By Dr. Joseph Mejia, DO, FAAPMR
Medical Director, Performance Ortho

Back pain is one of the most common reasons people miss work, avoid the gym, stop playing their favorite sports, or simply lose trust in their body. At Performance Ortho, we’ve helped New Jersey residents for over 25 years get back to their favorite activities and curb chronic back pain of all modalities and severities.

From a broad lens, ‘back pain’ is an umbrella term for mechanical irritation of joints, discs, or muscles that generally improves with time, targeted treatment and smart movement patterns. When back pain is treated comprehensively with long-term outcomes in mind, many patients avoid surgery and see improved quality of life.

Contrary to popular belief, the most ‘serious’ forms of back pain aren’t always the most painful at first. Patients often associate urgency for orthopedic intervention with their immediate pain levels, but this can be a trap. Sometimes the most serious cases of chronic back pain we treat start subtly. Numbness in a foot, a leg that feels weak on stairs, a pain pattern that keeps migrating across the body, or symptoms that don’t behave like a normal strain can often be clinical clues towards underlying conditions that require urgent intervention.

At Performance Ortho, we look at back pain the way it should be approached in orthopedics: as a mechanical problem to solve, not just a symptom to suppress.

“When back pain becomes serious, it not always because the pain is intense, rather it’s because the pattern suggests nerve involvement, structural instability, or a problem that won’t resolve without targeted care.”

— Dr. Joseph Mejia, DO, FAAPMR

Understanding Common vs. Serious Back Pain

‘Common’ back pain

One of the biggest misconceptions is that back pain is an all or nothing proposition, either ‘it’s nothing’ or ‘I need major surgery’. The reality is, most patients fall somewhere in the middle, and a comprehensive evaluation by a Performance Ortho physician can hone in on your pain’s true source and severity.

Typical minor back pain originates in the low-back, with pain usually presenting as irritated facet joints, mild disc irritation without nerve compression, and tight hips and hamstrings causing overload of the lumbar spine. With a non-invasive treatment plan, most patients experience relief within 2-4 weeks with improved function and decreased pain.

Minor back pain may hurt. It may spasm. It may be uncomfortable to stand up straight. But the key feature to monitor is no progressive neurological( weakness into the feet or numbness in the groin) or movement deficits.

Serious back pain

Serious back pain is often a sign of nerve compression, spinal stenosis/arthritis and spinal instability. Unlike common back pain, serious back pain tends to persist beyond expected healing timelines, worsen and spread over time and behave consistently with nerve involvement.

The risk of ignoring persistent back pain is that you overcompensate elsewhere, lose function, aggravate the nerve longer than necessary, or set yourself up for invasive surgery which is not always successful and comes with lengthy and intensive recovery times.

Signs Your Back Pain May Be More Serious than you Thought

Below are patterns that, clinically, make us treat back pain differently than a normal muscle strain.

There are clinical patterns that are indicators for our physicians on when to treat back pain differently than a normal strain. Once you begin your treatment journey with Performance Ortho, diagnostic measures will be taken to ensure intervention is targeted, effective, and tailored to your personal long-term health goals.

Pain that persists beyond a 4 week timeframe suggests disc pain that has not stabilized, facet-joint pain that is stagnant, spinal stenosis and/or nerve irritation. At this point, the goal isn’t more rest, it’s accurate diagnosis and a plan towards long-term remediation.

Pain That Radiates into the Legs or Arms

Back pain that radiates below the knee is commonly consistent with sciatica, often a byproduct of disc herniation or nerve pinching and inflammation. Orthopedically, it matters because radiating pain behaves differently than localized pain.

Radiating pain doesn’t automatically mean surgery, but it does mean you need a clinician who evaluates the nerve properly.

Weakness or Loss of Coordination

This is where intervention for serious back pain becomes non-negotiable. If you notice foot drop, loss of balance, a leg that feels weak when going upstairs, difficulty standing, or grip weakness, this is a troubling sign of neurological failure.

Why Early Diagnosis Matters

From a performance and orthopedic lens, early evaluation is strategically smart for maintaining long-term health goals. One long-term benefit of early diagnosis is preventing nerve damage. Long-term, unchecked nerve compression can lead to persistent numbness and chronic nerve pain that is increasingly difficult to treat as time goes on.

Early diagnosis also is increasingly important as pain becomes chronic. As nerve pain progresses without intervention, the nervous system becomes more reactive. Furthermore, early detection is also critical for reducing the need for invasive procedures. Largely, People don’t “end up in surgery” because they had back pain. They end up in surgery because they lost function, symptoms progressed beyond pain tolerance, and a comprehensive non-surgical plan was delayed too long.

Surgical Referral Only When Truly Needed

If imaging shows a structural problem with progressive weakness or uncontrolled symptoms, surgical consultation can be appropriate, but it should be based on our objective findings, not fear or guesswork. If we can’t help you at Performance Ortho, it’s our promise to refer you to a doctor who can. It’s healthcare with integrity.

Contact Performance Ortho for More Information

Are you or a loved one suffering from back pain and seeking non-surgical alternatives, or just want to evaluate your current state? Contact our NJ ortho clinics in Branchburg, Somerset, Watchung, and Hillsborough. Our compassionate team and their expertise are here to help you through every step of your journey to pain relief.