It is a part of the human experience to worry about an injury or health concern, but let’s clear up some head space by learning about the red flags of low back pain. 

Anyone with back pain–acute or chronic–is justified in their worries. Many thoughts that may surface are those like “something dangerous is going on with my back,” or “will this ever get better?” or “I don’t have any time or capacity for this right now.”
All of these thoughts are normal, like I said. However, we cannot stay in that space of excessive worry. It takes up too much brain space. Figuratively and literally.
So when should you really worry about your low back pain? Read on for the red flags (or warning signs) of low back pain.

Here are a few things about the amazing capacity of your body to heal itself.

  1. All tissues in your body heal within 3 months. (Although some would say a full disc herniation can take around 6 months to naturally heal on it’s own, with the first 2 months being the most painful.) Then why am I struggling with this pain for much longer than 3 months? Another post for another time, but if you would like to read more on pain, you can check my blog post on pain. 
  2. Hurt does not always mean harm. Just because you may have pain somewhere, does not mean the actual tissue or structure is injured. This is when it is good to see a physical therapist so they can assess if the tissue or structure is compromised.
  3. Only a small percentage of people with an injury seek a physical therapist. What does that tell me? People are healing, on their own–granted, maybe more slowly. Big picture, the body will heal.
  4. The body needs stress and the appropriate load to heal well. Yes, the body will heal on it’s own (there are exceptions like significant trauma and chronic diseases, of course, that need more medical intervention), but in order to heal well and become stronger, we need stress and load. This is where a PT’s help is critical–they can help guide the healing process appropriately.

What Are “Red Flags?”

So yes, all this is true that the body will heal, and you can expect that of your body. But there are cases when something serious is actually going on–more than just the back pain. Red flags are signs and symptoms found in a patient’s history and clinical examination that may tie a disorder to a serious pathology.

My list isn’t an exhaustive list, but I will share with you what I include in my history taking as a physical therapist. The chance of this being the case is rare, less than 2%. I would rather be safe than sorry, however. If something seems wrong, then it might be wrong.

Disclaimer: This is not medical advice. This content is for informational purposes only.

What Is Back Pain?


 Back pain is pain, muscle tension, or stiffness localized below the ribs and above the inferior gluteal folds (bottom of your buttocks). Low back pain can include or exclude sciatica (or pain/numbness/tingling done your leg(s). Low back pain that persists longer than 12 weeks is defined as chronic or persistent.

Nonspecific low back pain is pain not attributed to a recognizable pathology (e.g., infection, tumor, osteoporosis, rheumatoid arthritis, fracture, inflammation). This type of back pain is the most common.

What Are The Red Flags For The Low Back?

With low back pain, I keep an eye out for Cauda Equina Syndrome, possible infection (like a spinal epidural abscess) , lumbar compression fracture, pelvic or sacral fracture, spine cancer and ankylosing spondylitis.
Here are a few of the questions that I use to help guide my examination, that help me tease out the possible source of your pain.
Have you had sudden or unexplained weight loss in the last month?
Do you have any pain that is worse at night, and is unrelieved by position change? (Many people have pain at night do to mechanical low back pain, but the unique factor here is that NO position change improves their symptoms, and pain is worse at night.)
Have you had any loss of bowel or bladder function?
Do you have saddle parasthesia or numbness? (This is numbness between the legs, inner thighs and groin.)
Have you had any traumatic event happen recently? Like a car wreck or fall that resulted in their back pain?
I would also check to see if there was any motor or sensory loss in the lower extremities. If there is distinct loss in a myotomal (group of muscles) or dermatomal (group of sensory nerves) pattern, this may warrant an appointment with the client’s physician.
All these questions can help guide my clinical decision making for each client, and refer out when necessary. If a client were to present with any of these signs and symptoms I would ask that they see their physician to get the appropriate tests and/or imaging necessary before resuming physical therapy.
Not that I want people to panic or even worry, but these are the signs and symptoms that are cause for alarm.

What About Bulging or Herniated Discs?

I will most likely write another post on this subject later, but I am less worried about bulging or herniated discs. There have been studies done on the general population and found there are many people walking around without any symptoms that have bulging or protruding discs. Having a bulge is quite normal, and does not mean you will have pain. On top of that, there are things you can do for it!!
With disc herniations, these can be very painful! However, they are treatable with physical therapy, and like I said above, they even heal on their own if left without intervention.
I say this to provide some encouragement. If you have had imaging done that showed disc bulges or protrusions, that is normal and totally treatable. Same goes for disc herniation. Instead of letting worry take up your brain space, see a physical therapist to help you get on the right track and heal quicker!

When To Seek Help For Your Back Pain

If you have any of the signs and symptoms listed above, see your doctor.
If you have had either an acute onset of back pain, or persistent back pain, see a physical therapist! You should not have to live in pain, and a good physical therapist that listens to you and does a thorough examination can get you on the right track fast, and refer out when necessary.

Emily Warren

Dr. Emily Warren

Dr. Emily is a Doctor of Physical Therapy and Integrative Spine Specialist. She is the owner of Emily Warren Physical Therapy in Salt Lake City, Utah. She lives with her husband, 2 girls, 1 pup and enjoys anything outdoors. She wants people with back and neck pain to feel empowered and hopeful, and get back to the active lives they want. She has helped many people resolve their pain through physical therapy and online coaching. Check out her website HERE for more information on how she can help you.