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Beyond the ache: 4 serious warnings your low back pain could need urgent attention

  • Jan 14
  • 5 min read

Low back pain is incredibly common. Most people will experience it at some point, whether from lifting something awkwardly, sitting too long, sleeping in a strange position, or pushing a little too hard during a workout. In many cases, it improves with time, gentle movement, and appropriate care.

But sometimes, back pain is not “just your back.”



Woman looking at painting, deciding her next move

In a small percentage of cases, low back pain can be your body’s way of signaling something more serious. Chiropractors and physiotherapists are trained not only to treat musculoskeletal pain, but also to screen for warning signs, often called “red flags,” that suggest the pain may be coming from something other than muscles or joints.


Knowing these warning signs can help you understand when conservative care is appropriate and when further medical evaluation is necessary. This article is for education, not diagnosis. If you are concerned about your symptoms, it is always appropriate to contact a healthcare professional.



1. When Back Pain May Be Coming From an Internal Organ

Although we usually think of back pain as mechanical, problems inside the body can refer pain to the back. This means the source of the pain is not the spine itself, even though that’s where you feel it.


Certain patterns raise suspicion that the issue may be internal rather than musculoskeletal. Pain that begins in the side or mid-back and travels toward the groin can occur with kidney stones. This pain is often intense, may come in waves, and is sometimes accompanied by nausea or blood in the urine.


Back pain combined with fever and chills is another important warning sign. This can indicate a kidney infection or another systemic issue that requires prompt medical care.


For women, low back pain that is closely linked to the menstrual cycle or accompanied by abnormal vaginal bleeding may point toward a pelvic or gynecological cause rather than a spinal one.


If you experience severe pain, fever, chills, vomiting, or difficulty keeping fluids down, urgent medical care is recommended. If the pain is moderate but unusual or feels very different from your typical back strain, it is wise to contact a clinician to discuss your symptoms.



2. When Back Pain Becomes a Nerve Emergency

Most back pain is uncomfortable but not dangerous. However, there is a small group of conditions where nerves are compressed so severely that immediate treatment is required.


One major red flag is sudden weakness in one or both legs. This may show up as difficulty lifting the foot, frequent stumbling, or a noticeable and rapid change in walking ability.


An even more serious situation is a condition known as cauda equina syndrome. Clinicians become concerned when back pain is combined with a specific cluster of symptoms, including new difficulty starting urination, the sensation of not being able to fully empty the bladder, loss of bladder or bowel control, or numbness in the inner thighs, groin, buttocks, or genital area. This region is often referred to as the “saddle area.”


If you notice new bladder or bowel changes, saddle-area numbness, or sudden leg weakness, this should be treated as a medical emergency and evaluated immediately.



3. When Back Pain May Signal a More Serious Underlying Condition

Back pain is very rarely the first sign of cancer, but clinicians take certain patterns seriously, especially when risk factors are present.


Red flags include new, persistent back pain in people over the age of 50, unexplained weight loss, a personal history of cancer, pain that lasts longer than four to six weeks without improvement, or pain that does not ease with rest and feels constant or gnawing.


In these situations, a clinician may recommend further investigation such as blood tests or imaging to rule out more serious causes.


In some men over the age of 40, persistent back pain that does not improve, particularly when combined with urinary symptoms, may prompt a prostate evaluation. Risk is higher in Black men compared with white men, so clinicians may take symptoms and screening discussions especially seriously in this group.


If you have ongoing back pain along with unexplained weight loss, a history of cancer, or pain that does not behave like a typical strain, scheduling a medical visit is important.



4. When Back Pain Could Be a Hidden Fracture

Sometimes the most important clue is not how the pain feels, but how it started.


Back pain following a fall, especially landing on the buttocks, should always be taken seriously. The same applies to pain after a car accident or other high-impact trauma. Sudden, severe pain after bending forward quickly can also raise suspicion, particularly in people with fragile bones.


The risk of spinal fractures is higher in older adults, people with osteoporosis, and those who take long-term steroid medications. In these cases, clinicians often begin with an X-ray to check for compression fractures or other bone injuries.


If your back pain began after a fall or trauma, or if it is suddenly sharp and severe, prompt evaluation is recommended.



How This Is Approached in Chiropractic and Physiotherapy Care

At Roots Health Clinic, chiropractic and physiotherapy assessments are not just about finding sore muscles. A thorough initial evaluation includes screening for these red flags, understanding your full health history, and determining whether conservative care is appropriate or whether referral for further medical testing is needed.


When back pain is mechanical in nature, hands-on care, movement-based rehabilitation, and education can be highly effective. When warning signs are present, recognizing them early is critical for your safety.






Know the Red Flags, Not the Worst-Case Scenario

The vast majority of low back pain is not dangerous and improves with the right approach. Still, a small percentage of cases require timely medical attention.


Seek urgent or emergency care if you experience new bladder or bowel control problems, numbness in the groin or saddle area, sudden or rapidly worsening leg weakness, severe back pain with fever and chills, or severe pain that feels unlike a normal strain, especially if accompanied by vomiting or inability to keep fluids down.


Contact a clinician promptly if your back pain lasts longer than four to six weeks without improvement, is accompanied by unexplained weight loss, occurs in the context of a cancer history, or begins after a fall or injury.


Understanding these warning signs empowers you to take the right next step and ensures that back pain is treated appropriately, safely, and effectively.



Acute Back Pain: What to Do in the First Days

If your back pain does not involve any of the red flags discussed above, early management can make a meaningful difference. Knowing what to do in the first days helps reduce fear, avoid unnecessary rest, and support recovery.


At Roots Health Clinic, we also offer an Acute Back Pain Guide for people experiencing sudden back pain who want clear, practical guidance.


The guide covers:

  • What is safe to do and what to avoid in the early phase

  • When movement is helpful and when rest is appropriate

  • How to recognize signs that warrant professional assessment


You can explore the Acute Back Pain Guide here:






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