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When Lower Back Pain Could Be Serious



Most people with back pain worry about the same thing at some point:


“What if this is something serious?”


Firstly, it’s helpful to clarify what we mean by a serious condition. Examples of serious conditions include infection, cancer, cauda equina syndrome, aortic aneurism, fractures and a few others.


It’s also important to understand that these conditions are rare. Depending on the research, serious conditions account for around <1% of new onset back pain (Bardin, King & Maher, 2017).


To assess for serious pathology, healthcare providers look for “red flags”. The more red flags that fit a person’s presentation, the higher the level of concern.


If you experience any of the following symptoms, it’s important to seek medical care (Australian Commission for Safety and Quality in Health Care. Low Back Pain Clinical Care Standard., 2022):


  • New bowel or bladder difficulties

  • Numbness in the saddle area (pelvic floor area)

  • Sudden weakness in one or both legs (true weakness - not limitations due to pain)

  • Fever, chills or feeling very unwell with back pain

  • Unexplained weight loss

  • A history of cancer and new back pain

  • Significant trauma such as a fall or accident


This is an important point: you can experience severe pain even when serious pathology is unlikely. The amount of pain is not closely correlated with the seriousness of a condition.


An important point about red flags is that there are more than 163 described in the literature! In most cases of new onset low back pain, a person will have at least one red flag (Finucane et al., 2020). This is why a single red flag on its own is usually not enough to indicate serious pathology.


Even when serious causes have been ruled out, many people are left wondering what their pain actually means and what to do next.


If you’d like a clearer understanding of why back pain can persist even when serious conditions are unlikely, we’ve created a free ebook that walks through this in more detail.


It covers how pain works, why scans often don’t give clear answers, and how people start moving forward again safely, even when pain hasn’t fully settled.



You can download the ebook for free here

Living Well with a Bad Back







Written by


Samuel Bulten

Exercise Physiologist | Masters in Medicine (Pain Management)

Director, Adapt Movement


Disclaimer


This ebook and the emails that follow contain general educational information only and aren’t individual medical advice.


References:


  1. Australian Commission for Safety and Quality in Health Care. Low Back Pain Clinical Care Standard. Sydney: ACSQHC, 2022. Available from URL: https://www.safetyandquality.gov.au/publications-and-resources/resource-library/low-back-pain-clinical-care-standard-2022


  2. Bardin, L. D., King, P., & Maher, C. G. (2017). Diagnostic triage for low back pain: a practical approach for primary care. The Medical journal of Australia, 206(6), 268–273. https://doi.org/10.5694/mja16.00828


  3. Finucane, L. M., Downie, A., Mercer, C., Greenhalgh, S. M., Boissonnault, W. G., Pool-Goudzwaard, A. L., Beneciuk, J. M., Leech, R. L., & Selfe, J. (2020). International Framework for Red Flags for Potential Serious Spinal Pathologies. The Journal of orthopaedic and sports physical therapy, 50(7), 350–372. https://doi.org/10.2519/jospt.2020.9971



 
 
 

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