How to know if your back pain is serious?

What happened?

Option A: I woke up like this (ouch)

Option B: I lifted something heavy

Option C: I can’t remember when it started, but it’s been years

Generally speaking, most people with back pain will present to my clinic with one of the above answers to the question. It’s not a specific answer, rather a type of answer:

Option A: Acute, no idea what caused it

Option B: Acute, I think I know what caused it

Option C: Long-term, can’t remember what caused it

No matter which option you choose, or how your back became painful in the first place, I’ll ask similar questions in my assessment. I’m trying to figure out if it’s serious – meaning it needs immediate medical assessment and potentially a referral for imaging or medical specialist opinion.

Serious or sinister signs are what we refer to as “red flags”. Meaning you have back pain/symptoms and one or more of the following:

·       A history of trauma – a significant fall or trauma such as a car accident

·       Muscle wasting/weakness in the legs

·       Sensory loss or altered sensation in the groin/genital area (such as numbness or pins and needles)

·       Changes to your bladder or bowel function

·       Fever, chills or night sweating

·       Cancer history

·       Unremitting pain (Pain that doesn’t change no matter what you do)

This isn’t an exclusive list, but these are the more common red flags a physiotherapist or doctor will look for. The chances of serious injury are very, very low. The presence of one of these red flags has very little prediction of serious injury, but the presence of more than one (a cluster) can be an indicator that further medical investigation might be indicated.

What you may notice is that intensity of pain is NOT A RED FLAG! Remember from previous posts that pain is not an accurate indicator of the degree of your injury. You can be in 10/10 pain (the worst of your life) but still be relatively safe.

If you don’t have any of these red flags, or only one or a few, then there’s only a low chance that your back pain is a result of a sinister or serious issue. In my 10+ years of practice as a physiotherapist, I could count on one hand how many people I’ve seen who turned out to have a serious injury.

Whether or not a serious issue is indicated, it’s a very good idea to get it assessed by a GP or a physiotherapist. They can help guide you down relevant pathways (serious or not). From there, you can begin to look at ways to reduce your pain and get back to all of the things you enjoy.