//Can lower back pain / sciatica be a sign of something more serious?

Can lower back pain / sciatica be a sign of something more serious?

By |2019-01-23T10:51:16+00:00January 23rd, 2019|Causes of Low Back Pain|Comments Off on Can lower back pain / sciatica be a sign of something more serious?

In short, yes.  But let’s start by putting it into perspective.  Only about 1 in 200 lower back pains are due to a more serious underlying illness.  I’m not going to give you a big long list of possibilities, but yes, cancer is in there, along with a host of other nasties.  However, there is a widely accepted collection of questions that help to determine whether you should be seeking a medical opinion or not.  These are what clinicians refer to as “red flag” questions.  The list is specific to lower back pain, but if you have sciatica, they are relevant too.

  • Compared with during your waking day, is your background pain worse when trying to sleep?  (Not the sharper pain you get when you’re turning over, just the constant type of ache).
  • Have you lost any great amount of weight without meaning to over the last year?
  • Have you been diagnosed with Cancer at any time?
  • Have you had lower back surgery in the last 2 years?
  • Do you have any weakness (rather than pain) in any of the following?

When standing, lifting either big toe up

When standing, pushing up onto the toes of one foot (compared with the other, or compared with what you would expect is your normal)


  • Do you have any numbness (lack of sensation) or pins and needles in your pelvic floor area (up between your upper thighs, the area you would sit on if on a saddle)?
  • Have you had any recent change in sexual function?  Loss of feeling, erection or ability to orgasm?
  • Do you have any difficulty urinating or defecating (using the toilet)?  e.g. trouble starting or stopping, or not aware of your bladder filling
  • Have you suffered any significant trauma recently, which in any way could impact on your lower back?
  • Have you been on a prolonged course of oral corticosteroids in the past or now?
  • Have you had a persistent high temperature recently?

If the answer to all of the above is “no” then the chances that you have something nasty going on are extremely low.  At Active X Backs, we ask all of our clients these questions in a questionnaire before we even see them. However, if the answer to one or more is “yes”, it’s not that I won’t see you, but it indicates that I need to ask you for more detail, and if after that I’m concerned, then I’ll recommend that you consult a relevant medical professional (usually your family doctor).

There is another “however”.  Even if you answer “no” to all of the above questions, it is still possible that you have a “pathology”.  This is where the experienced clinician proves his/her worth.  I have seen so many non-pathological lower back problems that when something very subtly different comes along, I think I’m pretty good at sniffing it out – some people call it intuition;  I think it’s intuition based on over 25 years of experience.

Anyway, if you’re concerned that your lower back pain or sciatica may be due to something nasty, start with the above questions.  If you’re still concerned, then give me a ring or book an appointment to see me – in person or via skype.

About the Author:

Clinic Director and Osteopath. Gavin graduated as a Gold Medallist in 1991 and is now a Vice Patron of the British School of Osteopathy. Co-author of “The Back Book” with Gavin Hastings OBE in 1996, he has an MSc in The Clinical Management of Pain from the University of Edinburgh, and is currently working on a new book. He's passionate about helping to move people as far from illness and pain as possible, and in January 2015 set himself the target of helping a million people get a better back.