Most spinal pain is not serious, and it improves. But there is a small number of signs that change everything — and what decides the outcome, in those cases, is speed.
This page exists so that you recognise them and do not lose time deciding. It is not here to frighten you: it is to give you the information that lets you act quickly if you need to, and be at ease if you do not.
There are two different speeds, and confusing them costs on both sides: some things mean going to hospital now, others mean being seen within two weeks. Knowing which is which spares you an unnecessary trip to A&E — or saves you time that cannot be recovered.
Pain travelling down both legs, or that started in one and spread to both — and nothing else, without any of the signs that follow.
It is not an emergency. But it is not something to leave either: book, and do not wait a month.
Find a physiotherapist you trust — or talk to me, if you prefer. If during the assessment I find anything that needs emergency medical care, I send you there, and I tell you straight away.
Just one of the signs that follow on this page is enough — and if you have more than one, all the more so.
It is reason to go to an emergency department. It is not a matter of seeing a physiotherapist first — not me either — nor any other healthcare professional: it is medicine, with neurosurgery or spinal orthopaedics.
Here you do not book: you go.
⚠️ None of these signs, on its own, proves anything — and their absence rules nothing out either. They are reasons to be seen quickly, not diagnoses.
Start with the first — it applies to any part of the spine. The other two depend on where you feel the problem.
If you recognise any of these signs, what decides the urgency is when it started: if it was within the last 14 days, or if it is getting worse from one day to the next, it is today — emergency department, the same day.
These appear with pain travelling down one or both legs, or with severe low back pain. Any combination of them is reason to seek help immediately.
A medical appointment the same day, as soon as possible, with neurosurgery or spinal orthopaedics.
This is not a matter for physiotherapy, nor for any other healthcare professional.
And it is not a matter of waiting to see whether it improves. Here, time is what weighs most on the outcome: the sooner you are seen by a doctor, the better.
If you are unsure and do not know who to turn to, call SNS 24 on 808 24 24 24 — Portugal's national health advice line. It exists precisely for this question, and it is free.
Neck pain or a headache can, very rarely, be the first sign of a problem in a blood vessel. What sets these signs apart is that they are sudden and unlike anything you have felt before.
It comes on suddenly, at maximum intensity within seconds, and is unlike any headache you have had before.
Slurred speech or difficulty speaking · mouth or face drooping on one side · sudden loss of strength or numbness in an arm or leg · double vision or loss of vision · sudden loss of balance · difficulty swallowing.
In these cases do not drive and do not ask for a lift: call 112, the European emergency number. If it is what is feared, minutes count in a different way — and an ambulance starts treating you on the way.
If you have read all this and recognised yourself in none of it, that is both the most likely piece of information and the most reassuring. The overwhelming majority of spinal pain has none of these signs.
None of this means it is not worth being assessed. It means that it is not an emergency.
Then it is very likely that your case is one of those that improve. Describe what you feel to me in two lines — I answer, and I tell you frankly what I think.
Initial conversation free of charge. I always reply — and, most of the time, the same day.
NHS England / GIRFT. Spinal Surgery: National Suspected Cauda Equina Syndrome (CES) Pathway. February 2023, updated to March 2026. — the symptoms of suspected cauda equina syndrome, the MACP's patient-facing wording, and the distinction between emergency and urgent referral. Co-endorsed by ten organisations, among them the Chartered Society of Physiotherapy.
Rushton A, Carlesso LC, Flynn T, Hing WA, Kerry R, Rubinstein SM, Vogel S. International Framework for Examination of the Neck Region for potential of vascular pathologies of the neck prior to Orthopaedic Manual Therapy Intervention. IFOMPT, 2020. — the presentations of vascular pathology of the neck that can masquerade as musculoskeletal pain.
NICE. Low back pain and sciatica in over 16s (NG59) and Spondyloarthritis in over 16s (NG65). — the exclusion of specific causes of low back pain, and the criteria for rheumatology referral.
⚠️ This page does not replace a clinical assessment, and no list is there for you to diagnose yourself. It serves one purpose only: to recognise quickly whether your case needs to be seen today. If in doubt, call SNS 24 on 808 24 24 24 — Portugal's national health advice line. Outside Portugal, call your local health advice line, or the emergency number.