back pain treatment worry pathology red flags chiro physio chiropractor chiropractic physiotherapist physiotherapy sydney spine & sports centre s3c

When to Worry About Back Pain

Most patients are better off when they feel confident about their pain and management; the power of justified, rational confidence is a huge factor in back pain. But what are the key features to look out for in serious and non-serious cases?

Pain severity is not related to injury severity

Patients understandably assume that the worst back pain is the scariest. In fact, pain intensity is a poor indicator of back pain severity, and some of the worst causes are actually the least painful (especially in the early stages). For instance, in cauda equinae syndrome there is a real danger of a serious and permanent injury to their spine, but little pain. Meanwhile, many non-dangerous problems can cause severe back pain, such as muscle cramps and trigger points.

Musculoskeletal back pain

Musculoskeletal pain affects the bones, muscles, ligaments, tendons, and nerves. It can be acute (quick onset) or chronic (long-lasting). It can be localised in one area, or widespread. It is the most common musculoskeletal pain with around 1 in 5 adults reporting symptoms of back pain at any one time. Other common types include tendonitis, myalgia (muscle pain), and stress fractures. There are several causes of back pain, but most of them do not cause any long-term issues, often resolve well and do not require imaging or scans.

Key features you should look out for when suspecting a musculoskeletal cause to your back pain include:

  • Localised or widespread pain that can worsen with movement
  • Aching or stiffness of the entire body or specific regions
  • Have been involved in recent physically demanding work/exercise or in static postures for a long time (e.g., sitting at a desk for several hours in the day)
  • The feeling that your muscles have been pulled or overworked
  • Fatigue
  • Sleep disturbances
  • Twitching or spasms in muscles

Pathological back pain

Pathological back pain is uncommon with less than 1% of total cases causing back pain. In these circumstances, medical attention is required and in rare cases, it can be a medical emergency.

Three signs you should look out for when you have back pain that may warrant further investigation – not an emergency, include:

  1. It has been bothering you for more than about 6-8 weeks, particularly after conservative management with your chiropractor or physiotherapist
  2. It is severe and/or not improving, or actually getting worse
  3. There is at least one “red flag” sign or symptom

Key features you should look out for when suspecting a serious pathological cause to your back pain – medical emergency, include:

  • Incontinence and/or true numbness around the groin and buttocks in a “saddle” pattern, which may suggest spinal cord injury or compression
  • Bowel or bladder changes, such as difficulty with passing stool/urine or blood in the stool/urine
  • Any accident with forces that may have been sufficient to fracture your spine
  • Unrelenting pain, not associated with movement, and that keeps you awake during the night
  • Unexplained and significant weight loss/gain or fever/chills
  • Symptoms that spread equally into both legs, especially numbness and/or tingling and/or weakness, and especially if it is aggravated by lifting.
  • Progressive weakness in the legs and/or arms with muscle wasting


More information

For more information on spinal disorders, pain and dysfunction, please visit the following articles via our website:


Martin Frutiger chiro

Martin Frutiger

Martin is an experienced and qualified chiropractor, remedial massage therapist and has completed a Masters of Research. He has an active interest in sports conditions, over use injuries and problems related to the spine such as neck and back pain.