Safety & Red Flags

Red flags requiring urgent evaluation

Go to the emergency department or seek immediate medical attention if you have:

• Loss of bowel or bladder control (new incontinence, retention, or inability to urinate)
• Saddle anesthesia (numbness in the groin, inner thighs, or perineal area)
• Progressive weakness in the legs, especially if worsening over hours or days
• Fever with back pain (possible spinal infection)
• Major trauma (fall from height, high-speed collision, significant impact)
• Severe unrelenting pain at night that does not improve with position changes
• New severe neurologic symptoms (sudden foot drop, inability to stand, rapid progression)

Concerning features requiring prompt evaluation

Schedule an appointment with a healthcare provider soon if you have:

• Unexplained weight loss along with back or pelvic pain
• History of cancer and new or worsening musculoskeletal pain
• Symptoms that worsen despite rest or conservative management over several weeks
• Pain that wakes you from sleep consistently and does not respond to position changes
• Numbness, tingling, or weakness that is spreading or not improving
• Pain after age 50 with no clear mechanism (consider osteoporotic fracture, malignancy)
• Pain in a young person with morning stiffness lasting over an hour (consider inflammatory conditions)

When self-management is not appropriate

Do not self-experiment with exercises or interventions if:

• You have any red flags listed above
• You have not had an evaluation and your pain is severe or worsening
• You have known structural problems (fractures, tumors, infections) that require medical management
• You have neurological symptoms that are new or progressing

Stop rules during self-checks or interventions

Stop immediately if:

• Pain spikes sharply during or after an activity
• Symptoms escalate and do not return to baseline within a few hours
• You develop new numbness, tingling, or weakness
• You feel unstable, dizzy, or at risk of falling
• Pain spreads to new areas or changes character significantly

If symptoms rebound for hours or worsen the next day, reduce the dose or stop that intervention. Reassess with a professional if problems persist.

When to seek professional evaluation even without red flags

• Symptoms have not improved after 6–8 weeks of consistent, graded self-management
• You are unsure whether your symptoms match the patterns described on this site
• Pain limits daily activities or function significantly
• You are uncertain about safety or appropriate dosing
• Symptoms are confusing, inconsistent, or not responding as expected

Who to see

Depending on your situation, appropriate providers may include:

• Primary care physician: initial evaluation, red flag screening, referrals
• Physical therapist: movement assessment, load management, graded exercise
• Orthopedic specialist or sports medicine: structural assessment, imaging, injections if needed
• Rheumatologist: if inflammatory conditions are suspected
• Pain specialist: if pain is severe, chronic, or not responding to standard care

Do not ignore your instincts

If something feels seriously wrong, get evaluated. Do not delay because of information on this site. This resource is for people with mechanical, control-based pain patterns. It is not for people with serious underlying pathology.

Summary

• Red flags require urgent evaluation
• Concerning features require prompt evaluation
• Stop self-management if symptoms worsen or new problems appear
• When in doubt, seek professional care