Back and Neck Pain: When to seek medical care? Yellow and Red Flag Symptoms

Friends and family often request advice for when they should seek medical care after they have sprained their back or neck. Patients frequently come into the clinic who have taken visits to the Emergency Room, sometimes even twice in the same day when they just can’t get the relief they are looking for. That question has become more relevant these days with advancements in treatment options and new technology. However, the main driver of people running off to the doctor or emergency room when they have a severe episode of gut-wrenching, body-locking spasms, unable to move without 10/10 pain is simple – they just don’t know what to do. I want to answer that question, but first let’s consider a few things.

The typical situation may come with different specifics, but basically, the patterns are similar. The back or neck seizes up with severe pain and they are unable to move without 10/10 pain.  Sometimes it might directly onset after lifting a small child, onset after a long drive or airplane ride, or even waking the next morning after helping a friend move. Without going into too much detail consider two types of acute pain: 1) Immediate onset and 2) Delayed onset.  Immediate onset is just that, someone might overexert themselves lifting something and instantly they feel pain or maybe it starts gradually building over the next 30 minutes. Then there is the Delayed onset, where the pain begins well after the aggravating incident maybe even 24-48 hours, overnight, when they wake up the next morning, or during the next day.

So, what should you do?  Well, whether you are having immediate onset or delayed onset of pain, first ask yourself this question: Am I having Yellow or Red flag symptoms? What are Yellow and Red Flags, you ask.  Yellow flags are warming symptoms and not “show-stoppers” that you should take immediate action for like Red Flags would be. Examples of Yellow flag symptoms include: severe pain that causes fear and avoidance of activity, the expectation that passive rather than active treatment will be more helpful, and/or the tendency to withdrawal or become depressed about the pain.  Other yellow flag symptoms include things like nerve root involvement such as sciatica type pain, referred pain down the leg, numbness, tingling or even burning pain. Furthermore, keep in mind that symptoms like aching, sharp pain, spasms, locking, shooting pain and even pain that prevents you from getting up out of a chair are not even considered severe enough to rank as yellow or red flag symptoms.

Even if you are having yellow flag symptoms, first don’t panic because having episodes of gut-wrenching body-locking spasms, unable to move without 10/10 pain is actually normal.  The prevalence of back and neck pain is fairly high. It is estimated that at least 80-87% of humans will experience some sort of neck or back pain in their lives. Secondly, try to slowly resume normal activity as soon as you can and many times wearing a brace for several days is helpful. Also, apply cold packs regularly which can continue to be helpful up to 12 weeks or more after onset.  Thirdly, keep in mind that 80% of back and neck pain sufferers get resolution of symptoms in six to eight weeks sometimes longer and sometimes shorter.

What about Red Flags?  Red flags are signs and symptoms that have a more serious connotation and you should seek medical attention immediately. Structurally, if you have Red Flag symptoms then something might be relentlessly pressing on a nerve or worse yet the spinal cord.  Such symptoms include: weakness when trying to lift your toes and/or foot up with your heel on the ground (also known as drop foot), rapid-onset of isolated muscle weakness, difficulty with urination, bowel dysfunction, disturbed gait and a progressive difficulty with walking, a progressive neurological deficit, fever or unexplained weightless, and/or a thoracic band like pain. If you have any of these symptoms which are fairly rare expect for the foot drop symptoms having a slightly higher prevalence, then you should seek immediate guidance of a spinal neurologist or surgeon.

Again at least 80-87% of humans will experience some sort of neck or back pain in their lives.  It is also estimated that 50-85% of those 80-87% may not achieve full recovery of their symptoms and may have to deal with or manage their symptoms long term. The reason for this is cloudy and scholars have speculated many hypotheses. I feel that poor recovery from an acute episode of back or neck pain is because of mismanagement during the first few weeks of the injury.  Many people panic and run to seek immediate treatment.  Immediate treatment is good if you chose the right modalities, but unfortunately, many do not. They might try to get manipulated thinking that something is “out of place”; they might try muscle relaxers and opioids which may mask their symptoms and they might prematurely begin moderate strenuous activity too soon; or they might try stretching too soon and cause further irritation. When back and neck pain sufferers mismanage the acute phase of recovery by choosing the wrong treatment modality, it may actually seem that the treatment initially is helping, but more times than not there is a resultant rebound effect that increases structural disruption and prolongs the inflammatory response.  As the sufferer continues to engage in such premature strenuous activity, incorrect treatment or incorrect modalities, then the structural disruption persists and the pain persists potentially prolonging the recovery indefinitely.

Coming full circle, so to speak, when you or anyone gets a severe episode of gut-wrenching, body-locking spasm, unable to move without 10/10 pain that is not associated with red flag symptoms such as drop foot, isolated muscle weakness, or the others listed above; then the first step is rest and use cold packs for a day or two. Then begin to slowly return to your normal activity as long as that normal activity does not include any lifting or awkward twisted postures. And thirdly, consult a Fellowship trained Orthopedic Manual Physical Therapist to accelerate the process of rehabilitation to full recovery without creating a rebound effect prolonging you return.