Warning signs not to overlook with lower back pain

Lower back pain is common and in most cases does not immediately indicate a serious condition.

However, some symptoms may require prompt medical evaluation to confirm severe nerve compression, fracture, infection, or other conditions.

The presence of one risk sign does not necessarily mean a serious disease. Conversely, not being included in the checklist does not completely rule out all possibilities. The medical team must evaluate the current symptoms and medical history together.

The following symptoms may require an urgent evaluation to confirm a condition of severe compression of the lumbar nerve.

• Sudden difficulty in urination
• Difficulty holding urine or stool
• Urination and defecation sensations differ from usual.
• Reduced sensation in the inner buttocks, around the genitals and in the perineum
• Severe pain or numbness occurs in both legs.
• Leg strength weakens rapidly.

If these symptoms occur together, you should seek a medical facility that can provide prompt evaluation rather than waiting for a general appointment.

Feeling unable to exert force because of pain may be different from actual muscle weakness.

If the following changes are newly observed, nerve function must be assessed.

• Dragging the foot along the ground
• Difficulty lifting the ankle or toes
• The knee repeatedly gives way
• Suddenly, climbing stairs becomes difficult.
• Weakness in one or both legs
• Walking suddenly becomes unstable.

Even if pain has decreased, it should not be judged as improvement if muscle weakness progresses.

In the following cases, you can first confirm whether a fracture is present.

• Traffic accidents or falls from heights
• Severe lower back pain that occurred after falling
• New pain in a person with osteoporosis
• Pain occurring after a mild impact in elderly individuals
• In cases where steroids have been used for a long period
• In cases where a vertebral compression fracture occurred in the past
• When pressing directly on the spine, it is extremely painful.

Even if the trauma does not appear severe, fractures can occur in people with weak bones.

In such situations, we prioritize necessary imaging examinations and specialist consultations before performing strong stretching, self-correction, or Chuna manual therapy.

If you experience the following symptoms along with lower back pain, it is possible to check for infection.

• high fever or chills
• Recent severe infection
• Recent surgery or invasive procedures
• State with impaired immune function
• In cases where cancer is being treated
• In cases of diabetes mellitus or those undergoing dialysis
• Pain that persists day and night and is rapidly worsening
• Severe fatigue and generalized weakness

The absence of fever does not completely rule out infection, so tell your healthcare provider about your medical history and overall condition.

In the following situations, it is necessary to check for tumors or systemic diseases.

• A new lower back pain occurs in a person with a history of cancer.
• Weight loss without any specific reason
• Pain continues to worsen even when resting or changing position.
• Severe nocturnal pain accompanied by generalized weakness occurs.
• Even with standard treatment, the pattern of pain continues to change.

Nocturnal pain alone does not necessarily indicate a serious condition. Evaluation is required when there are concurrent symptoms and other conditions.

Even if you feel pain in your lower back, it could be a problem with another organ.

• Severe abdominal pain or flank pain
• Hematuria and dysuria
• chest pain or shortness of breath
• Cold sweat and a feeling of nearly fainting
• Severe new-onset lower back and abdominal pain during pregnancy
• Symptom where the leg suddenly becomes cold and pale

In such cases, a medical evaluation to identify the cause should be performed before musculoskeletal treatment.

If the following symptoms appear suddenly, consider visiting a medical facility where rapid evaluation is possible, such as an emergency room.

• Changes in bowel and bladder control and decreased sensation in the perineal region
• Rapidly progressing leg paralysis or muscle weakness
• Severe pain that makes it difficult to move after a major trauma
• High fever, decreased consciousness, or severe systemic weakness
• Pain accompanied by chest pain, shortness of breath, and a sensation of fainting

If movement is difficult or symptoms are worsening rapidly, you should use the local emergency medical system.

• Do not let someone press or twist your lower back forcefully.
• We do not perform self-correction to produce joint sounds.
• Do not forcibly stretch while enduring severe pain.
• We do not judge muscle weakness as merely fatigue or muscle stiffness.
• We do not delay necessary evaluations simply because pain is reduced by analgesics.
• We do not watch nerve symptoms worsen while repeating the same treatment.

When treating a patient with lower back pain, the following are examined before deciding whether to apply Chuna manual therapy.

• The trigger and progression speed of the onset of pain
• Risk of trauma and fracture
• Leg muscle strength and sensation
• Knee and ankle reflex
• Gait and Balance
• Changes in urination and defecation, and sensation in the perineal region
• Fever and risk of infection
• History of cancer, osteoporosis, and systemic diseases

If it is determined to be general musculoskeletal pain, Chuna manual therapy, acupuncture/pharmacopuncture, and exercise may be considered.

However, if there is suspicion of warning signs, it is safer to first guide toward imaging examination and emergency/specialist consultation rather than Chuna manual therapy.

Pain relievers and injection therapy may help control severe pain.

However, even if the pain decreases, re-evaluation is necessary if the following symptoms are present.

• Leg strength continues to weaken.
• Dragging leg
• The range of sensory loss is widening.
• Changes in urination and defecation functions
• Persistent high fever or systemic weakness

Reduction of pain and resolution of warning signs are not the same thing.