Back Pain Red Flags You Should Never Ignore

The overwhelming majority of back pain is mechanical - it comes from muscles, joints, and discs that are overloaded or irritated, not from anything dangerous. But a small subset of back pain presentations are warning signs for serious conditions including infection, fracture, tumour, or cauda equina syndrome. Knowing the difference is important.

Red flags that require same-day assessment

• Changes to bladder or bowel function alongside back pain - inability to urinate, loss of control, or reduced sensation in the saddle area (inner thighs and groin)
• Weakness in both legs, especially if it comes on suddenly
• Back pain following significant trauma such as a fall from height or motor vehicle accident

These symptoms may indicate cauda equina syndrome or spinal cord injury, both of which require emergency assessment. Do not wait.

Red flags that require prompt assessment (within days)

• Unrelenting pain that is present at rest and at night, not relieved by any position
• Unexplained significant weight loss alongside back pain
• Back pain in someone with a history of cancer
• Fever or signs of infection alongside back pain
• Back pain in someone over 70 after a minor trip or fall (possible fragility fracture)
• Pain in someone under 20 that is worsening despite rest

What's not a red flag

Leg pain (sciatica), stiffness in the morning, pain that's worse with sitting or lifting, and pain that varies day to day are all common and not concerning on their own. They should be assessed, but they don't need emergency management.

If you're unsure, err on the side of getting assessed. A physio or GP can quickly rule out the serious causes and point you in the right direction.