Red Flags- Identifying More Serious Back Problems

Serious back problems are fortunately very rare. Nonetheless, health professionals always check for particular signs and symptoms to help identify whether someone may have more worrisome back problem. These signs and symptoms are known as Red Flags. If you have any of these symptoms you should seek medical advice as they require further investigation. Listed below are a few of the most common findings that would be identified by your doctor as raising the index of suspicion that there may be a more serious problem. This list is not exhaustive and contains mainly signs that you will report to the doctor. I have not included any of the red flags that the doctor may find when they examine you.


Red flag sign

Why we are interested

Age: in particular under age 10 or over age 51

These age groups are more likely to get cancer, and in those under 10, infection is another worry.

Medical history of cancer, TB, HIV/
AIDS, osteoporosis, IV drug user

All these diseases can cause spinal disorders and pain.

Recent unexplained weight loss

This may be a sign of cancer.The key word here is unexplained, if you have lost weight because of diet or exercise or because pain and worry has been reducing your appetite then that is not such a concern. If you have lost weight and you have no idea why then this may be a sign of a more serious back problem.
  • Urinary retention or incontinence (can't go or can't stop)

  • Loss of bowel or urinary sensation (can't feel it when you use the toilet)

  • Feacal incontinence (bowel accidents)

  • Saddle anaesthesia (altered sensation in the saddle area e.g. pins and needles or numbness)

  • Loss of leg control and pins and needles or numbness in both feet/legs

These could be signs of cauda equina syndrome which is compression of the bottom part of the spinal cord. These symptoms are serious so if you have them, you need to get urgent medical care.

Generally unwell e.g. fever, chills, night sweats or recent infection

This can be a sign of infection, inflammation, or cancer.

Major trauma such as vehicle accident or fall from a height

Minor trauma, or even just strenuous lifting, in people with osteoporosis - this might be a cause for fractures.

Severe night pain

This can be a sign of cancer.This is a bit trickier because although people with serious back problems do get night pain, lots of people with nothing seriously the matter get it too. A study in the UK examined 213 patients who had night pain, with 90 having pain every night. No serious problem was identified with any of them (see reference 1 below). However, If you have this symptom it is important that you discuss it with your doctor.

A bit more detail...

Changes in bladder and bowel control

This usually means loss of control of your bladder or bowel or an inability to pass water. Many people with lower back pain have constipation, this may be due to using pain killers, reduced activity levels or pain, don't confuse this with these other more serious symptoms

Loss of control of your legs

Or your legs don't feel like they belong to you. Don't confuse this with difficulty walking because you are in pain, this is more about feeling a sense of weakness or tripping because you don't have good control over your legs. Watch out for symptoms of dropped foot too.

If you have any of these symptoms you MUST go and see a qualified medical practitioner immediately. If you have cauda equina symptoms you need to seek emergency treatment, don't hang about, get this checked out straight away. If you are unsure or worried discuss it with your doctor.

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(1) Harding I, Davies E, Buchanan E, Fairbank J.The symptom of night pain in a back pain triage clinic. Spine 2005; 30 (17):1985-1988.

(2)Non-Specific or Simple Lower Back Pain Guidelines

(3)Sciatica Guidelines

(4) Greenhalgh, S. & Selfe, J., 2009. A qualitative investigation of Red Flags for serious spinal pathology. Physiotherapy, 95(3), pp.224–227.

(5) Spinal disc problems including Red Flags (2016)

More information on the causes of lower back pain

Lower Back Pain Toolkit Home Page

February 2, 2018



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