Not just a stiff muscle: The warning signs that prove your back pain requires investigation | Dr. Itay Gal

The pain that disguises itself: Almost every person has had back pain at some point. After lifting bags, prolonged sitting, training, poor sleep, or a busy day, the back signals. In most cases, it is truly muscular or orthopedic pain that passes with time, moderate movement, and simple treatment. But sometimes pain in the back is just the place where the body feels the problem, and not the place where it starts. Here it is important to know when not to settle for ointment and stretching.

Muscular back pain tends to be related to movement. It worsens with bending, twisting, lifting, prolonged sitting, or a certain position, and improves with rest, heating, or changing position. Sometimes you can press on a painful point and elicit the pain. It can be sharp or dull, local or radiating to the leg, and sometimes stems from muscle strain, nerve irritation, or a disc problem. This is the common pain, but it is not the only one.

Kidney pain is sometimes felt in the side of the back or the waist, below the ribs, and sometimes radiates to the groin. A kidney stone can cause intense, episodic pain that comes in waves, with restlessness, nausea, vomiting, and sometimes blood in the urine. A kidney infection can cause waist pain along with fever, chills, weakness, burning during urination, or frequency. Unlike muscular pain, kidney pain does not always change when you move your back, and it does not disappear just because you find a comfortable position.

Pain originating in the heart can radiate to the back, mainly to the upper back, between the shoulder blades, to the neck, jaw, shoulder, or arm. A heart attack does not always appear as classic chest pain. In some people, and especially women, the elderly, and diabetics, there may be back pain, shortness of breath, nausea, sweating, weakness, or discomfort in the upper abdomen. Pain that appears during exertion, is accompanied by shortness of breath or sweating, or is not similar to known back pains, requires urgent examination.

A rarer but especially dangerous condition is a problem with the aorta, the large blood vessel that exits the heart. Sudden, very strong, tearing, or unusual pain in the back or chest, especially with weakness, fainting, sweating, shortness of breath, a difference in blood pressure, or wandering pain, is a medical warning sign. This is not pain you wait with for an orthopedic appointment.

The digestive system can also cause pain that radiates to the back. Pancreatitis sometimes causes strong pain in the upper abdomen that radiates to the back, accompanied by nausea and vomiting. Gallbladder problems can cause pain in the upper right abdomen that radiates to the back or right shoulder, especially after a fatty meal. A stomach or duodenal ulcer can sometimes cause pain that is also felt in the back. In such cases, symptoms around meals, nausea, vomiting, or fever provide a direction.

The lungs and the pleura can also radiate pain to the back. Pneumonia, pulmonary embolism, or pleurisy can cause pain that worsens with deep breathing, coughing, or shortness of breath. If back pain appears with fever, cough, blood in the phlegm, shortness of breath, or sharp pain during breathing, it is not regular back pain until proven otherwise.

There are also orthopedic red flags that must not be missed. Back pain after significant trauma, pain with weakness in the leg, loss of sensation in the groin area, lack of control over urine or stool, fever, weight loss, pain that wakes you from sleep and does not improve, a background of cancer, immunosuppression, or prolonged use of steroids, all require investigation. Most back pains are not dangerous, but these flags exist to identify the minority that does require quick treatment.

How to distinguish at home? It is not always possible, but there are clues. Pain that changes greatly with movement, touch, or position is more suitable for muscle or skeleton. Pain that comes with fever, abnormal urine, shortness of breath, sweating, chest pain, severe nausea, weakness, or weight loss requires broader thinking. A new, very strong, or different pain from everything you have known is not pain that you automatically mark as "stiff back".

What can be done for regular back pain without warning signs? Continue moderate movement, avoid complete rest in bed, use local heating, consider a suitable painkiller according to medical condition, and gradually return to activity. If the pain continues, returns, or radiates to the leg, it is worth contacting a doctor or physiotherapy. But if there is one of the warning signs, home treatment should stop.

The important message is to know your pain. Someone who has suffered for years from lower back pain that worsens with sitting and is relieved by movement usually knows the pattern. But new pain in the side of the waist with fever and burning during urination, pain between the shoulder blades with sweating and shortness of breath, or abdominal pain that radiates to the back are not "more of the same". The body sometimes uses the back as a bulletin board. Not every notice is important, but some require immediate reading.

Dr. Itay Gal is a specialist in pediatrics, sports and aviation medicine, and the medical commentator for Maariv. For more articles on health and technology topics, click here.