‘Red flag’ symptoms for back pain – when you need to seek medical attention

Back pain is a common ailment that affects all sorts of people and can happen for any number of reasons. However, sometimes serious back pain can be the sign of a much more serious underlying problem.

Here, our spinal experts help you to understand when back pain along with other symptoms should be throwing up “red flags”.

What are the ‘red flag’ symptoms of serious spinal issues?

There is a range of serious spinal issues for which there are well-known ‘red flag’ symptoms, such as cauda equina syndrome or spinal abscess. Both of these conditions can have disastrous outcomes, with untreated spinal abscess likely to lead to paralysis, and delay in treating cauda equine syndrome likely to lead to permanent bowel and bladder dysfunction, and loss of or impairment of sexual function, so it is very important to be able to detect the onset of such a condition.

Cauda equina syndrome red flags

Cauda equina syndrome is a condition that occurs when nerves at the base of the spinal cord are compressed.

If you present with the following symptoms, these are ‘red flags’ that you might be developing cauda equina syndrome, which can either develop within 24 hours (acute onset) or more gradually (gradual onset):

  • Problems urinating – including an inability to urinate, loss of sensation, or loss of control of the urge to urinate
  • “Saddle anaesthesia” – numbness or a change in sensation around the groin, buttocks, genitals, or inner thighs
  • Leg weakness
  • Loss of sexual function
  • Bowel disturbance – either incontinence or a loss of sensation

Spinal abscess red flags

Spinal abscess is a very rare condition, but the consequences of it can be devastating. The abscess, if allowed to grow, can impinge upon the spinal cord and eventually lead to paralysis.

If you experience the following symptoms, it is a sign that you should seek urgent medical attention. Although they change depending on whether the abscess is growing, or has already grown.

Whilst a spinal abscess is growing you may experience:

  • sharp and sudden pain radiating to the arms and legs
  • weakness in the arms and/or legs
  • reduced or lost sensation below the level of the abscess
  • a raised temperature of 38°C or above

Then, as the abscess continues to grow, you may find:

  • paralysis below the level of the abscess
  • loss of control of your bladder
  • loss of control of your bowels

Other red flag symptoms

There are other symptoms experienced with back pain that could be a sign of other conditions, such as cancer, which can include:

  • unexplained weight loss
  • swelling of the back
  • constant back pain that doesn’t ease when lying down
  • pain in your chest or high up your back
  • pain down your legs and below the knees
  • pain caused by a recent trauma or injury to the back
  • pain that is worse at night

Back pain or the above symptoms can also be more serious if you are someone who:

  • is less than 25 years old or more than 55 years old
  • has a recent history of violent trauma
  • has a past history of malignant tumour
  • uses, or has used, corticosteroids for a prolonged period
  • has a history of drug abuse, immunosuppression, or has HIV
  • is systematically unwell
  • has a structural deformity

What should happen if you experience ‘red flag’ symptoms?

When you experience ‘red flag’ symptoms with back pain, and present them to a medical professional, they will often follow-up with a series of tests and treatments depending on the type of symptoms you are presenting.

For example, if you present with symptoms of spinal abscess, doctors will recognise this as a medical emergency and carry out:

  • blood tests (blood count, ESR, CRP)
  • a lumbar puncture
  • a CT scan
  • an MRI scan

If a spinal abscess is confirmed, this will then be followed up with intravenous antibiotics and an operation will be carried out to drain the abscess.

With any spinal condition though, a doctor or other medical professional should ensure that you are tested and treated as a matter of medical emergency. Time is of the essence, so if an operation is required it will need to be carried out urgently.

The causes of back pain

The above examples are rare conditions. Usually, back pain is a symptom of easier- to treat conditions.

These easier-to-treat causes of back pain can include:

  • poor posture
  • lifting something awkward or heavy
  • a minor injury such as a sprain (pulled ligament) or strain (pulled muscle)
  • feeling stressed or run down

Luckily, these will all usually get better within a few weeks.

However, there are other causes of back pain that – whilst not as serious as cauda equina or spinal abscess – are not as easy to treat:

  • a slipped disc – this is where a cartilage disc in the spinal column presses on a nerve, identified by back pain and numbness, tingling, and weakness in other parts of the body
  • sciatica – this is an irritation of the nerve in the lower back that runs to the feet, identified by pain, numbness, tingling and weakness in the lower back, buttocks, legs and feet
  • ankylosing spondylitis – this is where the joints in the spine well and cause pain and stiffness, which is usually worse in the morning and improves with movement
  • spondylolisthesis – or, when a bone slips out of position, causing lower back pain and stiffness alongside numbness and a tingling sensation

Each of these conditions, whilst not a medical emergency in most cases, will need to be treated by a medical professional in order for them to improve.


Bad back pain can be very uncomfortable and debilitating but is not always a sign that you have a medical emergency on your hands. However, it is definitely worth understanding when other symptoms, alongside back pain, can represent ‘red flags’ so that you can get the medical assistance you need as quickly as possible.