Last updated: September 2026 • Reading time: ~4 minutes
Fall in Connecticut means raking leaves, dragging bags to the curb, and climbing ladders to clear the gutters. By Sunday night, a lot of us feel it in our lower back.
Usually it’s a strained muscle that heals. A few cases need a doctor quickly.
Here are five red flags that your lower back pain is serious.
By the numbers: Low back pain is the world’s leading cause of disability, affecting about 619 million people in 2020 (Ferreira et al., 2023). In a study of more than 1.2 million people seeking care for back pain, only 2.9% were diagnosed with a serious “red flag” condition within 90 days (Rhon et al., 2026).
How Do I Know If My Back Pain Is Serious?
“Red flags” are signs that back pain may come from more than sore muscles. Think of your car’s check engine light. It says: get it checked.
The 5 Red Flags You Should Never Ignore
1. Bladder or bowel changes, or numbness “in the saddle”
Trouble starting to pee, not feeling when your bladder is full, leaking, or losing bowel control can signal cauda equina syndrome. So can numbness where you would sit on a saddle: inner thighs, groin, and buttocks.
It’s rare, but it is an emergency. In a UK study of 621 people with this condition, 31% had urinary retention serious enough to need a catheter before surgery (Woodfield et al., 2023).
What to do: Go to the emergency room the same day.
2. Back pain with a fever or feeling sick
Pain plus fever, chills, or night sweats can mean an infection in the spine or kidneys. Risk is higher after recent surgery or a back injection, or with a weak immune system.
In the study of 1.2 million people, infection was the most common red flag diagnosis, at 1.2% (Rhon et al., 2026).
What to do: Call your doctor today. Go to the ER if the fever is high or you feel very unwell.
3. A history of cancer, or weight loss you can’t explain
A 2025 review found that a past history of cancer was the single most reliable red flag for cancer in the spine. The warning grew stronger when paired with weight loss you can’t explain (Maselli et al., 2025).
Still, it’s rare: 0.1% to 1.6% of low back pain cases.
What to do: Book a visit with your doctor soon and mention your history.
4. Pain after a fall, a car crash, or a hard hit
A slip off a ladder. A fender bender on I-95. A tumble on wet leaves.
A 2023 Cochrane review found four clues were most useful for spotting a spinal fracture: age over 70, a recent fall or trauma, bruises or scrapes on the back, and long-term use of steroid medicines that can weaken bones (Han et al., 2023).
After a car crash, pain can show up hours or days later, once the adrenaline wears off. Feeling fine at the scene doesn’t mean you are fine.
What to do: Get checked after any real crash or fall, even if the pain seems mild.
5. Leg weakness or numbness that keeps getting worse
Pain down one leg is often sciatica, and it usually settles. Worry about weakness that worsens: a foot that drags or slaps the ground, trouble standing on your toes or heels, or numbness that keeps spreading.
What to do: See a doctor promptly. Weakness that worsens fast means a trip to the ER.
What Happens When You See a Chiropractor for Back Pain?
A good chiropractic visit starts with safety, not treatment. Your chiropractor asks about your history and checks your reflexes, strength, and feeling in your legs, looking for the red flags above.
If one shows up, you get referred to a medical doctor or for imaging. If not, care usually includes gentle adjustments, movement, and simple home exercises.
Most people don’t need an X-ray. In a 2022 study of 498 back pain patients at a Canadian chiropractic teaching clinic, only 3.4% were sent for imaging (Smith et al., 2022).
Can I Treat Lower Back Pain at Home?
If no red flags apply, often yes. What tends to help:
-
Keep moving. Short, easy walks beat days in bed.
-
Use ice. Wrap an ice pack in a thin towel and apply it for 15 to 20 minutes at a time.
-
Change positions often. If you sit for work, get up every 30 to 45 minutes.
One firm rule: if a red flag appears, or your pain spikes instead of easing, stop and get checked.
If pain isn’t improving after a week or two, or keeps coming back, see a chiropractor, physical therapist, or your doctor.
How to Prevent Lower Back Pain Going Forward
-
Rake with your legs, not your back. Keep a wide stance and switch sides often.
-
Fill leaf bags halfway. Two light bags beat one heavy one.
-
Keep ladders steady. Set them on firm, level ground and have someone hold the base.
The Bottom Line
Most lower back pain is not dangerous. It usually improves with movement, time, and smart care.
Red flags change the plan. If any of the five above show up, get checked. When in doubt, get checked.
Sources & Further Reading
-
Ferreira ML, de Luca K, Haile LM, et al. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. The Lancet Rheumatology. 2023;5(6):e316–e329. https://doi.org/10.1016/S2665-9913(23)00098-X
-
Rhon DI, Parsons NA, Boeth R, Yuan X. Prevalence of non-spinal pathology and red flag diagnoses associated with care seeking for low back pain in the Military Health System. Scientific Reports. 2026;16:25587. https://doi.org/10.1038/s41598-026-51658-w
-
Woodfield J, Hoeritzauer I, Jamjoom AAB, et al. Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: a multi-centre prospective cohort study. The Lancet Regional Health – Europe. 2023;24:100545. https://doi.org/10.1016/j.lanepe.2022.100545
-
Maselli F, Notarangelo G, Margelli M, et al. Diagnostic utility of red flags for detecting spinal malignancies in patients with low back pain: a scoping review. Journal of Clinical Medicine. 2025;14(20):7174. https://doi.org/10.3390/jcm14207174
-
Han CS, Hancock MJ, Downie A, et al. Red flags to screen for vertebral fracture in people presenting with low back pain. Cochrane Database of Systematic Reviews. 2023;8:CD014461. https://doi.org/10.1002/14651858.CD014461.pub2
-
Smith A, Kumar V, Cooley J, Ammendolia C, Lee J, Hogg-Johnson S, Mior S. Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian chiropractic college: a historical clinical cohort study. Chiropractic & Manual Therapies. 2022;30:30. https://doi.org/10.1186/s12998-022-00447-z
This article is for general education and is not a substitute for a personal medical evaluation.
