Spinal injury, the signs you should not ignore

Most back pain is not a sign of anything dangerous and settles with time. A small number of signs are different, and they are worth knowing precisely because they are uncommon.

Signs that need urgent assessment

• Difficulty passing urine, loss of control of bladder or bowel, or numbness around the back passage, buttocks or inner thighs.
• Weakness in both legs, or weakness that is getting worse rather than staying the same.
• Numbness that is spreading, or unsteadiness on the feet that is new.
• These are emergencies. They are not something to observe over a weekend.

Signs that need assessment, though not the same hour

• Pain following a significant fall or road accident.
• Back pain with fever, or with unexplained weight loss.
• Pain clearly worse at night and not relieved by lying down.
• New back pain in someone with a history of cancer or long-term steroid use.

What ordinary back pain looks like

• It varies with position and movement, it eases with time, and it is not accompanied by any of the above. Most of it improves within weeks.
• Staying gently active generally does better than bed rest.

Why imaging is not always the answer

• Scans of people with no pain at all frequently show disc bulges and wear. Imaging is most useful when it will change what is done, which is why it is not the first step for uncomplicated back pain.