Warning Signs to Watch For

The 7 Red Flags

If you experience any of the following, see a doctor as soon as possible.

1. Leg Weakness

If you notice weakness in your foot or toes — difficulty lifting your foot, frequent tripping, or your shoe slipping off — these may be signs that a nerve is being compressed.

If the weakness is getting worse day by day, seek medical attention urgently.

2. Bladder or Bowel Problems

  • Difficulty urinating, or loss of bladder control
  • Loss of bowel control
  • Numbness around the buttocks and groin area (the "saddle region")

These symptoms may indicate cauda equina syndrome — a condition where the bundle of nerves at the base of the spine is severely compressed.

Cauda equina syndrome is a spinal emergency. Surgery within 48 hours is recommended (Kohles 2004). If you notice these symptoms, call your doctor immediately or go to the emergency room.

3. Fever

If you have back pain along with a fever of 100.4°F (38°C) or higher, it could indicate a spinal infection (osteomyelitis, discitis, or epidural abscess).

You are at higher risk if you:

  • Recently had a spinal injection or surgery
  • Have diabetes
  • Take steroids or immunosuppressive medications

4. Unexplained Weight Loss

If you are losing weight without dieting or trying to, over a period of weeks or months, it could be a sign of cancer or another systemic illness.

5. History of Cancer

If you have been treated for cancer in the past, new back pain should be evaluated to rule out metastasis (cancer spreading to the spine).

In patients with a history of cancer, spinal metastasis is found in approximately 33% of those who develop new back pain (Downie 2013, BMJ). This is a much higher rate than for any other red flag.

6. Night Pain

If your pain does not improve when you lie down and wakes you up in the middle of the night, this deserves attention. Most back pain gets better with rest, but pain from infection or cancer may not respond to changes in position.

7. Pain After a Fall in Older Adults

If you are over 50 and develop back pain after a fall, a fracture should be considered. In people with osteoporosis, even a minor fall or landing hard on the buttocks can cause a broken bone.