Is My Back Pain Serious? Red Flags Symptoms You Should Never Ignore

Back pain is one of the most common reasons people visit a physiotherapist. While most back pain is mechanical and improves with exercise, movement, and advice, there are times when it may indicate a more serious underlying problem. Recognising the warning signs known as red flags is essential for safe and effective care. 

As physiotherapists, we are trained to assess, screen, and manage back pain, and to know when to refer patients to a GP or specialist.

When Back Pain Is Usually Not Serious

Most back pain:

• Comes on gradually or after physical activity

• Improves with gentle movement or rest

• Does not affect bladder, bowel, or leg strength

This type of pain is often managed effectively with physiotherapy, posture correction, exercise programs, and patient education.

Red Flags Symptoms That Should Never Be Ignored

1. Changes in Bladder, Bowel, or Saddle Sensation

Seek urgent medical attention if you experience:

• Difficulty controlling urine or bowel movements

• Numbness around the buttocks, inner thighs, or genitals

These symptoms may indicate a serious spinal condition that requires immediate assessment.

2. Progressive Leg Weakness or Numbness

Warning signs include:

•  Increasing weakness in one or both legs

• Trouble walking or maintaining balance

• Worsening pins and needles or numbness

These may suggest nerve compression or other spinal issues.

3. Back Pain After Injury

Back pain following:

• Falls, accidents, or trauma

• Especially in older adults or those with osteoporosis or long-term steroid use

Should always be assessed to rule out fractures or structural injury.

4. Unexplained Weight Loss, Night Pain, or Constant Pain

Be cautious if back pain is accompanied by:

• Persistent pain that does not improve with rest

• Pain worse at night

• Unexplained weight loss

These symptoms may indicate infection, inflammation, or other systemic conditions.

5. History of Cancer or Systemic Illness

New or persistent back pain in patients with a history of cancer, recent infection, or immune compromise should be assessed promptly.

How Physiotherapy Can Help

As physiotherapists, we can:

• Screen for red flags and identify serious symptoms

• Conduct thorough musculoskeletal assessments

• Provide personalised exercise and rehabilitation programs

• Offer advice on posture, movement, and pain management

• Refer to GPs or specialists when necessary

Early assessment and intervention can reduce pain, prevent complications, and improve recovery.

When to Seek Medical Advice

• Call your GP or contact a healthcare professional if you notice any red flag symptoms.

• Go to A&E immediately if you have sudden bladder or bowel changes, saddle numbness, or rapidly worsening leg weakness. 

Remember: most back pain is not serious, but knowing the warning signs ensures you get the right care at the right time. Back pain is common and usually manageable, but some symptoms should never be ignored. Physiotherapists are trained to assess, treat, and refer appropriately, helping patients recover safely and confidently.

Written By Shariqa Anum, Senior Physiotherapist, HomePhysio By Nicola Ltd