The 6 times your back pain is a medical emergency and you must call 999 – from heart attacks to incontinence
BACK pain is very common and in most cases, it's nothing more than an inconvenience.
But for some, it becomes persistent and can really mess with physical and mental wellbeing.
If you have been experiencing back pain, you may be wondering what is normal, what warrants seeing a doctor, or even if it is so bad you should call 999.
In some cases, calling 999 or turning up in A&E is absolutely warranted, for it could be the sign of a heart attack, for example.
According to research from , four out of five adults experience back pain at some point throughout their lives.
The same research found that back pain stops 51 per cent of us from socialising and 41 per cent from exercising.
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Physiotherapist Sammy Margo, part of the expert hub behind Mind Your Back, explains that pain can occur anywhere in the back. However, the lower back is the most common spot.
“The lower back bears more of the load of the body’s weight and effort than higher up the back,” she says.
“And the bones and joints in the lower back flex and move more than those in the upper back – apart from the neck which also moves a lot and can be a cause of pain.”
What's causing your back pain?
Sammy says one of the main reasons people suffer from back pain is injury to a muscle or ligament.
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“These strains may occur for many reasons such as poor posture, improper lifting [including during exercise] or being too sedentary and not having enough exercise,” she says.
“Using too much weight when weightlifting causes the body to flex and tilt, increasing stress on the spine and rendering the back prone to injury and pain.
“Lack of exercise causes the muscles in the back to become weak making the back stiff and painful.
“Being overweight may also cause back pain as a result of putting excess strain on joints and muscles.”
Slouching and other poor posture positions constrict the nerves and blood vessels in the back, resulting in pain.
Poor posture can also distribute the weight in your back unevenly, leading to strain and pain in the lower back tissues.
Marc Sanders, chiropractor and member of the British Chiropractic Association, says that many people are unaware of how simple lifestyle choices can impact their back pain, “such as your mattress, how you manage stress, how you sit at your desk or the amount of movement in your day”.
When to call 999...
Back pain, along with other symptoms, can be a sign of something more serious and potentially a medical emergency.
Marc says: “Chest pain combined with back pain could be a sign of a heart issue or another serious medical condition, so it's crucial to call for help immediately."
The signs of a heart attack are chest pain, and pain that can spread to other parts of the body, including the back, feeling lightheaded or dizzy, shortness of breath, sweating and nausea.
“If the pain started after a serious accident, such as a car accident, trauma from it could result in hidden injuries or fractures that may not be immediately apparent, so it's wise to have a healthcare professional assess your condition as soon as possible," he adds.
“If you have back pain plus any of these symptoms, don’t delay. Please call 999 or go to A&E immediately.”
Marc says that if you experience pain, tingling, weakness, or numbness in both legs, especially if these symptoms are rapidly worsening, then it could be a sign of severe nerve compression or damage.
He adds: “Numbness or tingling around your genitals or buttocks can be symptoms indicative of a serious neurological issue, whilst difficulty urinating might suggest nerve compression in your back affecting your ability to pee.
“You have some degree of bladder control, but you may need to strain to pee, you may pee more often than usual, pee smaller amounts of urine than usual (despite having drank a lot of liquid), or not feel the sensation of peeing as much as you usually do.”
Sudden loss of bladder or bowel control (unable to hold it in) is another red flag that the NHS says you should call 999 for.
“It may indicate a severe spinal cord problem,” Marc says.
“You may be retaining pee, as in, your bladder fills up but you don’t feel the sensation or urge to pee, leading to incontinence.”
Marc adds that a loss of sexual function with back pain might suggest nerve compression in your back.
“You may have reduced feeling or no sexual sensation in your genitals, or you may have erectile dysfunction,” he said.
When to see a doctor
Generally, you should see your GP if your back pain has not improved over a few weeks, is stopping you from doing your daily activities, the pain is severe or you are worried about it.
In some instances, it is worth getting an urgent GP appointment or calling NHS 111, such as if you have a high temperature.
“It may indicate an underlying infection,” explains Marc.
You should also book to see your GP if you've lost weight without intentionally trying to do so, “as unexplained weight loss can be a sign of an underlying serious health issue such as infection or tumour”, he adds.
“When you notice a lump or swelling in your back or if your back has changed shape, as this could be indicative of a structural problem,” Marc says.
It’s also worth noting where your pain originates; if it originates from the top of your back (between your shoulders) rather than your lower back, then Marc says it should be evaluated by a healthcare professional.
He says: “Most causes of upper back pain are due to completely normal mechanical problems, but it is worth your GP ruling out other causes alongside an assessment from your physio or chiropractor.”
For temporary pain
Sammy explains that back pain can be treated at home if it is temporary.
She says: “If you think your back pain is the result of twisting, lifting, digging or a minor sports injury, for example when running or walking or on the golf course, then if it is not severe and unremitting, and you can try treating it at home.
“But if it worsens or continues over a couple of weeks, see a doctor.”
If you spend most of your day sitting down, “make sure that you take regular breaks, ideally every 20 to 30 minutes,” says Marc.
“Stand up, change position and walk around a little.”
Follow and keep as active as possible.
Research by the The British Chiropractic Association showed that 63 per cent of Brits use exercise to manage back pain.
Marc says: “Exercise is key to a healthy back.
“This doesn’t mean that you need to embark on any extreme fitness regimes.
“Adding just a few extra minutes of walking a day can hugely benefit your back health.”
When sitting down - particularly if you sit for work all day - Sammy says your ear, shoulder, and hip should be in line.
“Try sitting with your bum against the back of a chair and feet flat on the floor,” she says.
Your sleep position is also important.
“Sleep with your spine straight when lying on your side.
“Try placing a pillow between your legs (if you sleep on your side) or under your knees (if you sleep on your back),” explains Sammy.
Hot topical products can also help to soothe muscles if they are tight or painful, while cold therapy such as ice packs, can provide fast, soothing, and comforting cooling relief.
Sometimes, your back pain needs the help of a physiotherapist.
Marc says that around 90 to 95 per cent of back pain can be effectively managed by physios and chiropractors without medical interventions.
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He says: “If the pain is moderate to severe (ranging from 4/10 to 10/10) or if it is worsening over time, this may indicate an underlying problem that needs specialised care to get you back on your feet and active again.
“A physiotherapist or chiropractor can provide tailored guidance and strategies to manage both the physical and psychological aspects of your back pain.”
