How To Fix Your Chronic Low Back Pain V6.0: Beware the Red Flags!

Hey friends, I have a special treat for you today- an appetizer if you will. Later this week I will be publishing my 6th installment of the “How to Fix My Lower Back Pain” series with a very DEEP dive into the world of surgical interventions. Before going down that road, I thought it would be prudent to take a break and discuss something that really pertains to almost everything I’ve covered in the first 5 articles written so far. Something all professionals who work with people dealing with back pain should be able to recognize and refer out to a neurosurgeon if not an ER. These are considered the red flags of lower back pain.


Most of the time lower back pain is a nuisance at best and debilitating at worst. For those on the former end of the scale, many non-professional fields can supply pain relief (Yoga, Pilates, or Meditation for example), If your pain is more toward the latter, you likely want to see someone considered a medical professional (MD, DO, DPT, DC). Sometimes, rehabilitation isn’t the number one concern though, sometimes lower back pain can be an emergency or indicate some significant findings needing MD/DO intervention immediately.

Red Flags

The first thing we will discuss is a soft red flag. This would mean that if a professional or non-professional found this, they would want to refer you to a doctor, but not an ER necessarily. The first symptom we will discuss is that there is no activity or position that decreases or increases pain.

It may be difficult to find a way to manage your pain, but there should be something that helps- sitting up, lying down, standing, bending backwards, bending forward, leaning on your left, leaning on your right, SOMETHING! Worse than just that, is when, in conjunction, you cannot find an activity that causes you increased pain.

The reason this is worrying is because lower back pain is neuro-musculoskeletal in nature. If an activity can affect the pain in your back, the cause must be nerve, muscle, or bone in nature. If your pain doesn’t follow these rules, it may be a larger underlying issue

Example: referred pain from the pancreas (the organ responsible for our production of insulin- a hormone needed to balance our blood sugars) will cause lower back pain along the left lower back. If movement doesn’t help, this may one of the things a doctor rules out with Xray/MRI/CT scan



The next two go together in that they both display EXCESSIVE dysfunction of normal nerve function in the spine. The first red flags isthe inability to handle your own weight in your legs. If you were able to walk fine one day, then you get into a car accident and now you cannot walk due to weakness that demands immediate medical care. The other one of the same category is having radicular pain or paraestheias (numbness/tingling) along all 4 extremities. These both show an inability for nerves to function properly

Example: following traumatic fall off ladder, a person tries to get up on their own, but has no strength in their legs accompanied by tingling in all 4 limbs


The next 2 red flags have to do with normal expectations and rhythms in regards to pain. First, there is the expectation that pain is intermittent and (as mentioned earlier) related to nerve, muscle, or bone injury. If that were the case, CONSTANT pain would be a red flag. It’s worth mentioning the difference between continuous and constant. Continuous here refers to pain that never completely goes away, but can decrease whereas constant implies it is consistently this bad. This really follows along the same issue as the first red flag where there is no activity better or worse. The other red flag here has to do with feeling pain while asleep. Should never happen! We have normal cicardic rhythms that dictate our sleep/wake cycles which causes us to sleep when tired. Often pain will keep us awake, or moving in bed may increase pain- but for back pain, you should never feel it while asleep nor should it wake you up. Our nerves that send that info to our brain are being over ridden when we’re asleep

Example: Someone complains of pain in bed at night waking them up even though they were not moving in bed.


The next pair has to do with infection and disease. If you notice night sweats connected to your back pain, you may be running a fever or having other issues that require pretty immediate imaging. Next is the weight loss/weight gain in an unexpected fashion. Lost weight due to change in diet or activity level? Awesome! Lost weight for no reason? Get checked out- may be infection-may be worse. Ditto with weight gain. Unexplained weight gain may be the representation of a tumor growing inside the spine

Example: someone has unexplained 10Lbs. weight loss in the past 9 days and vicious night sweats as well as low back pain ends up being diagnosed with spinal cancer


The final three are about poor vascular supply and spinal cord involvement/cord compression. These three symptoms may be the most emergent. ***One more time in caps*** THESE THREE MAY BE THE MOST EMERGENT! If any of these apply to you or a loved one, please call an ambulance ASAP to take you to the ER.

Starting with blood supply, if someone mentions having a pulsating back pain that they feel at their stomach as well may be unknowingly developing an abdominal aortic aneurism. In plain English, this means the MAJOR artery that brings blood away from the heart and towards the legs is having issues maintaining its closed connection and staying in one piece. A tear here could be immediately life threatening,

The other two belong to the same issue which is called cauda equine syndrome. This is when there is damage to the bottom part of your spinal cord- a region that looks like a horse’s tail (latin: Cauda Equine). The symptoms here would be changes in your bowel and bladder (using the bathroom more or less than usual for no reason). The last of the red flags is saddle numbness. Numbness in the area that would be touching a horses saddle while riding (groin region and inner thighs). Cauda Equina syndrome is a medical emergency and requires immediate medical attention to avoid complete paralysis of the lower extremities.

Example: A person notices they haven’t voided their bladder in the past 18 hours and is having numbness in groin gets rushed to hospital by roommate who read this article.


Ok, there you have it. Informative, you bet! Fun and motivating, probably not. However, it is important to be mindful for what to look out for in case of red flags ever showing up.


Well, this is a little “hold me over” until later this week’s article on surgical mgm’t of lower back pain.


See you soon- Be Well,

Dr. Daniel Davids PT

(646) 733-4737

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