At some point in our lives, we all face mild cases of neck and back pain- may be a sore neck after a long day of staring at a screen for work, or an injury while playing a sport. These kinds of pains are usually resolved by an over-the-counter anti-inflammatory drug, heat and cold therapies, or rest.

For sustainable recovery, sometimes physiotherapy for neck pain, exercises, manual therapies etc are also recommended. But what happens when there is a back and spinal injury or pain that needs emergency medical attention? In this article, we examine cases where your back and spine injury may be an emergency.

Red Flag Signs of Back and Neck Pain

Before we move on to the six cases where medical attention and urgent care is required, let us look at symptoms that are red flags that need immediate attention- 

  • Incontinence (urinary and bowel) 
  • Disabling spine pain
  • Severe numbness and tingling in the arms 
  • Loss of sensation in the biuttocks, groin and inner thigh 
  • Difficulty walking 
  • Difficulty breathing and controlling your hands 

Also Read: Common Neck Injuries and Their Treatments

Emergent and Serious Cases of Back and Neck Pain

Cauda Equina Syndrome or CES

Cauda Equina Syndrome, or CES as it is commonly known, is a rare disease but if it happens needs immediate medical attention. It requires surgical attention as this disorder involves a bundle of nerves formed at the tail end of the lumbar spine or the lower back. These nerves that get bunched up are called the cauda equina which is latin for horse’s tail.

These bunch of nerves are responsible for the motor movement of the bowels, bladder and legs so people affected by this disease face incontinence, loss of sensation and numbness in their pelvis and thigh area. People with CES face severe low back pain and a considerable loss of sensation in one or two legs.

If you have been in an accident that has caused spinal damage, an elongated period of a herniated disk, you might be at risk for developing CES. Consult with your doctor immediately if you have any of these symptoms.


Myelopathy is caused when the spinal cord is compressed within the neck or back. With the neck, it is called cervical myelopathy and with the back, it is called thoracic myeloptahy. This disorder is usually caused by a serious fracture, herniation, tumor or a grave injury or accident. People with myelopathy face the following symptoms- 

  • Incotinence in the bowel and urinary tract 
  • Pain near the spine that gets worse day by day 
  • Tingling in the arms and the leg
  • Difficulty walking with balance 
  • Losing motor control in the fingers making it difficult to perform day to day tasks 

This is a serious disease as it affects the spinal cord and if left untreated can lead to your symptoms worsening and getting severe over time. Patients with myelopathy are at a risk for developing more serious spinal cord injuries which can lead to paralysis and loss of sensation.

Herniated Disk

Your spinal cord is made of small bone-like structures that are structured and have discs in between these small bones that are made of gel-like substances that act as shock-proof materials. These discs act as a safety net for the vertebrae to prevent any grave injury to the spinal cord. However, due to degenerative changes like arthritis, or a traumatic accident, these gel-like substances can leak and impinge on the nearby nerves and cause irritation in the spinal canal. Other causal factors like obesity, bad posture and lifting techniques may also cause a herniated disk rupture. The symptoms of a herniated disk are- 

  • Localized Sharp pain felt in the back or neck 
  • It can cause sciatic pain or radiating pain form either leg originating from the buttock 
  • Numbness and tingling sensation in the arms and legs 
  • Loss of movement and difficulty controlling motor movement 

In most cases of a herniated disk, the initial pain is extremely severe but can be solved without surgical intervention. Localized injections, pain meds, and physiotherapy for back pain can help the herniated disc reabsorb the fluid over time. In some serious cases, however, if left untreated it can compress many multiple nerve roots at once causing CES or myelopathy. Because of this, patients are unable to move without severe pain or may feel that they have lost sensation of their arms and legs. This type of pain presentation requires immediate care.

Accidents and Falls

Sometimes, we are involved in serious accidents and falls that cause a spinal fracture. The excessive and violent pressure can cause the small vertebral bones in the spinal column to break causing severe neck and back pain. In some cases, a spinal fracture is caused because of degenerative diseases without the presence of a traumatic force.

For example – osteoarthritis and osteoporosis is bone disorders that can make a person vulnerable to spinal fractures. It severely affects the alignment and stability of the spinal column, making them vulnerable to developing myelopathy, CES and other problems. If you have a suspected spinal fracture, you must get that treated immediately.


If you suspect an infection in the spinal cord, get that checked out immediately. An infection in the spinal cord is fast-moving and caused by bacteria, fungi, TB and much more. Depending on the location of the infection, the infection is given different names. If the infection is in the bone only it is called osteomyelitis, if it is the infection of the discs between the bones, it is called Discitis. If there is a collection of infected material between the bones like infected material or pus it is called an abscess. 

A bacteria invades the spine by entering another part of the body and traveling through the blood. It might be also caused due to sharing of needles during a surgical procedure. People with poor nutrition, HIV, people who use intravenous drugs using unsanitary needles, diabetes, age, cancer and obesity are at increased risk for developing spinal infections. The symptoms that you should be on the lookout for:

  • A high fever and chills
  • Severe weight loss 
  • Neck and back pain
  • Stiffness and soreness in the neck and back 
  • Muscle spasm 

If left untreated, this disease can be life-threatening causing further complications and development of CES, Myelopathy and other neurological problems.

Spinal Cancer

Myelopathy or compression of the spinal cord, CES and increased frequency of fractures may be an indication of spinal cancer. The cancer spreads to other parts of the body, meaning that it is metastatic, so cancer may have originated somewhere else but has spread to the spine.

The cancer cells break away from the initial site and travel to other parts of the body through the bloodstream. If these cells settle and thrive in the spine, they can form new tumors there too. These cells that compress the spinal cord cause symptoms similar to CES and myelopathy.

A more serious case is when these cancer cells develop deep into the spine that may give rise to presentations of more serious symptoms in and around the spinal cord. 

Also Read: Top 10 Tips to Prevent Neck Pain

For more information about physiotherapy for neck pain, head over to Phyt Health. Phyt Health is India’s first digital physiotherapy platform using 3D Imaging and Artificial Intelligence to accurately capture your movements and recommend relevant treatment plans.  On the physiotherapy app, you will find a wealth of exercises that are curated by expert physiotherapists that you can perform in the comfort of your own home.
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