Understanding Serious Pathology in Back Pain: What You Need to Know

Back pain can be a real pain—literally! It affects so many of us at some point in our lives. But did you know that serious pathology accounts for only about 1% of all back pain cases? (Budtz et al., 2021; Finucane et al., 2024). While these cases are rare, it's crucial to recognise the signs and symptoms that may warrant concern. Let’s dive into this topic and arm ourselves with knowledge.

Recognising the Signs of Serious Pathology

When it comes to back pain, knowing when to seek help can make all the difference. Here are some serious conditions to be aware of:

Infection

Infections can strike quickly, often presenting with severe and progressive pain. You might notice an increase in discomfort over hours or days, usually localised to one specific area. Along with the pain, you might feel generally unwell, experiencing symptoms like fever, severe fatigue, or sweating. If you notice these signs, don’t hesitate to reach out for help.

Cauda Equina Syndrome

You may have heard of Cauda Equina Syndrome, but it’s quite rare. This condition involves compression of the spinal cord and can lead to alarming symptoms. Key signs include an inability to urinate (retention), loss of rectal fullness, changes in bladder sensation (like numbness or tingling), and significant changes in strength or sensation in both legs. If you experience these symptoms, seek medical attention immediately.

Cervical Myelopathy

Cervical myelopathy is another serious condition that doesn’t get as much attention. It involves compression of the spinal cord in the neck and can mirror some symptoms of Cauda Equina. However, it can also cause changes in strength and sensation in both arms. If you’re experiencing these issues, it’s important to consult a professional.

Fractures

Fractures are often associated with trauma, but they can also occur with mild injuries, especially in individuals with osteoporosis. Many people may have undiagnosed osteoporosis, so if you experience pain after minor incidents like getting up from a chair or twisting, it’s worth getting checked out. If an X-ray reveals a fracture without trauma, further blood work through your GP may be necessary to determine the cause.

Cancer

Cancer can present with symptoms similar to those mentioned above. If you have a history of cancer and experience persistent back pain—especially pain that worsens at night or when still—this warrants further investigation. Symptoms can vary, with some days being better than others. In cases of myeloma, the pain is often very localised initially.

Inflammatory Back Pain

I’ll cover inflammatory back pain in more detail in a separate post, but it’s important to note the patterns associated with it. If you experience symptoms that worsen for longer than 30 minutes in the morning, improve with movement, and worsen when still or at night, you may be dealing with inflammatory back pain. Family history can play a role, and while these conditions mainly affect those under 45, there are exceptions.

When to Seek Help

While these conditions are rare, it’s always better to be safe than sorry. If you have any concerns regarding the symptoms mentioned above, I recommend booking an appointment with a professional—like me! Together, we can create a personalised plan to ensure you get the right investigations and support.

The Importance of Early Intervention

Early intervention can make a significant difference in your recovery journey. The sooner we identify the underlying issue, the better the chances of effective treatment. Whether it’s through physiotherapy, medical intervention, or lifestyle changes, taking action early can help you get back to feeling great.

Building a Supportive Community

At Bath Spine and MSK Physiotherapy, we believe in the power of community. We’re not just here to treat your symptoms; we want to support you in your journey to recovery. By using smart technology and fostering a welcoming environment, we aim to be your go-to place for expert, personalised physiotherapy, especially for those tricky back and muscle problems.

Embracing a Holistic Approach

It’s essential to take a holistic approach to back pain. This means not only addressing the physical symptoms but also considering emotional and psychological factors. Stress and anxiety can exacerbate pain, so incorporating relaxation techniques, mindfulness, and even gentle exercise can be beneficial.

Staying Informed

Knowledge is power! The more you understand about your body and potential issues, the better equipped you’ll be to manage your health. Keep an eye on any changes in your body and don’t hesitate to ask questions.

Conclusion

In conclusion, while serious pathology in back pain is rare, being informed about the signs and symptoms can empower you to take action when necessary. If you’re ever in doubt, reach out to a professional. Remember, you’re not alone in this journey, and there’s a supportive community ready to help you get back on track.

Daniel Smith

Bath Spine and MSK Physiotherapy