When to Worry About Lower Back Pain: Warning Signs

Back pain is very common. Most of the time, it comes from muscles, joints, or discs, and it settles with time and movement. But "most of the time" isn't much comfort at 2 a.m. when your back won't let you sleep. Here's how to tell the ordinary from the urgent.

When should you worry about lower back pain?

Worry when back pain comes with other symptoms that don't fit a simple strain. These include bladder or bowel changes, numbness in the groin, fever, a recent serious injury, or weight loss you can't explain. Those signs need a medical doctor, and some need the ER.

Ordinary back pain looks different. It usually follows a lift, a twist, a long drive, or a bad night's sleep. It may be sore when you move and ease when you change position. According to Mayo Clinic¹, most back pain improves with home care, often within a few weeks.

Pain level alone isn't the best guide. A pulled muscle can hurt a lot and still be harmless. What matters most is the company your back pain keeps. Learn more about lower back pain causes and care on our main back pain page.

Which back pain symptoms need emergency care?

Don't drive yourself. According to NHS guidance², ask someone to take you or call for an ambulance.

Pressure on the nerves at the base of the spine

The first four signs can mean pressure on the bundle of nerves at the bottom of the spine. Doctors call this cauda equina syndrome. According to the American Association of Neurological Surgeons⁴, trouble urinating is its most common sign. Prompt surgery gives the best outcome, so speed matters⁴. Leg pain that travels below the knee has its own set of warning signs. See sciatica warning signs.

A problem with the aorta

The aorta is the large blood vessel that runs through your belly. A bulge in its wall is called an abdominal aortic aneurysm. According to Mayo Clinic⁵, an enlarging aneurysm can cause back pain, deep belly pain, or a pulsing feeling near the navel. A rupture can cause sudden, severe back or belly pain that feels like ripping or tearing. Mayo Clinic⁵ notes it's most common in people 65 and older, in men, and in people who smoke.

Could my back pain be an infection or my kidneys?

It could, if back pain comes with fever, chills, or changes when you urinate. Your kidneys sit just under your lower ribs, toward your back. So kidney problems can feel like back pain.

According to Mayo Clinic⁶, a kidney infection can cause fever, chills, and back, side, or groin pain. It can also cause burning when you urinate, needing to go often, or cloudy or bloody urine. Mayo Clinic advises seeking care right away for fever, chills, severe pain, bloody urine, or vomiting⁶.

Kidney stones can cause sharp pain in your back, side, lower belly, or groin⁷. NIDDK advises seeing a health care professional right away for symptoms like these⁷.

Rarely, infection reaches the spine itself. A family medicine review lists fever, a recent urinary infection, or a recent spine surgery as strong warning signs³. Past IV drug use and a weakened immune system raise the risk, too³.

Get medical care the same day for fever or urinary symptoms with back pain. A chiropractor isn't the right first stop for these.

When can back pain be a sign of cancer?

Rarely. Cancer is an uncommon cause of back pain, but a few signs raise the odds enough to need a doctor's visit. According to a family medicine review³, the strongest is a known cancer that has spread to bone. Unexplained weight loss is a moderate warning sign³. A past cancer with back pain that doesn't ease with rest is a weaker one³.

NHS guidance² adds a few reasons to see a doctor:

• You've lost weight without trying
• You notice a lump or swelling, or a change in the shape of your back
• The pain doesn't improve with rest or is worse at night
• The pain is high in your back, between your shoulder blades

None of these mean you have cancer. They mean a medical doctor should look before you start hands-on care. If you've had cancer before, tell every provider who treats your back.

What if back pain started after a fall or injury?

A serious fall or crash needs a medical check first. A family medicine review lists significant injury as a strong warning sign for a fracture³. That includes a car crash or a fall from a height.

For some people, a much smaller event can matter. According to the same review³, a minor fall or even heavy lifting can cause a fracture in someone with osteoporosis. Long-term steroid use raises that risk, too³. Older adults should take new back pain after a small fall seriously. Read more about back pain in older adults.

If your pain started with an ordinary lift, see what to do in the first 48 hours after lifting.

When should you see someone for back pain that isn't an emergency?

When it lasts longer than a few weeks or keeps getting in your way. According to Mayo Clinic¹, contact a health care professional for back pain that:

• Lasts longer than a few weeks
• Is severe and doesn't improve with rest
• Spreads down one or both legs, especially below the knee
• Causes leg weakness, numbness, or tingling

That's a good time for an exam. Your doctor listens to how the pain started and what makes it better or worse. Then your doctor checks how your back and hips move and tests strength, reflexes, and feeling in your legs. X-rays are taken only if your exam calls for them. If anything needs medical care first, your doctor will tell you and help you get it. Not sure where to start? Here's how to choose a chiropractor or doctor for back pain.

Care at our clinics is natural and drug-free. It may include gentle joint movement, gentle muscle work, exercise, and spinal adjustments if you want them. Some plans add physical therapy at our Menomonee Falls, Waukesha, and West Allis North clinics.

Find out what's behind your back pain

Not knowing is often the worst part. You keep checking for new symptoms, and every twinge makes you wonder. Once serious causes are ruled out, you can focus on feeling better.

We're here to help you find out. Chiropractic Company has cared for Greater Milwaukee since 1982, with 400,000+ patients, 1,400+ five-star Google reviews, and 20+ neighborhood clinics. Our doctors care for lower back pain every day, and we work alongside medical doctors when you need both. We look for the cause of your pain, not just the symptoms. Your care is designed around your condition, your medical history, your daily routine, and your goals. You choose your care, and you see the same doctor as it continues.

Care is natural and drug-free. Treatment begins at your second visit, or the same day in acute cases if your doctor decides it's appropriate. Some plans add physical therapy at our Menomonee Falls, Waukesha, and West Allis North clinics, or massage therapy at Hales Corners and Oconomowoc. Learn more about our lower back pain care.

We're in-network with most insurance companies and accept Medicare and auto accident claims. Eligible new patients can start with the $29 new-patient special, which includes a consultation, an exam, and X-rays if needed. *See offer terms.

Visit one of our 20+ neighborhood clinics across Greater Milwaukee: Milwaukee East, Milwaukee North, Milwaukee Third Ward, Shorewood, Glendale, Mequon, Cedarburg, Grafton, Germantown, Brookfield, Menomonee Falls, Waukesha, Oconomowoc, New Berlin, West Allis, West Allis North, Greenfield, Hales Corners, Franklin, Muskego, and Cudahy.

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