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Back and Spine; Orthopaedics; Rehabilitation

5 signs your back pain might be an emergency

March 26, 2025

Back and Spine; Orthopaedics; Rehabilitation

Kavita Trivedi, D.O. Physical Medicine and Rehabilitation

woman holding her lower back in pain — About 80% of adults will experience back pain in their lives, so it’s important to be able to identify the severity of your symptoms.

In our 20s and 30s, “normal” back pain often can be attributed to factors of daily life, such as sitting too long, picking up children, or overdoing it while exercising.

In our 40s and older, work injuries and the beginnings of arthritis and degenerative conditions are more common.

Back pain is so common, in fact, that many patients shrug off symptoms that might indicate a medical emergency.

Approximately 80% of adults will experience back pain in their lives, so it’s important to be able to identify the severity of your symptoms and track how long the pain lasts.

If back pain can be associated with a specific activity, such as lifting or twisting wrong, and the pain goes away within 72 hours after resting and applying ice, it’s usually nothing to worry about. However, if pain creeps on gradually, appears suddenly, or doesn't go away, you might have a more serious condition.

5 symptoms that might indicate a medical emergency

1. Sharp pain rather than a dull ache: This could indicate a torn muscle or ligament, or a problem with an internal organ in the back or side.2. Radiating pain: This pain "moves" or shoots to the glutes or legs, which could indicate a nerve compression condition.

A man in cycling gear, holding his lower back in pain while standing next to his bicycle. — Radiating pain could be a sign of nerve damage.

3. Sudden weakness in the legs: Limb weakness can be caused by compressed nerves in the spine due to conditions like sciatica or spinal stenosis. However, sudden leg weakness could also indicate a stroke.4. Incontinence: Back pain paired with inability to control the bowels or bladder might be a sign of serious nerve compression or a spine infection, such as discitis or meningitis.5. Numbness or pins and needles in the groin or glutes: This is known as saddle anesthesia and is also a sign of a serious nerve or spine condition.

If you have leg weakness, incontinence, and numbness together, you might have cauda equina syndrome, a serious illness characterized by spinal cord nerve damage. This is a medical emergency, and patients usually need surgery immediately to decompress the nerves and reduce permanent damage.

Related reading: Get help for back, neck, and leg pain caused by spinal stenosis

Other conditions that cause back pain in older adults

We often see a range of less serious but still painful spine conditions in seniors. Most patients with these conditions will not require surgery. Physical therapy, medication, injectable anesthetics, or a combination of treatments usually can control symptoms.

Degenerative disc disease, which can cause whole spine pain, and lumbar arthritis, which usually causes low-back pain, commonly develop with age and are considered wear-and-tear conditions.
Sacroiliitis is an inflammation of the joints that connect your spine and pelvis. This condition can cause pain in the low back, glutes, and upper legs.
Ankylosing spondylitis is an inflammatory arthritis that causes patients’ spines to become inflexible, resulting in a continual hunched forward position and spine pain.
We also check for adult degenerative scoliosis and kyphosis, spine-curving conditions that can result in back pain and weakness in the lower extremities.

Rare, non-spine conditions that cause back pain

Occasionally, our spine team finds that a patient’s back pain is caused by an underlying condition that is not spine related.

Kidney and digestive issues, including pancreatitis and gallstones, can cause low-back discomfort that patients might assume is spine pain. In women, uterine fibroids and endometriosis are notorious for causing core pain that can radiate into the back.

Rarely, we discover that a patient with sudden, severe back pain has experienced a ruptured aneurysm, which is a weakening and tearing of part of a blood vessel. This is a medical emergency because it causes internal bleeding that can lead to a heart attack or stroke. Similarly, aortic dissection – the tearing of an inner layer of tissue in the aorta, the main vessel carrying blood from the heart to the rest of the body – sometimes causes back pain and can be fatal if not immediately treated.

Research suggests the spine is also prone to receiving cancer cells that spread from other parts of the body. Batson’s plexus, a network of veins that connect the venous system and spine, might (for unknown reasons) direct spreading cancer cells to the spine. For example, prostate cancer has been known to spread to the spine.

Related reading: Prostate Cancer Awareness Guide

Unscripted: Get to know more about Dr. Dickson

Born and raised in Ghana, Douglas Dickson, M.D., came to the U.S. with $50 and a dream to become a doctor. Despite facing financial struggles and homelessness, he persevered. Now, as an orthopedic spine surgeon at UT Southwestern, he’s known for his commitment to giving back – to his patients and his home country.

Why back pain requires a team approach to care

Whether back pain requires surgery or is manageable with conservative treatment, it’s important to see a spine specialist for diagnosis and care. The doctors at our Spine Center work as a team with experts in nerve, muscle, and bone conditions, as well as nurses and physical therapists who work closely with patients to manage symptoms and reduce the risk of recurrence.

Each week, our multidisciplinary team meets to discuss challenging cases and educate each other on the latest research and techniques. Together, we see a range of patients with complex medical needs. For example, if a patient with a spinal infection is taking a medication that suppresses the immune system, such as immunotherapy for cancer, we work together to find an effective treatment that is safe for their unique needs.

Some medications or medical conditions put patients at greater risk for low bone density, fractured vertebrae, or back pain. In these cases, we get referrals from and collaborate with oncologists, hematologists, rheumatologists, mineral metabolism doctors, and primary care doctors to reduce patients’ risks and manage their symptoms.

If you are worried about back pain, come see us for reassurance. The earlier you are diagnosed, the better your outcomes can be.

If you or a loved one might benefit from a back pain consultation, call 214-645-8300 or request an appointment online.

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