How do I know if my back pain is serious?

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When you experience lower back pain it can be quite scary. Sometimes the pain can come about for no apparent reason and often leave you scratching your head as to why. Other times there are seemingly obvious reasons as to what has caused this onset. For example if you significantly overdo a certain activity outside of your current capacity. So how do you know if your lower back pain requires further investigation? Or if it is something that will heal over time due to the natural history of symptom improvement?

Current guideline treatment for the management of acute and chronic lower back pain recommend the following as red flags. Meaning, if you onset of back pain is alongside some other symptoms, or if you are experiencing anything from the list below, then it is worth further investigation.

These include:

History of cancer

Unexpected/unexplained weight loss

Significant trauma

Suspicion of fracture

Unexplained fever

Signs of infection

Constant 24 hour pain/severe night pain

Loss of bladder/bowel control

(Greenhalgh 2006, Oliveira 2018, Guevara 2011)

If you don't have any of the above (what the health industry call 'red flags') then current guideline care recommends;

  1. You engage in regular normal activity to a level that is tolerable to you.
  2. Avoid bed rest
  3. Be reassured that you will be ok and that the prognosis is favourable.
  4. Use non steroid anti inflammatory medications as needed
  5. Participate in exercise therapy of some form in either individual or group setting, find something that you like (eg. weight training, swimming, yoga, pilates)
  6. Avoid regular use of imaging/MRI outside of suspected serious pathology.

(Oliveira, 2018, Guevara 2011)

Lower back pain has been shown to significantly improve after the 6 week mark, even with no help from a professional and just letting it resolve on its own (Menezes 2012). Therefore based on the current best evidence available, in the absence of the red flags you can follow the current guidelines and expect an extremely favourable prognosis.  If you would like further help in making sense of your situation and guidance on an exercise plan, hit book now to organise an initial consultation with one of our team.



1. Menezes Costa L, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012;184(11).

2. Greenhalgh, S. and Selfe, J. Red Flags: A guide to identifying serious pathology of the spine. Churchill Livingstone: Elsevier. 2006.

3. Oliveira, C.B., Maher, C.G., Pinto, R.Z. et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;2791–2803(27)

4. Guevara-Lopez U, Covarrubias-Gomez A, Elias-Dib J, Reyes-Sanchez A, Rodriguez-Reyna TS. Consensus group of practice parameters to manage low back P. Practice guidelines for the management of low back pain. Consensus group of practice parameters to manage low back pain. Cir Cir. 2011;79(3):264–279.

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