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Red Flags

Red Flags are symptoms which indicate serious problems requiring urgent action.

If you have any of these you should seek immediate advice from a doctor.

If you have any of these symptoms, it does not mean that you need an urgent operation, it means that you should seek URGENT assessment by a doctor who will decide whether urgent action should be taken.

If you, or a friend, has back pain related to any of the following, seek immediate help from a medical specialist:

  • Younger than 20 or older than 55 and getting back pain for the first time.
  • Back pain after a violent injury, e.g. road traffic accident.
  • Back pain is constant and getting worse.
  • Back pain is in the upper part of the spine.
  • Back pain and cancer in the past or at present.
  • Back pain and drug abuser, or HIV infected.
  • Back pain and generally unwell or feverish.
  • Back pain with significant unexplained weight loss.
  • Back pain and continuing to have great difficulty bending forwards.
  • Nerve related problems other than pain: loss of sensation (especially of the area that would sit on a saddle - so called saddle anaesthesia), loss of power, urinary or bowel incontinence.
  • Back pain with obvious structural deformity of the spine.
  • Debilitating back pain that is not reducing after 4 -6 weeks.
  • Traumatic onset;Constant, progressive, non-mechanical pain;
  • Thoracic pain;
  • Past history – Ca, steroids, HIV, drug abuse;Unwell, weight loss;
  • Iritis, skin rashes, colitis, urethral discharge;
  • Persisting, severe loss of forward lumbar flexion or movement in all directions;
  • Peripheral joint involvement;Widespread neurological symptoms or signs;
  • Structural deformity;
  • Sphincter disturbance, difficulty with micturation;
  • Gait disturbance

Nerve root pain:

  • Unilateral leg pain> back pain;
  • Pain generally radiates to foot or toes;
  • Numbness/paraesthesia in same distribution;
  • Reduced SLR, reproduces leg pain;
  • Local motor, sensory or reflex changes

Immediate referral to spinal surgeon if the neurological signs are progressing.

If you are in doubt about any of these symptoms, you should seek urgent advice.


This document should be used for guidance only. It should not be regarded as a substitute for medical advice, given in person by a trained specialist.

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