Low back pain: causes, self-care and warning signs
Low back pain usually comes from a strain of the muscles or ligaments. Most people improve a lot within the first week and recover within 4 to 6 weeks, and staying active helps more than bed rest. By video, the doctor can assess your pain, check for warning signs and recommend treatment, without opioids.
Can we help by telehealth? Yes, we can help by telehealth.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Loss of bladder or bowel control
- Numbness in the groin, buttocks or inner thighs
- Weakness in the legs, or trouble walking or keeping your balance
- Fever with back pain
- Pain after a fall or a hard blow
- A history of cancer, unexplained weight loss, steroid use or injected drug use
Help lines:
- 911 — Emergencies
- 1-800-981-0023 — Línea PAS (mental-health crisis line)
- 988 — Suicide & Crisis Lifeline
- 1-800-222-1222 — Poison Help
Common causes of low back pain
Acute low back pain usually starts with a sudden injury to the muscles or ligaments that support the back. It can come from lifting something heavy, a sudden movement or sitting for a long time. Other causes include muscle spasms, a herniated disk and sciatica (pain that runs down the leg).
Symptoms
The most common symptoms of low back pain are:
- Pain or stiffness in the lower back
- Muscle spasms
- Pain that gets worse when you move, bend or lift
- Pain that runs down one leg (sciatica)
What helps: activity, ice and heat
These steps, based on MedlinePlus and NICE guidance, help most people:
- Cut back a little for the first few days, but avoid bed rest: ease back into your normal activities.
- Use ice for the first 48 to 72 hours, then heat.
- Sleep in a comfortable position, with a pillow between your knees if you sleep on your side.
- After 2 to 3 weeks, start gentle aerobic activity such as walking, cycling or swimming.
- Physical therapy can teach you exercises and how to move safely.
- Back belts and corsets are not recommended for low back pain.
Medication (no opioids or controlled substances)
Over-the-counter pain relievers such as ibuprofen or acetaminophen can help when used as directed. Anti-inflammatories are not right for everyone (for example with stomach, kidney or heart problems), so ask the doctor.
We do not prescribe opioids or other controlled substances. If appropriate, the doctor can prescribe other medication.
When you need imaging or physical therapy
X-rays and MRIs are usually not needed in the first 4 to 6 weeks unless there are warning signs. Clinical guidelines advise against routine imaging.
The doctor may recommend an in-person evaluation, physical therapy or a specialist if the pain lasts more than 4 weeks, spreads below the knee, is worse when lying down or keeps you awake, or comes with numbness or weakness in your legs.
What a video visit can do in Puerto Rico
If you are physically in Puerto Rico, including as a visitor, in a US$79 online doctor visit the doctor can ask how the pain started, have you do a few movements on camera, check for warning signs, recommend care and exercises, and give you a sick note after the visit if you need one for work, at no extra charge. See how a visit works and what we do not do by telehealth.
Back pain in children and teens
Back pain is less common in children. A child with back pain plus fever, weight loss, pain that wakes them at night, or pain after a fall or blow needs an in-person evaluation. We see patients from 6 months old, and patients under 21 need a parent or legal guardian on camera for the whole visit. The doctor is not a pediatrician.
Video visit: US$79 · Pay by card · See the price and what is included
Before you book
- You must be physically in Puerto Rico during the visit (visitors and tourists are welcome).
- We see patients from 6 months old. Patients under 21: a parent or legal guardian must be on camera for the whole visit.
- Real-time video only; we do not do phone-call visits.
- We do not prescribe controlled substances.
Frequently asked questions
- When should I worry about back pain?
- If you lose control of your bladder or bowels, have numbness in the groin or buttocks, weakness in your legs, a fever, or the pain started after a hard fall or blow, get emergency care. The same applies if you have a history of cancer or unexplained weight loss.
- How long does low back pain last?
- Most people improve a lot in the first week and recover within 4 to 6 weeks. If it lasts more than 4 weeks, get it checked.
- Do I need an X-ray or an MRI?
- Usually not in the first 4 to 6 weeks if there are no warning signs. The doctor will tell you if your situation needs imaging.
- Can I get a work note for back pain?
- Yes, after a real visit, if the doctor judges that your condition keeps you from working. See sick note.
Sources
- MedlinePlus (NIH): Low back pain, acute (accessed 2026-09-30)
- NICE NG59: Low back pain and sciatica in over 16s (accessed 2026-09-30)