The great majority of back pain is not caused by anything dangerous, and most of it settles. But a small number of features point to something that needs prompt medical assessment rather than physiotherapy.
Medically reviewed by Dr Arjit Vashishtha, MPT
Last reviewed: 2 August 2026 · Our clinical team
Seek emergency care immediately if you develop difficulty controlling your bladder or bowels, numbness around the groin, inner thighs or buttocks, or new weakness in both legs. This combination can indicate cauda equina syndrome, which is a surgical emergency — delay can cause permanent damage. Do not wait for a physiotherapy appointment.
Features that need prompt medical assessment
- Back pain following significant trauma — a fall, an accident — or any injury in someone with known osteoporosis
- Unexplained weight loss, fever, or night sweats alongside back pain
- Constant pain that does not change with position and is not relieved by rest, particularly pain that is worse at night
- A history of cancer
- New progressive weakness or numbness in a leg
- Pain in someone taking long-term steroids, or with a suppressed immune system
- Onset in someone under 20 or over 55 with no clear cause
These do not mean something serious is present. They mean the possibility should be excluded before treating the pain as mechanical.
What ordinary mechanical back pain looks like
- Varies with position and movement — better in some positions, worse in others
- Often follows an awkward movement, a period of unusual load, or a spell of inactivity
- Eases with gentle movement, and tends to improve over days to weeks
- May refer into the buttock or thigh without progressive weakness
This kind of pain generally responds well to staying active and to physiotherapy.
Two common misunderstandings
Severity does not equal seriousness. Very painful episodes are frequently mechanical, and mild persistent pain occasionally is not.
Scan findings are common in people without pain. Disc bulges and degenerative changes appear on the scans of many pain-free people. A scan finding is not automatically the cause of your pain.
Related
Medical disclaimer: this article is general information and is not medical advice, diagnosis or treatment. It is not a substitute for individual assessment. See our medical disclaimer.