When back or neck pain needs prompt medical care

Most back and neck aches are the ordinary kind that settle with time. A smaller number are signs of something that needs a doctor promptly, and a few are emergencies. This page gathers the warning signs published by MedlinePlus and by the American Academy of Orthopaedic Surgeons, so that they are easy to find when they matter.

That advice comes from OrthoInfo's page on neck pain, which explains that if severe neck pain follows an injury such as a motor vehicle accident, a diving accident or a fall, a trained professional such as a paramedic should immobilise the injured person to avoid the risk of further injury.

Get help right away

Seek medical help immediately, through your local emergency number or an emergency department, if back, neck or head pain comes with any of these:

• a fever and headache with a neck so stiff that you cannot touch your chin to your chest;
• signs of a heart attack, such as chest discomfort, shortness of breath, sweating, nausea, vomiting, or pain in the arm or jaw;
• pain after a serious injury, such as a car crash, a dive or a fall, especially with numbness or weakness, or if you cannot move an arm or leg;
• loss of control over bladder or bowels;
• a headache after a blow to the head, or a headache with a stiff neck, fever, confusion, loss of consciousness, or pain in the eye or ear.

These signs are drawn from MedlinePlus's articles on neck pain and on headache, and from OrthoInfo. Pain between the shoulder blades that arrives with chest pain or breathlessness belongs in this list too, because the heart and lungs can cause pain felt in the back.

Contact a health care provider promptly: back pain

MedlinePlus's article on acute low back pain lists signs that mean you should contact your provider right away, including:

• back pain after a severe blow or fall;
• burning with urination, or blood in the urine;
• a history of cancer;
• loss of control over urine or stool;
• pain travelling down the legs below the knee;
• pain that is worse when you lie down, or that wakes you at night;
• redness or swelling on the back or spine;
• severe pain that does not let you get comfortable;
• unexplained fever with back pain;
• weakness or numbness in the buttocks, thigh, leg or pelvis;
• difficulty walking or keeping your balance.

The same article advises contacting your provider if you have been losing weight without trying, or if you have had back pain before but this episode is different and feels worse, or if the pain is simply not settling.

Contact a health care provider promptly: neck pain

MedlinePlus's article on neck pain advises contacting your provider if:

• symptoms do not go away with self-care;
• you have numbness, tingling or weakness in your arm or hand;
• your neck pain was caused by a fall, a blow or an injury;
• you have swollen glands or a lump in your neck;
• your pain does not go away with regular doses of over-the-counter pain medicine;
• you have difficulty swallowing or breathing along with the neck pain;
• the pain gets worse when you lie down or wakes you at night;
• your pain is so severe that you cannot get comfortable;
• you lose control over urination or bowel movements;
• you have trouble walking and balancing.

OrthoInfo adds that you should seek medical care when neck pain is continuous and persistent, severe, accompanied by pain or numbness that spreads down the arms or legs, or accompanied by headaches, numbness, tingling or weakness. It also notes that radiating pain or numbness in the arms or legs that causes weakness should be evaluated even if the neck itself does not hurt much.

After a sports or everyday injury

For injuries to muscles, ligaments and joints, it is worth being checked if you cannot put weight on a leg or use an arm, if a joint looks misshapen or feels unstable, if there is numbness, or if pain and swelling are severe or not improving. The sports injuries and sprains and strains pages explain the common injuries.

If you are not sure

These lists are not complete, and they are not a way to diagnose yourself. If you are worried about your pain, or it simply does not seem right to you, contacting a health care provider is always reasonable. Many areas also have nurse advice lines or urgent care services for questions that do not seem to be emergencies but should not wait. When you do speak to someone, it helps to say when the pain started, what you were doing, where it hurts and whether it spreads, and whether you have any of the signs above.

This page describes public guidance from MedlinePlus and OrthoInfo in plain words. It is not medical advice, and it does not replace the judgement of a professional who can hear your whole story and examine you.