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Back Pain Red Flags: When to Go to the ER or See a Doctor

Six signs mean go to an emergency department now: new numbness, tingling or change in feeling in the saddle area, new changes in sexual function, new bladder or bowel changes, new pain, tingling, numbness or weakness in both legs, leg or foot weakness that is getting worse, or back pain after a recent serious accident. Six more mean stop the exercise and see a clinician today.

One item is enough. You do not need two. If you cannot get there safely or you feel seriously ill, call your local emergency number. If you are not sure whether something counts, call anyway and describe it.

Go to emergency care now

• New numbness, tingling or change in feeling in the saddle area Emergency. Go now

  The skin that would touch a bicycle saddle: around the groin, the inner thighs, the genitals and the anus. It can feel numb, tingly, or different when you wipe. The nerves that serve this area also control the bladder, bowel, and sexual function, and delays in treating a problem there can cause permanent damage.

• New changes in sexual function Emergency. Go now

  New trouble getting or keeping an erection, not being able to orgasm, or a change in feeling during sex. The same nerves serve the saddle area.

• New bladder or bowel changes Emergency. Go now

  Trouble starting or stopping pee, a weak stream, not feeling when you need to go, or leaking pee or poo. Say what changed and when it started.

• New pain, tingling, numbness or weakness in both legs Emergency. Go now

  Any of these in both legs at once. Other new weakness or numbness in one leg or foot needs a clinician today. Leg or foot weakness that is getting worse needs emergency care now.

• Leg or foot weakness that is getting worse Emergency. Go now

  Tripping over your own foot or a foot that slaps down when you walk, with the weakness getting worse over hours or days. This means the leg or foot, not a back that feels tired.

• Back pain that started after a recent serious accident Emergency. Go now

  A car crash or a bad fall. Soreness after a hard workout does not count.

See a clinician today

Use urgent care if you cannot get an appointment today.

• Other new weakness or numbness in one leg or foot See a clinician today

  New trouble standing on your heels or toes on one side, or a patch of skin on one leg or foot that has gone numb. If it shows up in both legs, or a weak leg or foot keeps getting weaker, it belongs on the first list: go now.

• Fever or chills alongside the back pain See a clinician today

  Tell them about any recent infection, surgery, or injection, and whether your immune system is weakened by an illness or a medicine.

• New pain after a recent smaller fall or knock See a clinician today

  A slip, a bump, or a fall that did not seem serious at the time. Tell the clinician if you are older, have osteoporosis, or have taken steroid tablets for a long time.

• Unexplained weight loss, or a history of cancer See a clinician today

  Weight coming off without trying, or back pain in someone who has had cancer, including a cancer treated years ago. In a 2013 review of red flags, a past cancer was the most useful single sign of cancer in the spine.

• Pain that is rapidly getting worse See a clinician today

  Pain that gets worse quickly over hours or days, even if you have had pain like it before.

• Pain that is constant at rest and worse at night, not tied to movement See a clinician today

  Constant pain that does not ease when you lie still or change position, and gets worse at night. Ordinary back pain usually changes with movement and position. Stiffness in bed that eases once you get moving is common and does not count on its own.

If the pain is in your legs

If pain goes into a leg, or spreads that way while you exercise, stop the back-extension work and do not add load. The app does the same thing: when your latest pain log is in the legs, it shows no session.

Go to emergency care now for new numbness, tingling or change in feeling in the saddle area (groin, inner thighs, genitals or anus), new changes in sexual function, new bladder or bowel changes, new pain, tingling, numbness or weakness in both legs, leg or foot weakness that is getting worse, or back pain after a recent serious accident. See a clinician today for other new weakness or numbness in one leg or foot, fever or chills alongside the back pain, new pain after a recent smaller fall or knock, unexplained weight loss or a history of cancer, pain that is rapidly getting worse, or pain that is constant at rest and worse at night, not tied to movement. Use urgent care if you cannot get an appointment today. Do not try to train through any of these. If none of them are present, use the flare-up plan: no bench work until your pain logs settle.

If you were hurt or had surgery recently

Back pain after a recent serious accident is on the emergency list, and new pain after a smaller fall or knock is on the today list. Beyond those checks, this site's program is for back pain that has lasted months or years, in people cleared to exercise. Once you have been checked after a recent injury, fall, car accident, or surgery, finish the recovery plan your doctor set before you start it. The app stops setup at the same point.

What to say when you call

Say which item applies, when it started, and whether it is getting worse. Mention recent illness or injury, your medicines, any cancer history, and any change in strength or feeling. You do not need to guess the cause.

How doctors use this list

Back-pain guidelines such as NICE's ask clinicians to look for specific causes like cancer, infection, trauma, and inflammatory disease. Red flags are how they decide who needs an exam or a test sooner. Many of these signs also turn up in people with no serious problem, and the research on how well each one predicts a serious cause is thin. Go anyway. The exam and any tests are how a doctor tells the ordinary cases from the rest.

I am not a clinician. This page tells you when to get care. It cannot tell you what is wrong, and it cannot clear you to exercise. General education, not a diagnosis.

After you have been checked

If a clinician has checked you and cleared you to exercise, the program starts in the progression guide. Keep the flare-up plan for ordinary bad weeks, and come back here first if anything above shows up. If you still need that clearance, bring the appointment questions.

Common questions

What does saddle numbness feel like?

Reduced or odd feeling in the skin that would touch a bicycle saddle: around the groin, the inner thighs, the genitals and the anus. Some people first notice it when wiping. New numbness, tingling or change in feeling there needs emergency care now, with or without a bladder or bowel change.

Is weakness in one leg an emergency?

Leg or foot weakness that is getting worse, such as tripping or a foot that slaps down, means go to emergency care now. So do new pain, tingling, numbness or weakness in both legs. Other new weakness or numbness in one leg or foot means see a clinician today.

Is back pain at night a red flag?

Pain that is constant at rest, worse at night, and does not change with movement or position is one. See a clinician today, or urgent care if you cannot get an appointment today. Stiffness in bed that eases once you get moving is common and is not a red flag on its own.

Can this checklist clear me to exercise?

No. It tells you when to get care. Only a clinician who examines you can say what is wrong or clear you to exercise.

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