Call 999 or go to A&E
Call 999 or go to A&E: loss of feeling or numbness around the genitals or bottom, new trouble peeing or controlling your bladder or bowels, changes in genital sensation during sex or problems with erections or orgasm, or pain, tingling, weakness or numbness in both legs. These are signs of cauda equina syndrome, which needs treating in hospital urgently. Don't drive yourself.
Call 999 or go to A&E: back pain with chest pain, or back pain that started after a serious accident, such as a car crash.
Sources 32, 37
Get help the same day
Same day: leg weakness that is getting worse.
Same day (urgent GP appointment or NHS 111): new difficulty lifting the front of your foot or toes (foot drop), or a foot that slaps down or catches as you walk, especially if it is getting worse. Weakness in both legs, or with numbness around the genitals or bottom or bladder or bowel changes, is the 999 emergency above.
Same day (GP or NHS 111): back pain and you feel hot, cold, shivery or generally unwell, or severe pain that starts suddenly or is getting worse quickly.
Same day: you have or have had cancer, and new back pain that is severe and doesn't let up, is getting steadily worse, is worse at night and disturbs your sleep, is worse when you cough, sneeze or strain, or comes with tenderness over the spine. Contact your cancer team or GP urgently. With cancer, new weakness, difficulty walking, numbness or bladder or bowel problems are an emergency.
Source 32
If your slip sends pain down a leg
Leg pain with numbness around the genitals or bottom, new trouble starting or controlling peeing, not knowing when you need to poo or losing control of it, sciatica in both legs, or weakness or numbness in both legs that is severe or getting worse. These can be signs of cauda equina syndrome, which needs treating in hospital as soon as possible.
Same day: leg weakness that is getting worse; new leg pain with a history of cancer, HIV, TB or inflammatory arthritis; or leg pain with a fever, feeling unwell, loss of appetite, unexplained weight loss or night sweats.
If your sciatica hasn't improved after a few weeks of looking after it at home, is getting worse, or is stopping you doing your normal activities. In many areas you can refer yourself to NHS physiotherapy for back problems.
Source 37
See a GP
Lower back pain, or pain in your thighs or bottom, that doesn't go away after 3 to 4 weeks, or pain, numbness and tingling down one leg for more than 3 or 4 weeks: see a GP.
You're finding it difficult to walk or stand up straight, or you're worried about the pain or struggling to cope: see a GP.
Other symptoms as well as the pain, such as a high temperature, sweating at night or losing weight without trying: see a GP.
Source 9
Back pain on arching
Back pain that is worse arching back and has lasted more than a couple of weeks can be a stress fracture of the spine (spondylolysis): get it checked.
Leg symptoms on standing or walking
Buttock or leg pain, heaviness or tingling that comes on when you stand or walk and only eases when you sit or bend forward, or the distance you can walk keeps shrinking: see a GP or physiotherapist (possible spinal stenosis). Leg weakness that is getting worse, or numbness around your genitals or bottom, is urgent (above).
Leg ache when you walk that goes after a few minutes' rest: possible peripheral arterial disease (narrowed leg arteries), especially if you smoke or have diabetes.
After a fall
Sudden mid or lower back pain after a minor fall, lift, cough or sneeze, especially from 50 or with long-term steroid tablets.
Often worse moving or changing position and eased by lying down. It can be an osteoporotic spinal fracture, so see a GP; height loss or a new curve in the upper back are other signs.
With osteoporosis
Modify or avoid exercises that round your back deeply or repeatedly, especially with a weight: sit-ups, toe touches, Pilates roll-downs and curl-ups, and extreme yoga forward folds. Bend from the hips instead. You do not need to avoid bending, twisting or lifting altogether: move smoothly and keep your upper back straight.
Twisting should be safe if you do it smoothly and comfortably. Slow down and shorten fast or forceful twists, and leave out the added weight.
During yoga
Stop or shrink any pose that sends pain, tingling or numbness further down your leg, or leaves your back worse the next morning (our suggestion, from the back pain rule).
A joint pain that is sharp, gets worse during a session, lingers into the next day or changes how you move is a reason to use an easier version, and to see a GP or physiotherapist if it keeps happening (the rule in our plans). Muscle soreness for a day or two after something new is normal. In a hot class, stop if you feel dizzy, sick or unwell; our hot yoga guide lists the signs of heat illness.
Chest pain or fainting while exercising: call 999
Call 999 if:
- You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
- The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
- You have chest pain and feel sweaty, sick, light-headed or short of breath.
- Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.
Sources 38, 39
Breathlessness
Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.
Source 40
Before you start
The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.