Clinics in Bedford
Open Mon-Fri 9-5pm

Back Pain Red Flags

Back pain affects four out of every five individuals at some time in their life. But sometimes, it can be a warning for more significant health issues.

Infection, cancer, and a disorder known as cauda equina syndrome may all cause back discomfort, as can the compression of nerve roots that results in the loss of both sensation and mobility.

Lower back pain may be accompanied by several warning signs or “red flags” that may suggest an underlying medical concern to your doctor. 

Back Pain Red Flag Signs and Symptoms

  • Patient’s age (being younger than 18 or older than 50)
  • Flu or a high fever
  • Recovering after an illness or surgery
  • Trauma
  • Cancer history
  • Weight loss 
  • Pain throughout the night 
  • Incontinence
  • Analgesia seated on a saddle 

Weak, numb, or excruciating leg muscle discomfort

When certain red flags appear simultaneously, it may be a sign of something more serious. A spinal infection, for example, might be the cause of a fever, chills, and recent sickness. Unexplained weight loss and discomfort at night or while resting are two of the most common symptoms of cancer. 

Cauda equina syndrome is characterized by urinary retention, numbness or weakness in the legs, and loss of sensation in the buttocks and inner thighs.

Infection and cancer aren’t the only possible causes of back discomfort that may raise a red signal.


Acute back pain might be a reason for worry whether you’re under the age of 18 or above 50. Stress fractures in vertebrae may occur in persons under 18 who have back pain without a history of trauma. People who engage in gymnastics and weightlifting are at risk for this kind of injury because of their repetitive use of the lower back.

Severe discomfort, particularly at night, significant weight loss that wasn’t intentional, or worsening pain while lying on your back are all warning signs of a spinal tumour or cancer, especially in those under the age of 18. 

An increase in back discomfort in an older adult might indicate many different medical issues, including a tumour or an infection in the spinal column. 

Even something as ordinary as kidney stones or a life-threatening weakening in the key conduit supplying blood to your legs, an abdominal aortic aneurysm, might cause new back discomfort. Most (70%) nontraumatic spinal fractures occur in the thoracic spine.

Patients diagnosed with cancer may be referred for further testing by their healthcare professional.

Fever, Chills, or Recent Illness or Surgery

Meningitis, infection in the epidural area around your spinal cord or a surgically-related infection may cause a fever.

Fever, chills or a recent illness may accompany low back pain and indicate a spinal epidural abscess. Boils, infections of the bloodstream or bones of the spine, and recent back surgery are all risk factors for spinal epidural abscesses. A spinal epidural abscess is more common in those who use intravenous medications.

If you take IV drugs, have a weakened immune system (as a result of HIV, steroids, or a transplant), or have had a urinary infection, you may be more susceptible to a spinal infection.

The risk of infection or epidural hematoma may also be increased after a recent lumbar puncture during surgery or an epidural injection to treat back pain. Untreated infections can cause serious life-changing implications including severe neurological deficits.

It is critical to acquire an appropriate diagnosis as soon as possible if you have a spinal infection.

Treatment aims to eliminate the infection, alleviate discomfort, improve nutrition, preserve spinal stability, and restore the functioning of your neurological system.


Spinal fractures may occur due to severe trauma, such as a vehicle accident, a serious fall, or a sports injury. Accessory nerve or spinal cord damage may result after a vertebral fracture.

When it comes to small injuries, even if they’re slight, there can still be a reason for worry; especially if you’re over the age of 50 or have a disease that weakens the bones. Minor trauma may injure the spine, such as twisting, reaching, or falling from a standing position.

Trauma may potentially cause an epidural hematoma if you are using anticoagulant medication. If this is the case, back discomfort, numbness, or tingling are all possible symptoms.

History of Cancer

Cancer can spread to other body regions, and back discomfort may be a sign of a recurrence or metastasis.

Also, unexplained weight loss and night time or resting discomfort in the back may suggest malignancy.

Some forms of cancer are more likely to cause strain on the spine than others. Prostate, breast, and lung cancer all have an increased risk of compressing the spinal cord. Those with bone cancer spread to the spinal cord may also experience epidural spinal compression.

Back pain red flags – Night Pain

Back pain that worsens at night or while you’re sleeping might indicate something more severe like an infection or cancer.

This is especially true if you also have other symptoms in addition to your back discomfort when you sleep or relax. 

Saddle Anaesthesia and Incontinence

The most common cause of numbness in the inner thighs and groyne, cauda equina syndrome, may be lurking right in front of your eyes.

Compressed lumbar spinal nerve roots cause paralysis of the buttocks and inner thighs in people with this disease (saddle anaesthesia). Without prompt treatment, paralysis and loss of sensation might become permanent.

Cauda equina syndrome is a common cause of saddle anaesthesia if accompanied by new and severe back pain.

Cauda equina symptoms include failure to empty your bladder, increased frequency of urination, and overflow incontinence.

Sexual dysfunction and leg weakness or sciatica are also common in patients with this illness, particularly if the symptoms are severe or continuously worsen. Or it may even lead to serious spinal pathology that can involve greater portions of the musculoskeletal system.

Back pain red flags – Weak, Numb, or Painful Leg Muscles

If your back pain started abruptly and you’re feeling nerve discomfort, your doctor may want to check the strength of your legs. Leg numbness or tingling might be a sign of spinal cord compression or nerve roots.

If your leg pain or lumbar spine pain doesn’t go away, consult your orthopaedic and get a complete physical examination. Also, if you often feel back discomfort and notice that your lower limbs are becoming weaker, this might indicate neurological impairment.

A man holding his back pain red flag

Treatments For Back Pain


Many of the structures in the back have a poor blood supply, which is why they can struggle to heal on their own. It is the oxygen and nutrients in our blood supply that help to heal these structures.

Prolotherapy involves the injection of a regenerative solution into these structures to provide a direct supply of what is required to heal and repair.

As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.

Pain between the shoulder blades

The Bottom line – Back pain red flags

It is possible that a major underlying medical issue is causing back pain and the red flags listed above, i.e osteoporosis – which can often cause acute low back pain. Symptoms like these should prompt you to seek help from clinicians. Managing symptoms with paracetamol or non-steroidal anti-inflammatory drugs is usually effective.

Even if the test was performed by a physical therapist, personal trainer, or holistic practitioner, it is prudent to review the findings with your primary care physician. Patients may seek invasive treatments, including surgery or epidural corticosteroid injections, for chronic back pain symptoms.

As healthcare practitioners, they can help you diagnose and treat any underlying medical conditions causing your back discomfort.


  1. Joines JD, McNutt RA, Carey TS, Deyo RA, Rouhani R (2001) Finding cancer in primary care outpatients with low back pain: a comparison of diagnostic strategies. J Gen Intern Med 16(1):14–23
  2. Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A (2008) McAuley JH Prognosis in patients with recent-onset low back pain in Australian primary care: inception cohort study. BMJ 337:a171. doi:10.1136/BMJ.a171
  3. Frymoyer JW, Cats-Baril WL (1991) An overview of the incidences and costs of low back pain. Orthop Clin North Am 22:263–271
  4. van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A et al. (2006) European guidelines for managing acute nonspecific low back pain in primary care. Eur Spine J 15:S169–S191
  5. Downie, A., Williams, C. M., Henschke, N., Hancock, M. J., Ostelo, R. W. J. G., Vet, H. C. W. de, Macaskill, P., Irwig, L., Tulder, M. W. van, Koes, B. W., & Maher, C. G. (2013). Red flags to screen for malignancy and fracture in patients with low back pain: NHS Systematic review. BMJ, 347, f7095. https://doi.org/10.1136/bmj.f7095
  6. Verhagen, A. P., Downie, A., Popal, N., Maher, C., & Koes, B. W. (2016). Red flags presented in current low back pain guidelines: A review. European Spine Journal, 25(9), 2788–2802. https://doi.org/10.1007/s00586-016-4684-0
  7. Galliker G, Scherer DE, Trippolini MA, et al. Low back pain in the emergency department: prevalence of serious spinal pathologies and diagnostic accuracy of red flags. Am J Med. 2020;133(1):60–72.e14.
  8. Ostelo R, de Vet H, Macaskill P, Irwig L. Red flags to screen for malignancy in patients with low-back pain. Cochrane Database of Systematic Reviews. Pubmed 2013(2).

Read more: