Should I have back surgery or try physiotherapy first?
For most back pain and sciatica, try guided exercise and staying active first. Surgery is for a smaller group: those with serious nerve damage signs, or severe leg pain that does not settle despite good rehabilitation.
The decision rests with you and your spine surgeon. Our part is to help you get stronger and moving, and to tell you when we think you should go back to the doctor.
How common is back pain, and what do the guidelines say?
The World Health Organization (WHO) reports that low back pain affected 619 million people in 2020, about 1 in 13 [3]. You are far from alone.
WHO’s first guideline on chronic primary low back pain recommends education, structured exercise and certain physical therapies, and advises against 14 interventions including lumbar braces and opioids [1]. WHO also says painkillers should not be the first-line treatment, and that physical therapies and staying active can help [2].
That is the foundation. Surgery is not the first line for common back pain.
Which signs mean I should not wait?
A few signs need prompt medical care, not weeks of exercise. Learn them, and tell the family.
- Numbness around the groin, buttocks or inner thighs.
- Trouble passing urine or controlling the bowel.
- Weakness in a leg that is getting worse, such as a foot that drags.
- Severe pain after a fall or accident.
- Fever with back pain, or a history of cancer with new back pain.
Go to the emergency department at Hospital Raja Permaisuri Bainun or a private hospital in Ipoh if any of these appear. Our page on back pain: when to worry covers them in more detail.
Does a bad scan mean surgery?
No. A scan shows structure, not pain. Some people with no symptoms have bulging or worn discs on a magnetic resonance imaging (MRI) scan.
Treatment is decided by your symptoms, your examination and how you respond to care. Read scans and what they mean before you let a report frighten you. Ask the doctor how the picture fits what you feel.
What does surgery help, and what does it not?
Surgery can relieve pressure on a nerve and help severe leg pain, weakness or a narrowed spinal canal (spinal stenosis). It does not replace strength, and it does not change habits such as long hours sitting or heavy lifting.
That is why recovery after surgery still needs rehabilitation. See our page on spinal surgery rehabilitation for what to expect.
What can I do in the months before deciding?
Keep moving within comfort. Walk, change position regularly and practise the exercises a physiotherapist gives you. Our guide on slipped disc and sciatica explains how those exercises are chosen.
Think about your daily load. A driver on the Ipoh to KL highway, a hawker standing for hours, a teacher bending to desks or an office worker at a screen each need a different plan. A short assessment helps, and we can adjust your set-up at home.
How can a physiotherapist help at home?
We look at how you move, sit, stand and lift. We build a programme for your back and show you how to do it safely.
Home physiotherapy in Ipoh lets us see your bed, chair and kitchen height. If surgery goes ahead, we plan your return afterwards. Our Canning Garden centre is opening soon for those who prefer to travel.