Back pain red flags
Most back pain settles on its own within a few weeks. A few signs mean it should be checked soon, and some need urgent care.
Nearly everyone has back pain at some point. In most people it comes from a strained muscle, a stiff joint or a long day in a poor position, and it improves over four to six weeks with gentle movement and simple pain relief. Scans are usually not needed at the start.
Doctors look out for a short list of "red flags": signs that the pain may have a more serious cause. Having one does not mean something is wrong, but it does mean you should be examined.
Go to an emergency department now if you have
- Numbness in the groin, buttocks or inner thighs
- New difficulty passing urine, or loss of bladder or bowel control
- Weakness in both legs, or legs that suddenly give way
- Back pain after a serious fall or road accident
These can be signs of pressure on the nerves at the base of the spine (cauda equina syndrome) or a spinal fracture. Both need treatment within hours.
See a doctor within a few days if
- The pain comes with fever, chills or feeling generally unwell
- You have lost weight without trying
- You have had cancer, or take steroid tablets long-term
- The pain is worse at night or when lying still
- Leg pain, tingling or weakness keeps spreading
- You are over 50 and this is new back pain, or under 20
- You have osteoporosis and the pain started after a minor fall
What usually helps
Keep moving as much as the pain allows. Short, frequent walks are better than long bed rest, which tends to make backs stiffer. A warm pack, changing position often and pain relief as advised by your doctor or pharmacist help most people through the first few weeks. A physiotherapist can show you exercises to rebuild strength once the worst has settled.
When a spine surgeon can help
Most people never need surgery. It is worth seeing a spine specialist if pain running down the leg lasts more than six weeks despite treatment, if you notice weakness in the foot or leg, or if the distance you can walk keeps shrinking because of leg pain. A proper examination, and a scan only when it will change the plan, helps decide the next step.