing.
- Rarely, inflammatory, infectious or tumour-related diseases.
Prolonged sitting is also the most frequently reported risk factor in European workplaces: in the ESENER 2024 survey, 64% of establishments in the EU-27 named it. Pain from internal organs, such as the kidneys and gallbladder, or in the chest area even from the heart or aorta, can also be felt in the back.
Sources: VÚBP (2024); EU-OSHA, first findings of the ESENER 2024 survey (in Czech); Vnitřní lékařství 2022.
Lumbar spine
Lower back pain and lumbago
Pain in the lower part of the back is the most common form of back pain. Doctors call it lumbalgia, and if the pain radiates into the leg, lumbosciatic syndrome.
Lower back pain typically gets worse with long sitting, bending forward or lifting, and the back is often stiff in the morning or after sitting for a long time. According to neurologist Prof. Ivana Štětkářová, simple muscular pain usually settles within a week, at the latest within three weeks.
Lumbago (acute low back strain)
Lumbago comes on suddenly, usually after bending forward sharply while twisting the trunk, for example when lifting a load or working in the garden. Most often it is a strain or tear of muscle fibres, tendon attachments or fascia, especially when the core muscles are weak. A slipped disc is a less common cause. The pain is sharp and people often cannot straighten up.
What helps is a short time in a position that eases the pain, pain relief as advised by a doctor, heat and an early return to movement. If shooting pain into the leg, weakness or numbness is added, it is no longer simple lumbago and a doctor should assess it.
Source: 3rd Faculty of Medicine, Charles University, interview with Prof. Štětkářová.
Neck and shoulders
Neck pain: from overload to pain radiating into the arm
Neck pain most often appears after long hours at a computer, with stress or after getting chilled, and usually comes with a stiff neck.
According to a Czech medical review, simple neck pain is usually the result of overload; with degenerative changes, getting chilled can also make it worse. So-called pseudoradicular (cervicobrachial) syndromes are common, in which pain radiates into the shoulder and arm but the nerve root is not irritated. When a slipped disc or a narrowed opening where the nerve exits compresses the root, shooting pain into the arm and fingers, tingling or hand weakness is added.
Prof. Štětkářová points out that stress can show as a forward head posture with the shoulders pulled forward, after which the neck starts to hurt. A slipped disc in the neck can also result from a sudden forward-and-back movement of the head in a car accident (whiplash).
Do not delay an examination if your hand is getting weaker, you notice changes in sensation or you have difficulty walking. Compression of the spinal cord in the neck (cervical myelopathy) shows exactly as problems with sensation and movement.
Sources: Vnitřní lékařství 2022; 3rd Faculty of Medicine, Charles University, interview with Prof. Štětkářová.
Nerve root
Slipped disc: symptoms worth knowing
A slipped disc mainly causes symptoms when the herniated part of the disc irritates or compresses a nerve root.
In a herniation, the soft inner part of the disc pushes through a tear in its firmer outer layer into the spinal canal. Typical is pain shooting from the back into the buttock and leg, or from the neck into the shoulder, arm and fingers, which may get worse when coughing or sneezing.
- Radiating pain down the back or side of the leg, often below the knee.
- Tingling, pins and needles or numbness in a particular area of the leg or arm.
- Muscle weakness: with L5 root involvement, for example, a person cannot stand on their heel or lift their big toe.
- Reduced reflexes, which the doctor finds on examination.
Treatment usually starts without surgery: pain relief, rehabilitation and a gradual return to movement, and in acute root compression possibly an injection. Surgery is considered when the disc clearly presses on the root mechanically, the pain does not respond to treatment, or weakness and loss of sensation develop.
If a disc in the lower back herniates centrally, it can compress all the nerve roots below the end of the spinal cord (cauda equina syndrome). Prof. Štětkářová states that surgery is then needed immediately, within 24 hours at the latest. How to recognise this condition is summarised in the box in the Warning signs section.
Source: 3rd Faculty of Medicine, Charles University, interview with Prof. Štětkářová.
First symptoms
First symptoms and warning signs
Most back pain has a harmless cause. Some symptoms, however, mean you need to act straight away.
Common first symptoms
- Dull or burning back pain that gets worse when sitting or bending forward.
- Stiffness in the morning or after sitting for a long time.
- Pain radiating into the buttock, leg or arm, tingling and pins and needles.
- Limited movement, muscle tension, pain when coughing or sneezing.
Other signs a doctor should assess soon
- Pain at rest or at night that does not ease when lying down.
- Unexplained weight loss, loss of appetite or excessive tiredness.
- A history of cancer.
- Back pain appearing for the first time before age 20 or after age 50.
- A temperature of 38 °C or higher.
- Osteoporosis or long-term use of corticosteroids, especially when the pain began after a minor injury.
- No improvement after 4–6 weeks of treatment.
Sources: Vnitřní lékařství 2022 (table of warning signs); 3rd Faculty of Medicine, Charles University, interview with Prof. Štětkářová.
Examination
How a doctor looks for the cause of back pain
The basis is a detailed conversation about the pain and a clinical examination. Imaging is not always needed.
| Step | What it shows |
|---|---|
| History and examination | Type of pain, radiation, mobility, muscle strength, reflexes and sensation |
| Spine X-ray | Degenerative changes, alignment of the spine, fractures |
| Magnetic resonance imaging (MRI) | Discs, nerve roots, stenosis; with warning signs or when treatment is not working |
| CT | Detailed bone structures, if MRI is not possible |
| Blood tests (CRP, ESR, full blood count) | Signs of inflammation or infection |
| EMG | Damage to nerve roots |
What the scans show may not match how badly the back hurts. Most people develop degenerative changes in the spine with age, so a doctor always assesses the scan together with the symptoms and examination. Depending on the problem, a rehabilitation physician, neurologist, orthopaedic surgeon or neurosurgeon follows on; if inflammatory pain is suspected, a rheumatologist. In an online consultation, our doctor explains which tests you need and arranges the referral to a specialist.
Sources: Vnitřní lékařství 2022; 3rd Faculty of Medicine, Charles University, interview with Prof. Štětkářová.
Treatment and prevention
Treatment and prevention of back pain
Most people are helped by movement, targeted rehabilitation, adjusting their workload and short-term medication.
Acute phase
- Stay active: long bed rest does not help the back. After a short rest, gradually return to your usual activities.
- Short-term painkillers and anti-inflammatory medicines, or muscle relaxants, always as advised by a doctor.
- Heat, reducing the load and a gradual return to activity.
Chronic pain
- Rehabilitation and physiotherapy: strengthening the core, mobilisation and correcting movement patterns.
- Back school: learning to lift, sit and exercise correctly at home.
- Weight loss and regular activity, such as walking, swimming or yoga.
- Interventional treatment: injections for selected patients.
- Psychological support and attention to sleep for long-term pain.
- Surgery: for nerve compression with loss of function, severe stenosis or spinal instability, when conservative treatment fails.
Prevention
- Break up long periods of sitting with movement and alternate sitting and standing.
- An ergonomic workstation: feet on the floor, monitor at eye level, regular breaks.
- At least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity activity a week, plus strength training on 2 days a week, if your health allows.
- Correct lifting technique, a healthy weight and not smoking.
Sources: Vnitřní lékařství 2022; 3rd Faculty of Medicine, Charles University, interview with Prof. Štětkářová; NZIP, physical activity recommendations for adults with chronic conditions.
Delayed treatment
What can happen if you ignore back pain
Problems you push through can turn into a long-term condition that limits both work and daily life.
- Chronic pain: repeated episodes and persistent pain, a more sensitive nervous system.
- Nerve damage: permanent weakness, loss of sensation or bladder problems with untreated compression.
- Loss of mobility and muscle strength, falls and reduced independence.
- Long sick leave, job loss and disability.
- Psychological effects: anxiety, depression and sleep problems.
- Missing a serious cause: an infection, fracture or tumour.
- Overloading other parts of the body and overuse of painkillers.
The shift to chronic pain is also driven by psychosocial factors, known as yellow flags: fear of movement, the belief that work damages the back, avoiding everyday activities, too much rest, poor sleep because of pain, depression or an unsupportive work environment. This is why a doctor asks about them as well as about the pain itself.
Source: Vnitřní lékařství 2022 (yellow flags).
What experts say
What Czech experts say
“Sedentary work, whether in an office, behind the wheel or in a factory, plays a large part in causing these health problems.”
MUDr. Michaela Tomanová, head physician of the Brandýs nad Orlicí Rehabilitation Institute, for Novinky.cz (2012).
“More than 75 per cent of people have degenerative changes in the spine visible on X-ray by the age of 45 to 50.”
Prof. MUDr. Ivana Štětkářová, CSc., MHA, head of the Department of Neurology of the 3rd Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, in an interview published by the 3rd Faculty of Medicine.
Video consultation
How an online consultation with a doctor helps
An online consultation is a good first step: the doctor assesses your symptoms, identifies warning signs and suggests next steps, without you having to travel with a painful back.
- Assessing the pain. Where it hurts, since when, where it radiates, what makes it worse and what work you do.
- Warning signs. Targeted questions about symptoms that need immediate or in-person examination.
- Simple tests on camera. The doctor may ask you to do a few movements, such as bending forward or walking on your heels and toes.
- Tests and scans. When needed, the doctor recommends an X-ray, MRI or blood tests.
- Treatment plan. Adjusting your workload, exercise, painkillers and how to take them safely.
- Follow-up and specialist. At a follow-up, the doctor reviews whether the treatment is working and, if needed, arranges a referral to a rehabilitation physician, neurologist, orthopaedic surgeon, neurosurgeon or rheumatologist.
Video cannot fully replace a physical examination of the spine, reflexes and muscle strength. If your problem needs an in-person examination, the doctor will tell you openly and agree the next steps with you.
Note when the pain started and how it has developed, a list of the medicines you take, and the results of previous scans or medical reports. Book an online consultation for musculoskeletal and pain problems. You can find out more about the doctor in the profile of MUDr. Ahmed Maklad.
Care in Czechia
Talk to a doctor online
Has your back hurt for more than a few weeks, or are you unsure whether it is a warning sign? Have a doctor assess your symptoms from home.
- Online consultation: musculoskeletal and pain problems
- MUDr. Ahmed Maklad: doctor profile
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Has your back hurt for more than a few weeks?
In a video consultation, a doctor assesses your symptoms, rules out warning signs, recommends the tests you need and suggests treatment. If a specialist is needed, the doctor arranges the referral.
Sources
Medical sources for this article
Sources checked on 18 October 2026.
This article is based on Czech sources (ČSÚ, ÚZIS/MPSV, VÚBP, NZIP, Czech medical journals and faculties of medicine) and the European EU-OSHA survey, checked on 18 October 2026. The national figures on prevalence (ČSÚ 2011) and on sick-leave duration (ÚZIS 2013) are the most recent data found with this breakdown; we give the year for every figure. The article does not name medicines or doses.
Frequently asked questions
Frequently asked questions about back pain
When should I see a doctor about back pain?
When the pain lasts longer than a few weeks, radiates into the leg or arm, wakes you at night, or comes with weakness, tingling, fever or unexplained weight loss. If you have problems passing urine or stool, numbness in the groin area or rapidly weakening legs, call 155 or 112.
How can I tell whether lower back pain is caused by a slipped disc?
A slipped disc is suggested by pain shooting from the back into the buttock and leg, often below the knee, and by tingling, numbness or weakness in the leg. Simple lower back pain stays in the back and usually settles within a few weeks. Only an examination gives certainty.
What should I do if I have lumbago?
Rest briefly in a position that eases the pain; heat and painkillers as advised by a doctor can help. Return gradually to normal movement as soon as possible. If the pain shoots into the leg, weakness or numbness appears, or things do not improve within a few days, have a doctor assess it.
Why does neck pain develop?
Most often it is overload from long hours at a computer, stress with a forward head posture, or getting chilled. Pain radiating into the arm, tingling fingers or hand weakness may mean an irritated nerve root, for example from a slipped disc, and should be examined.
Can back pain be dealt with online?
Yes, as a first step. In a video consultation, a doctor assesses your symptoms and warning signs, recommends tests, suggests treatment and, if needed, arranges a referral to a specialist. If an in-person examination is necessary, the doctor will tell you.
