Is My Back Pain Serious? How Physiotherapists Know the Difference
Back pain is one of the most common health complaints in Canada. At Avenue Physio in downtown Calgary, we see it every day; office workers, busy parents, weekend warriors, and active retirees. But one of the biggest concerns we hear from patients is:
It’s a fair question. Back pain can be intense and disruptive. It can shoot down your leg, keep you up at night, or make it hard to walk, work, or sleep. Naturally, many people worry they might have a serious medical condition.
The good news? Most of the time, back pain is not serious — even if it hurts a lot.
What the Research Says: 95% of Back Pain Isn’t Dangerous
Many people worry that back pain means something serious is wrong. But here’s what we now understand from decades of research:
- Only around 1% of low back pain cases are due to serious conditions like cancer, infection, or fracture
- Another 4%–5% involve a disc herniation with true nerve compression
- That means 90–95% of back pain is not caused by anything dangerous or structurally abnormal
In fact, advanced imaging (like MRIs) often shows disc bulges or degeneration in people who don’t have any pain at all. These findings are common as we age and don’t always mean something is wrong.
This is why physiotherapists don’t rely on imaging alone. We combine your story, symptoms, and a thorough hands-on assessment to determine whether your back pain is one of the rare serious types—or part of the very treatable majority.
How Physiotherapists Screen for Serious Back Pain
When you come in for an assessment, our first priority is to make sure your pain isn’t being caused by something that needs urgent medical care. We use a structured process that includes:
- Listening to your story
- Asking targeted screening questions
- Performing a detailed physical examination
Red Flags That Signal a More Serious Condition
These are the signs we screen for that could suggest a more serious cause of your back pain:
Condition | Red Flags We Look For |
|---|---|
Fracture | Recent trauma (e.g., fall), osteoporosis, corticosteroid use, sudden severe pain |
Cancer | History of cancer, unexplained weight loss, constant night pain unaffected by position |
Infection | Fever, chills, recent illness or surgery, feeling generally unwell |
Cauda Equina Syndrome | Changes in bladder/bowel function, saddle numbness, leg weakness |
Inflammatory Disease | Morning stiffness lasting over 30 minutes, age under 45, family history of autoimmune issues |
These red flags are uncommon, but when they appear, we take them seriously and refer you to the appropriate provider immediately.
Real-Life Example: Red Flag vs Mechanical Back Pain
Imagine you come in with back pain that started after moving a couch. It feels stiff in the morning but gets better when you walk around. It worsens with prolonged sitting.
✅ This is a typical case of mechanical back pain: safe for physiotherapy and often very treatable.
Now picture this: You’ve had unexplained weight loss, your pain wakes you at night, and nothing eases the discomfort.
That pattern raises red flags, and we would refer you for further medical assessment before starting treatment.
What If We Suspect Something Serious?
If red flags are present, we will:
- Pause treatment
- Refer you to your family physician or walk-in clinic
- Provide a referral letter with our findings
- Coordinate with your healthcare team if needed
In Alberta, physiotherapists currently cannot order publicly funded MRIs or X-rays directly. However, we play a key role in guiding you to the right care pathway quickly.
Common Questions We Hear at Avenue Physio
“If my pain is going down my leg, doesn’t that mean it’s serious?”
Not always. Radiating pain, like sciatica, can still fall within the 95% of mechanical cases. Many patients improve significantly with conservative treatment.
We only recommend imaging when:
- Symptoms include progressive numbness or weakness
- Red flags are present
- Pain is not improving after 6–8 weeks of proper care
“My pain is severe and keeps me up at night. How is that not serious?”
Pain intensity doesn’t always match the severity of the condition. The nervous system can become over-sensitized, especially in people who are stressed, fatigued, or worried. In these cases, the brain may “turn up the volume” on pain to protect you, even when there’s no major injury.
So What Is the Other 95% of Back Pain?
Once serious causes are ruled out, the majority of back pain falls into these categories:
- Mechanical pain from joints, muscles, or discs
- Postural strain due to sitting or poor ergonomics
- Muscle imbalances or deconditioning
- Stress-related tension
- Myofascial trigger points
- Fear-avoidance and reduced movement
- Heightened nervous system sensitivity
These types of pain respond well to evidence-based physiotherapy — and you don’t need an MRI to start feeling better.
What We’ll Cover in the Next Blog Post
In our next article, we’ll explore:
- What truly causes most back pain
- Why imaging often doesn’t match symptoms
- How we treat mechanical and postural back pain effectively — without needing surgery or scans
Key Takeaways
- Only a small percentage of back pain is linked to serious health conditions
- Physiotherapists are trained to spot warning signs and refer when needed
- Most back pain is mechanical and can improve with tailored treatment and movement
- The nervous system can amplify pain — even without structural damage
Book a One-on-One Back Pain Assessment at Avenue Physio
Whether your pain is brand new or something you’ve lived with for years, we can help. At Avenue Physio, every appointment is one-on-one with an experienced physiotherapist who will listen, assess, and guide you toward the right plan, or refer you if needed.
Don’t guess, let us assess.