Most acute low back pain without red flags settles within weeks, and early imaging does not improve outcomes. It does find incidental degenerative changes that can increase anxiety, lead to further tests and medicalise a self-limiting problem.
Red flags that change the picture include a history of cancer, unexplained weight loss, fever or immunosuppression, significant trauma, progressive neurological deficit, and bladder or bowel disturbance or saddle numbness suggesting cauda equina syndrome.
- Ask about red flags at the first consultation and document them.
- Advise staying active and returning to normal activities as soon as possible.
- Avoid imaging in the first weeks when there are no red flags.
- Safety-net: new numbness in the saddle area or bladder change needs same-day assessment.
Why it matters
An X-ray or MRI often creates a diagnosis the patient did not have before.
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