Back Creek originates in the Great North Mountain range along the Virginia-West Virginia border in Frederick County, Virginia, flowing northward through a scenic valley for approximately 60 miles before joining the Potomac River near Hedgesville in Berkeley County, West Virginia. The creek's headwaters begin at Farmer's Gap, descending through agricultural valleys flanked by North Mountain to the east and White Pine Ridge to the west, creating a distinctive corridor through the Appalachian highlands.

The paddling opportunities on Back Creek vary considerably by location and season. In Virginia's Frederick County, the upper sections from Route 50 near Gore to Dehaven offer Class I flatwater suitable for beginners, spanning roughly 12 miles through pastoral farmland with minimal rapids. The middle section between Route 704 bridge and Route 50 presents more technical water with Class II-III rapids over approximately 6 miles, requiring intermediate skills and appropriate water levels. In Berkeley County, West Virginia, the lower section from West Virginia Route 9 to McCoy's Ferry provides Class II(III) whitewater across 8 miles, featuring occasional ledges and rock gardens that demand competent boat control.

Optimal paddling conditions typically occur from late winter through late spring (February-May) when snowmelt and seasonal rains maintain adequate flows. Summer levels often drop significantly, rendering many sections too shallow for navigation. The creek requires recent precipitation to be runnable, with gauge readings from nearby Hogue Creek serving as useful indicators for boaters planning trips.

Back Creek supports diverse aquatic life including smallmouth bass, rock bass, and stocked trout in designated delayed-harvest sections near the Bath County Pump Storage Station tailwater. The riparian corridor hosts osprey nests, white-tailed deer, and various waterfowl. Rare species including the federally endangered harperella plant have been documented in portions of the watershed.

Access points include Route 50 bridge near Gore, Virginia; Dehaven at Warm Springs Ford; West Virginia Route 9 bridge near Hedgesville; and McCoy's Ferry near the Potomac confluence. The creek flows past small communities including Gore, Gainesboro, and Glengary before reaching Hedgesville, the largest nearby town.

The watershed has historical significance dating to colonial settlement, with George Washington surveying lands in the region. The name "Back Creek" derives from its location behind (west of) North Mountain from the perspective of early settlers approaching from the east.

Paddlers should note that agricultural lands border much sections, with occasional barbed wire hazards reported across the creek. Low bridges may require portaging depending on water levels. The creek is designated as a High Quality Recreational Stream by West Virginia DNR, and fishing regulations vary by section and season.