Musculoskeletal Telehealth

Back Pain Treatment Online

Most low back pain is mechanical and resolves with conservative care. We diagnose, treat, and guide recovery for mild-to-moderate back pain — and tell you honestly when in-person care or imaging is needed instead.

Board-Certified HIPAA-Compliant Same-Day Available DE · MD · WA

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CRITICAL: These Back Pain Symptoms Require Immediate Emergency Care — Do NOT Use Telehealth

Telehealth is appropriate for mechanical, recurrent, or mild-to-moderate back pain. The presentations below represent neurological or systemic emergencies that require in-person evaluation and imaging. Call 911 or go to the nearest ER immediately for:

Cauda Equina Syndrome (Surgical Emergency)

• Saddle anesthesia — numbness in the groin, inner thighs, or perineal area
• New bowel or bladder incontinence or retention
• Progressive bilateral leg weakness
• Sexual dysfunction with new back pain

Spinal Infection

• Back pain with fever or chills
• IV drug use history with new severe back pain
• Recent spinal procedure with worsening pain
• Immunocompromised state with focal spinal tenderness

Major Trauma or Fracture

• Back pain after a fall, motor vehicle accident, or significant blow
• Sudden severe pain after lifting in older adults (vertebral fracture risk)
• Known osteoporosis with sudden onset back pain

Malignancy / Cancer Red Flags

• History of cancer with new back pain
• Unexplained weight loss with back pain
• Night pain that wakes you from sleep, unrelieved by rest
• Age over 50 with new persistent back pain

Abdominal Aortic Aneurysm (AAA)

• Sudden severe tearing back or flank pain in older adults (especially men > 65)
• Pulsating abdominal mass
• Signs of shock: pale, sweating, weak pulse, dizziness
• Smoking history with new severe back pain

IF IN DOUBT — GO TO THE ER. Cauda equina and spinal infections are time-sensitive: every hour matters for neurological recovery.

Back Pain Conditions Well-Suited to Telehealth

Once red flags have been excluded, the majority of back pain — about 85% — is mechanical and self-limiting. Most patients improve within 4 to 6 weeks regardless of treatment intensity. Telehealth is well-suited to guide the evidence-based approach:

Acute lumbar strain from lifting, twisting, or overuse

Mild-to-moderate sciatica without progressive weakness

Chronic mechanical low back pain with established diagnosis

Recurrent flare-ups in patients with known back history

Neck pain from poor posture, muscle tension, or strain

Post-exertional or work-related musculoskeletal pain

First-Line Treatment — What the Evidence Supports

The American College of Physicians recommends starting with non-pharmacologic and over-the-counter approaches for acute and subacute back pain. Imaging is not recommended in the first 6 weeks unless red flags are present, because it does not improve outcomes and often shows incidental findings that lead to unnecessary procedures.

Stay Active (within tolerance)

Bed rest beyond 1–2 days slows recovery. Continue light walking and gentle movement as tolerated. Avoid heavy lifting, prolonged sitting, and twisting. Most patients improve faster by gradually returning to activity than by resting completely.

NSAIDs (First-Line Medication)

Ibuprofen 400–600 mg every 6–8 hours, or naproxen 220–440 mg every 8–12 hours, taken with food. NSAIDs are the most effective OTC option for inflammatory back pain. Avoid if you have a history of stomach ulcers, kidney disease, or are on blood thinners — we will help you choose a safer alternative if so.

Muscle Relaxants for Acute Spasm

A short course of cyclobenzaprine (Flexeril) at 5–10 mg at bedtime can be prescribed for muscle spasm associated with acute back pain — typically for 5–7 days. It is sedating, so it is best taken at night. We do not prescribe controlled muscle relaxants such as carisoprodol via telehealth.

Heat / Ice & Topicals

Heat is generally more effective than ice for muscle-driven back pain after the first 48 hours. Topical diclofenac (Voltaren gel) is a good option for localized pain when oral NSAIDs are not tolerated. A heating pad for 15–20 minutes several times a day can substantially reduce stiffness.

Physical Therapy Referral

For pain lasting more than 2–4 weeks, physical therapy is one of the most effective interventions for both lumbar strain and sciatica. We refer you to a local PT and provide the referral documentation insurance often requires. Telehealth PT options are also available in MD, WA, and DE.

Sciatica — What Makes It Different

Sciatica refers to pain that radiates from the lower back down one leg, often below the knee, following the path of the sciatic nerve. It is caused by irritation of a lumbar nerve root — most commonly from a herniated disc. About 90% of disc-related sciatica resolves within 6 weeks with conservative care.

Telehealth Can Help Sciatica When:

Pain is mild-to-moderate and stable or improving
No new bowel or bladder symptoms
No progressive weakness (e.g., foot drop, difficulty walking on heels or toes)
No saddle anesthesia

Any of these red flags requires in-person evaluation and likely urgent imaging.

For appropriate sciatica, conservative management is the same as for mechanical back pain — NSAIDs, activity modification, and physical therapy. Short courses of oral steroids (e.g., prednisone or methylprednisolone) are sometimes used for severe radicular pain, though evidence for benefit is modest. We will discuss whether this is right for you.

When Imaging Is — and Is Not — Indicated

National guidelines (ACP, AAFP, NICE) all agree: imaging in the first 4–6 weeks of back pain does NOT improve outcomes for typical mechanical pain. MRI in particular shows abnormalities like disc bulges and facet arthritis in most asymptomatic adults, which can lead to unnecessary procedures.

Imaging IS Indicated

Any red flag symptoms (cauda equina, infection, trauma, cancer history, progressive neurologic deficit), pain persisting more than 4–6 weeks despite conservative care, or before considering injection/surgery.

Imaging Is NOT Indicated

Acute back pain < 4 weeks with no red flags, mild sciatica improving with conservative care, or pain clearly mechanical with reassuring exam.

When imaging is appropriate, we coordinate a referral to a local imaging center. MRI typically requires in-person referral to ensure clinical correlation.

Medical Disclaimer: This page is for informational purposes only and does not constitute medical advice. A licensed provider evaluation is required for diagnosis and treatment. Severe, sudden, or progressive back pain — especially with neurological symptoms — requires in-person or emergency evaluation.

Back Pain Treatment — Frequently Asked Questions

Most acute mechanical back pain improves substantially within 2 to 4 weeks and resolves by 6 weeks. About 30% of patients have a recurrence within a year. Sciatica typically takes longer — 6 to 12 weeks for full resolution — but 90% improves with conservative care alone.

Yes — non-controlled muscle relaxants such as cyclobenzaprine (Flexeril), methocarbamol (Robaxin), and tizanidine (Zanaflex) can be prescribed via telehealth when clinically appropriate. We do not prescribe controlled substances such as carisoprodol (Soma), opioids, or benzodiazepines for back pain. For severe pain unresponsive to first-line therapy, in-person evaluation is appropriate.

Probably not in the first 4 to 6 weeks. MRI is reserved for back pain with red flag symptoms (neurological deficit, cancer history, infection signs, trauma) or for pain that has not responded to 4 to 6 weeks of conservative care. Studies show that imaging early in typical back pain does not improve outcomes and can lead to unnecessary procedures.

If sciatica is not improving by 4 to 6 weeks despite NSAIDs, activity modification, and physical therapy, the next step is usually an MRI to evaluate the disc and nerve root. From there, options include epidural steroid injections, neurosurgery consultation, or continued conservative care depending on the findings. We coordinate the referral and stay involved in your care.

Yes. We provide a PT referral with the diagnosis documentation insurance typically requires. PT is one of the most effective interventions for back pain — both for acute strain and chronic mechanical pain. We will help you find an in-network or self-pay-friendly PT in your area.

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Honest, evidence-based care — without rushing to imaging or opioids you do not need. We will help you recover and tell you straight when in-person care is the right call.

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Serving DE · MD · WA | HIPAA-Compliant | Board-Certified