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

In short, yes.  But let’s start by putting it into perspective.  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.  Below you will find a list of questions. They are 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.  As an Edinburgh osteopath, I’ve been asking these questions daily for nearly 30 years!

Safety questions

  • 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. You’ll find them in our free online assessment.

However, if the answer to one or more is “yes”, it’s not that we can’t help you.  But it indicates that we 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.

So can back pain / sciatica be a sign of something serious?

Yes it can, but hopefully not for you.

Anyway, if you’re concerned that your lower back pain or sciatica may be due to something nasty, start with our free online assessment for low back pain / sciatica.  Go for self-help for low back pain / sciatica by clicking the button below!

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