Lower Back Pain Red Flags

'Some Symptoms Must Never Be Ignored'

By Definition –

Lower back pain red flags are what your family doctor will look for if you go to see them with back pain. They indicate the existence of something far more serious than just a pulled muscle or strained ligament, that may require expensive CT/ MRI scans, since everything from kidney stones to cancer could give you lower back pain.

Here we list all the lower back pain red flags, consider what other diseases would give you similar lower back pain and challenge you to remember the essence of the red flags yourself – because one day it just might save a life.

Lower Back Pain Red Flags – When It Isn’t ‘Normal’ Back Pain

Lower back pain can be extremely painful – but it is rarely dangerous. By that I mean, although it’s immediate impact on your lifestyle can be serious, most pain will fade away with massage, TENS therapy and a nice hot bath.

You may notice that I didn’t mention ‘rest’, because new studies have come to the conclusion that recovery times are actually much better if you keep moving while recovering, rather than spend four days sat on your sofa!

However, there are certain occasions when your lower back pain is more than just a ‘mechanical’ pull or strain and instead it is something far more dangerous (if not necessarily any more painful).

These ‘lower back pain red flags’ need to be taken seriously and immediate action must follow. If you find yourself experiencing any of them, an immediate trip to your doctor is required as you are likely to need various tests/ scans to either confirm or rule out something potentially far more life threatening.

So how do you know what early signs to look for that your lower back pain may in fact be something for more serious than the normal?

Well I’m sorry to say that the severity of your lower back is most certainly NOT one of the factors. Unfortunately, muscle damage often provides the most painful of injuries but isn’t of any real, long-term concern.

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Primary Lower Back Pain Red Flags

However, there are two basic immediate concerns that should result in a trip to the hospital without delay. These are –

1. Forceful Impact

If you have an accident that results in a force hitting your back that could be enough to fracture your spine. If this has just happened to you, tell the ambulance staff and make sure you get scanned before being discharged.

If you have even the smallest fracture in your spine, then the last thing you want to be doing is trying to carry out other activities.

2) Numbness

If you find yourself experiencing incontinence or start to feel numbness/ tingling around your groin and upper thighs. Doctors refer to this as being numbness in a ‘saddle’ pattern ie if you imagine yourself sitting on a horse, then the area that you would be in contact with the saddle is the area you want to focus on.

3) Deterioration

If you’re in severe pain and it either hasn’t improved, or has got noticeably worse.

4) Timescale

If it’s been a problem for more than 6 weeks.

Any pain following this sort of pattern requires immediate attention as it also points towards a spinal cord injury or something else that will only get very significantly worse if not treated asap.

Family doctors will normally use those guidelines as reason enough to refer you to a hospital specialist. They usually only need to see one of the four risks present to refer and they should be the first four elements that they seek to rule out when examining you.

Family doctors will normally use those guidelines as reason enough to refer you to a hospital specialist. They usually only need to see one of the four risks above as present to refer you and they will most likely be the first four elements that they seek to rule out when examining you.

Secondary Lower Back Pain Red Flags

However, family doctors will also have a whole series of secondary red flags that are highly suggestive of something else going on beyond the obvious back pain. The presence of two of these red flags should certainly warrant a visit to a hospital for CT/ MRI scans, while even one is frequently enough to justify the scans.

This is because, although a scan can be expensive, it is absolutely vital to catch many of the other potential causes early to have the best chance of treating them.

These other red flags can be listed as –

1. Unexpected Weight Loss

This can be tricky to quantify if the patient is very active or on a diet, as in those circumstances weight loss may be perfectly normal. However, it is also one potential indicator of cancer as well, so needs to be investigated fully.

2. Unexplained Fever

This could be a variety of things – either a serious infection that requires immediate antibiotics or something more long-term like the early onset of rheumatoid arthritis.

3. Out Of The Expected Age Range of 20-55 Years Old

This doesn’t actually mean anything in particular, except that it is statistically very unusual for you to develop lower back pain for the first time when you are either very young or post 55. The % chance of your lower back pain being something much more dangerous are substantially higher if your pain has presented itself before you reach 20 or after 55.

This does not apply in the same way if you’ve been suffering back pain on and off for years and then turn 55 – it is really if you’ve never had back pain and then suddenly at 60, start getting persistent pain.

4. Difficulty With Other Bodily Functions

This really covers if your back pain comes in lines with incontinence, difficulty urinating, numbness in various areas or even weakness (especially in your legs). This is typically indicative of some sort of neurological problem.

5. Drug Abuse, Steroid Use or HIV.

This is where you have to be honest with yourself and with your doctor (who should never judge you, but needs to know the full picture if they are to treat you as best they can). If, for example, you took drugs once when you were 20 and you’re now 45, then obviously that is now an issue.

If however, you took steroids to improve your muscle definition for 10 years, even if you’ve stopped now, then statistically the chances of a chances of a cancer of neurological problem are much more likely.

Similarly, if you are still taking recreational drugs (ie not prescribed be a doctor and tracked with a clinical record), then again this needs to be disclosed and considered.

Even just having a history of taking drugs for a prolonged period of time can leave you at much higher risk.

There is of course no guarantee that your back pain is something more sinister if you have HIV or a strong history of drug taking, but it does increase the chances and so makes the need for a scan to rule out other possibilities even more important.

6. Light Contact To Your Spine Is Painful.

This could be indicative of a whole host of painful problems, including spinal cord damage or a whole host of infections or other problems. Suffice to say, if your back is too painful to touch even if it’s ‘understandable’ because you’ve just been involved in a car accident or other injury, then get straight to the hospital.

If there is no obvious reason for it, then phone a friend and get them to take you to the hospital, or call an ambulance if it has come on all of a sudden. Do not take chances.

7. Pain In Other Joints.

Experiencing pain in other joints, especially if it is aligned with considerable stiffness in the morning and possible rashes, eye problems or digestive issues, is indicative of an autoimmune disease such as rheumatoid arthritis.

With any autoimmune disease, time is absolutely key – the quicker you get to the right physician, get an accurate diagnosis and put together a treatment plan (including some of the suggestions we’ve put together here), the better your chances of halting it’s progress.

8. Leg Pains/ Functioning Problems.

This is especially true if your symptoms (stiffness/ pain/ weakness/ numbness) present in both legs. It’s still a concern if just one leg is showing weakness, but you are at a particularly high risk if both legs are affected.

9. General ‘Unwellness’.

Something very few people really understand is that no-one knows your body like you do. If you are suffering with anything in combination with your lower back pain, it could be considered a red flag. Even fairly innoccuous issues such as heartburn, headaches or diorrhea.

If you are not well, and it goes beyond your back pain, then you need to make sure it is known to your doctor.
Back pain itself is a very poor indicator of something more serious – very often the most painful injuries carry nothing like the threat of a dull ache that continues to grow slowly.

Cancer and Back Pain.

I know in many cases, as soon as I write ‘when back pain is something more dangerous altogether’, at least half of you will immediately be thinking of the big C. It is only natural, so I thought I would deal with that elephant straight away.

The simple truth is that lower back pain can be a symptom of a whole range of cancers from bone cancer to all sorts of internal cancers. And for that reason, it is possible that some doctors will naturally want to order a scan to rule it out.

This however presents a difficult problem for a clinician, because the chance of you having a cancer such as bone cancer in the vertebrae, that does not present with any other symptoms, are relatively low.

To test everyone with lower back pain would be wholly unproductive and may block services to those at much higher risk.

Indeed, the far more likely diagnosis will rely on the assumption that, if no other symptoms have emerged, then you don’t need a scan as it will be another case of ‘mechanical’ back pain, caused by a pull or strain.

This is why understanding the importance of the other symptoms you may have – no matter how inconsequential they may seem at the time, may be essential to your family doctor in helping you.

But it gets more complicated because the stress of worry and focus on your back, can in turn cause other symptoms (of stress not any independent disease) to emerge. Which then creates an even bigger problem for a health care professional. The same symptoms will most likely be nothing, but 1 in 500 will be something much worse.

You can help them by trying not to panic, especially if your back pain is severe, as it ironically less likely to be cancer than if it is a slow ache with other lower back pain red flags as discussed above.

But even if you do have another red flag from above, try not to panic – it is statistically more likely to be nothing, it’s just that you need to be sure. Better to be safe than sorry should be the moto of all medicine after all!

So in short – make sure you got to the doctor if you start experiencing any of the lower back pain red flags as listed above. Make sure you report them all to your doctor, while trying not to panic, as it’s still very unlikely to be anything life threatening (and stress will only complicate the chances of a clear diagnosis) .

The Final Word –

Lower back pain itself is rarely something to panic about – even if the pain is severe, the chances are it’s just a pull or strain that will fade in a few days with some form of restorative treatment.

However, like everything, there is always the very small chance that your lower back pain will have been caused by something far more serious. And if it has, the last thing you want to do is ignore it and let whatever disease is lingering in the background slowly build up until it’s too advanced to combat effectively.

It doesn’t make sense for every person who has lower back pain to go through a full suite of scans/ tests to rule out something more serious, as resources would soon be even more jammed than they are now.

So instead, most family doctors use a series of lower back pain red flags to help decide if there is any chance of something else being present and therefore if they should refer you to the hospital for further diagnosis.

Given how many people just put up with lower back pain and don’t go to see a doctor at all, it is worth then knowing the basic red flags, so that if you suffer lower back pain at the same time as numbness in your legs for example, you should know not to ignore it and to get to a hospital NOW!

Frequently Asked Questions

Absolutely it can be – it just depends on the circumstances as to how likely it is that infection may be the cause. If you’ve recently undergone spinal surgery or treatment for a herniated disk, then it is a distinct possibility.

Similarly if the pain is deep and constant, that is a generally a possible sign of an infection.

In certain cases, the abscess formed though the infection could actually press on the spinal cord, causing the pain through sheer pressure. 

It really depends on why you back hurts. If it hurts following a physical collision, then definitely to rule out fractures, disc damage etc.

If it hurts after normal exercise, then not necessarily – wait for a few days (while trying to do most things as normal) and if it hasn’t got any better or has even got worse, then definitely go to the doctor for a scan.

Finally, if you experience any of the red flags above, don’t hesitate, don’t wait – just get yourself straight to the doctors TODAY. Time is of the essence. 

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