Mechanical back pain is the most common form of spinal pain and arises from dysfunction of the musculoskeletal components of the spine, including muscles, ligaments, intervertebral discs, facet joints, and supporting structures. Unlike inflammatory or neurological causes, mechanical back pain is typically activity-related and influenced by posture, movement, and mechanical loading.

Patients often present with localized back pain that worsens with physical activity, prolonged sitting, bending, or lifting, and improves with rest. Morning stiffness may be present but is usually short-lived. Pain may be acute following strain or develop gradually due to repetitive stress, poor ergonomics, or degenerative changes.

Orthopaedic evaluation emphasizes differentiation between mechanical pain and pain arising from neurological or systemic causes. A detailed history and physical examination assess posture, spinal alignment, range of motion, muscle tenderness, and functional limitations. Red flag symptoms are carefully excluded.

Imaging is selectively used and guided by clinical findings. Plain radiographs may demonstrate degenerative changes, while advanced imaging is reserved for persistent or atypical cases. Importantly, imaging findings must be correlated with symptoms, as degenerative changes are common in asymptomatic individuals.

Management focuses on education, activity modification, physiotherapy, and strengthening of core musculature. Early mobilization is encouraged, as prolonged rest may worsen outcomes. Pain control facilitates rehabilitation but should not replace functional recovery strategies.

Chronic mechanical back pain may develop when acute episodes are inadequately managed. In such cases, multidisciplinary management addressing biomechanics, conditioning, and ergonomics is essential. Surgical intervention is rarely indicated unless structural pathology with neurological compromise is identified.

Mechanical back pain requires structured orthopaedic care aimed at restoring spinal function, preventing recurrence, and maintaining long-term musculoskeletal health.