There you are, going about your daily routines. Washing your face. Brushing your teeth. Putting on your socks or shoes. Or perhaps you were involved in something more active like playing sports, golfing, or just going for a walk with your kids.

And then it happens.

That sudden grabbing sensation, powerful enough to make you catch your breath. Making you gasp audibly. Possibly dropping you to your knees. Or laying you flat out on the ground.

That feeling of pulsing fire spreading across your back with every wave of seemingly intractable spasm. The almost instant inability to move or function like you did just a few seconds ago.

Frozen in place. The fear. The anxiety. The apprehension. They all come rushing in.

Afraid that any little movement will set off another wave worse than the previous one.

That sinking sensation that something bad just happened.

Does that sound familiar?

In my years as a physiotherapist, the above is a fairly standard description of the first few minutes after an acute back spasm as often experienced by clients. I’ve received numerous phone calls, emails and texts from them over the years when this happens, and invariably the first question that comes up is the following:

“Should I go see a doctor?”

The answer, as it almost always comes up, is a resounding “it depends”.

While it might seem like the severity of the back pain is so intense that only immediate medical intervention and imaging (e.g. MRIs or X-rays) will give sweet relief, that’s not always the case for the former, and never the case for the latter.

In terms of emergency room wait times and hospital triage, someone heading to the ER for back pain and spasm may end up waiting for hours and hours, just to be seen. And often, they will be sent home with nothing more than a basic pain killer such as Tylenol and possibly some muscle relaxants for their troubles.

I don’t know about you, but I don’t know if that’s worth 7 or 8 hours of my life, especially because all that plays on the TV is CP24 on loop…

That being said, what if the back pain is caused by something more serious? What if a trip to the doctor or emergency room is the appropriate plan of action?

How could someone quickly and readily figure out if a trip to the doctor or ER is the best option?

Enter the Red Flags.

Red flags are a checklist of features, signs, symptoms or medical history that, if present, could indicate that more serious issues may be at hand. At the very least, these allow us to have a best practice approach as to when one should seek further medical investigation/treatment or when one should wait a few days to see how the natural course of the injury plays out.

Cancer

• Any history of cancer
• Any unexplained weight loss
• Night pain or pain at rest
• Failure to improve with treatment

Infection

• Persistent fever
• Recent bacterial infection (e.g. pneumonia, urinary tract infection etc)
• Immuno-compromised (e.g. organ transplant, HIV, diabetes etc)
• Intravenous drug abuse
• Pain at rest

Cauda Equina Syndrome

• Bowel or bladder issues (incontinence, retention)
• Saddle anesthesia (loss of sensation in the groin/buttocks)
• Bilateral lower extremity weakness or numbness

Significant Disc Herniation

• Significant muscle weakness
• Drop foot

Vertebral Fracture

• Recent history of significant trauma (big fall, car crash, industrial accidents etc)
• Any history of osteoporosis
• Age greater than 70
• Prolonged use of corticosteroid medication

While the above is not an exhaustive list, it is a good starting point.

That being said, if you have concerns, always follow up with the appropriate medical professional to be assessed in person. The internet, which happens to be where this post is found, should only be used for educational purposes and is not a substitute for, nor should it be construed as, medical advice.

Primal Human Performance