The good news first: the vast majority of back pain is not caused by anything serious, and it usually gets better with time, staying active and sensible treatment. But a small number of cases have a more serious cause, and it’s important to know the signs.
If any of these apply to you, see a doctor first. Chiropractic isn’t the right starting point.
Go to an emergency unit now if you have
- Numbness or tingling around your groin, genitals, buttocks or inner thighs (the “saddle” area)
- New difficulty passing urine, or loss of control of your bladder or bowel
- Weakness in both legs, or leg weakness that’s getting worse quickly
- Back pain after a major trauma, such as a car accident or a fall from height
- Chest pain, shortness of breath, or pain spreading to the jaw or arm, which may be a heart problem
- Sudden, severe pain in the back or tummy that feels tearing, especially if you’re older or have high blood pressure
Call 10177 for an ambulance, or 112 from a cellphone.
See a doctor soon if you have back pain with
- Fever, chills or feeling generally unwell
- A history of cancer
- Unexplained weight loss
- A weakened immune system, or recent infection or injection drug use
- Long-term steroid use or known osteoporosis, especially after a minor fall
- Pain that’s constant and getting worse, and doesn’t ease with rest or a change of position
- Pain in a child under about 10, or in anyone under 18 that persists
- Being over 50 with a first episode of significant back pain
- Long-lasting morning stiffness (more than about 30 minutes) that improves with movement, especially if you’re younger
- Pins and needles or numbness in one leg that’s spreading, or foot drop (catching your toes when walking)
What about sciatica?
Pain that travels down one leg, sometimes with tingling, is common and often settles with conservative care, including chiropractic. But if you have weakness that’s getting worse, numbness that’s spreading, or any of the emergency signs above, get medical help.
How chiropractors screen for these
Part of every first consultation is a set of questions and examination tests designed to pick up exactly these warning signs. If something doesn’t add up, I’ll refer you to your GP or the appropriate specialist, and won’t treat until it’s been checked.
Read next: lower back pain: what actually helps
Questions parents and patients ask
What is cauda equina syndrome?
It's a rare but serious condition where the nerves at the bottom of the spinal cord are compressed. Warning signs include numbness around the groin, buttocks or inner thighs, new difficulty passing urine or controlling your bladder or bowel, and weakness in both legs. It needs emergency treatment. Go to an emergency unit straight away.
Is back pain at night always serious?
No. Lots of ordinary back pain is uncomfortable when you lie down or roll over. What's more concerning is pain that's constant, doesn't change when you move or change position, and keeps you awake, especially with other symptoms like fever or weight loss.
This guide is general information, not a diagnosis. If you're worried about yourself or your child, get checked by a health professional. In an emergency, call 10177 or 112 from a cellphone.