This guide explains when physiotherapy is enough and when surgery may help. It also shows how Dr Imran Salim Malik decides with you. He sees patients at Omar Hospital & Cardiac Centre, Lahore.
What causes back pain?
Back pain can come from a strained muscle, an injury, wear and tear, poor posture, heavy lifting or long hours of sitting. Often it settles within a few weeks with simple pain relief and staying gently active.
Sometimes a slipped disc or a narrow spinal canal presses on a nerve. This can cause pain, tingling or weakness down the leg.
If the pain lasts for weeks or months, get it checked.
Back pain with a fever or feeling very unwell needs a doctor the same day. If the clinic is closed, go to an emergency department.
See a doctor within days, not weeks, if back pain comes with:
- weight loss you can't explain
- pain that is worse at night or at rest
- a past history of cancer or TB
- weak bones (osteoporosis)
Go to an emergency department now if you have back or leg pain with: loss of bladder or bowel control, new difficulty passing urine, numbness around the private parts, inner thighs or buttocks, or new or quickly worsening weakness in the legs.
Do not wait for a clinic appointment.
Severe back or neck pain after a fall or accident: keep the person still, do not move them, and call Rescue 1122.
How physiotherapy helps back pain
Physiotherapy (guided exercise treatment) is usually the first step. A physiotherapist teaches you exercises that strengthen your back and improve your posture and movement.
Physiotherapy can:
- Ease stiffness and improve flexibility
- Ease pain
- Improve posture
- Build stronger muscles to support your spine
- Help prevent future injury
- Spare you an operation and its recovery time
Many people with mild to moderate back pain feel better within a few weeks.
But physiotherapy alone may not be enough if a damaged disc, an unstable spine or a squeezed nerve is the cause.
When spine surgery may help
For most back problems that are not emergencies, surgery is considered only if physiotherapy and medicines have not helped. It aims to fix the cause, such as a disc pressing on a nerve.
The surgeon checks your MRI and history first, so the treatment fits the real cause.
Is spine surgery safe? Can it cause paralysis?
This is the most common worry. Serious nerve injury, such as paralysis, is rare. But every operation has some risks. For spine surgery they include:
- infection or bleeding
- blood clots in the legs
- a leak of the fluid around the nerves
- nerve injury
- pain that does not fully go away, or needing another operation
Dr Malik will explain the risks for your case, and what to expect if you wait instead, before you decide.
Which spine problems may need surgery?
- Slipped (herniated) disc
- Spinal stenosis (narrowing of the spinal canal)
- A squeezed nerve causing leg weakness or numbness
- Spinal deformity (a curved or bent spine)
- An unstable spine (spine bones that move more than they should)
- Pain that has not improved after months of proper treatment, when the MRI shows a clear cause
Common types of spine surgery
Your surgeon will choose the operation that fits your problem:
● Discectomy
Removes the part of a disc that is pressing on a nerve.
● Laminectomy
Removes a small piece of bone to make more room for the nerves.
● Spinal Fusion
Joins two or more spine bones together to stop painful movement.
What is minimally invasive (smaller-cut) surgery?
Some spine operations can be done through small cuts. It is not right for every condition. For suitable patients, it can mean:
- A smaller wound and less scarring
- Less pain after the operation
- A shorter hospital stay
- Often, getting back to daily life sooner
What is recovery like?
With physiotherapy
Recovery is gradual. You carry on with normal life while regular exercises build your strength and movement.
After spine surgery
How long recovery takes depends on the operation. A smaller operation, such as removing part of a slipped disc, usually has a quicker recovery. Fusion takes longer, often several months.
If surgery treats a clear cause, such as a squeezed nerve, pain can get much better once you have healed. You are usually up and walking within a day or so. A gentle exercise programme usually starts within a few weeks.
Stop smoking and all tobacco, including naswar and chewing tobacco. It slows bone and wound healing.
After spine surgery: when to get help
- Wound red, hot, swollen or leaking, or a fever: call +92 300 4890692 the same day.
- Pain or swelling in the calf: call the same day.
- Chest pain or sudden breathlessness: go to the nearest emergency department now or call Rescue 1122.
- Loss of bladder or bowel control, numbness around the private parts, or new leg weakness: go to an emergency department now.
If the clinic is closed or you cannot reach it, go to the nearest emergency department.
Do you need surgery? Ask yourself these questions
- Have you tried physiotherapy for several months?
- Have you tried medicines?
- Is the pain affecting your sleep, work, or walking?
- Do you have numbness or weakness in your legs? (If it is new or getting worse quickly, go to emergency now.)
- Does your MRI or X-ray show a disc or nerve problem?
If you answered yes to several of these, it makes sense to see a spine surgeon and talk through your options.
Not sure if you need surgery? WhatsApp your X-ray or MRI to +92 300 4890692 to book a consultation. Dr Malik will need to examine you before advising on surgery.
The consultation fee depends on the hospital you visit. We tell you the exact fee on WhatsApp before you book, so there are no surprises. A follow-up visit within 5 days of your first consultation is free to go through your reports and scans.
Who is Dr Imran Salim Malik?
Dr Malik is an orthopedic and trauma surgeon in Lahore, with more than 20 years of experience in orthopedic surgery. He has a special interest in spine surgery.
He treats slipped discs, spinal fractures, spondylolisthesis (a spine bone slipping forward) and long-term back pain. He explains the plan to each patient.
For most back problems, he suggests surgery only after non-surgical treatment has been tried. A few emergencies, such as a squeezed nerve causing loss of bladder control, need surgery straight away. If you do need an operation, Dr Malik performs it himself.
How to choose a spine surgeon in Lahore
Here is what you can check for yourself:
- Registered with the PMDC, with a qualification in orthopedic surgery or neurosurgery. You can check this on the PMDC website.
- Regularly does the operation you need
- Discusses not having an operation as one of your choices
- Works at a hospital with proper scans, an operating theatre and after-surgery care
- Explains the risks, the other options and the fees clearly, and gives you time to decide
You can meet more than one surgeon before you decide.
Already been told you need an operation? A second opinion is your right. Bring your reports and Dr Malik will go through your options with you, including non-surgical ones.
The bottom line
Most back pain is treated with physiotherapy. Surgery is for a smaller group: people with a clear cause that has not improved, and the rare emergencies described above. For them it can bring real, lasting relief, though results vary.
If your back pain has not settled, or it spreads down your leg, book an assessment with Dr Malik.
Lost control of your bladder or bowel, gone numb around the private parts, or have new or worsening leg weakness? Go to an emergency department now. Do not wait for the clinic.
From the clinics of Dr Imran Salim Malik, orthopaedic and trauma surgeon. MBBS (Allama Iqbal Medical College) · MS (Trauma & Orthopaedics) · PMDC Reg. 39646-P. Every patient is different: Dr Malik will tell you what applies to you.
