Back and shoulder pain are extremely common complaints that most people will experience at some point in their lives. While occasional mild back or shoulder pain often resolves on its own with rest, over-the-counter medications, and home remedies, sometimes these pains can indicate an underlying medical issue that requires prompt attention. Knowing when your back or shoulder discomfort is cause for concern is important to get appropriate treatment and prevent complications. This article will help you understand when back and shoulder pain is worrisome and requires medical evaluation.
When is back pain cause for concern?
Many episodes of back pain are caused by minor strains or injuries to the muscles, ligaments, discs or nerves and resolve in a few days or weeks. However, certain signs and symptoms warrant medical attention to look for underlying causes and prevent long-term problems. See your doctor promptly if you have back pain along with any of the following:
– Severe pain that makes it difficult to walk, stand up straight or find a comfortable position
– Pain that radiates down the leg to below the knee
– Numbness, tingling or weakness in the leg or foot
– Loss of bladder or bowel control
– Fever over 101°F
– Unexplained weight loss along with back pain
– Back pain that does not start to improve after a few days to weeks of home treatment
– Prior history of cancer, osteoporosis, steroid use or drug/alcohol abuse
Red flag symptoms
The above symptoms are considered “red flags” for potentially serious spine problems that require prompt medical evaluation. Possible causes include:
– Herniated disc compressing or irritating a nerve root
– Spinal stenosis (narrowing of the spinal canal) pinching nerves
– Inflammation or infection of the spine
– Vertebral compression fracture
– Spinal tumor or abscess
– Cauda equina syndrome – severe compression of the nerves at end of the spinal cord
Getting an accurate diagnosis for red flag symptoms allows early treatment to relieve nerve compression, infection, inflammation and prevent permanent damage.
Risk factors
You should also see your doctor for back pain if you have any conditions that increase risk, such as:
– Age over 70 years old
– Recent trauma or injury to the back
– History of cancer
– Prolonged steroid use
– Osteoporosis or osteopenia
– Smoking
– Drug or alcohol abuse
– Chronic inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis)
– Endocrine disorders (diabetes, thyroid problems)
– Neurological disorders (multiple sclerosis, Parkinson’s disease)
– Vascular disease
The risk factors above can make the spine more prone to compression fractures, infections and tumors. Early diagnosis and management improves outcomes.
When to go to the ER
Seek emergency care immediately if you experience:
– Sudden severe back pain with loss of nerve function or paralysis in the legs
– Inability to stand up due to leg weakness
– Inability to urinate or loss of bowel control
– Fever over 102°F along with back pain
These emergency red flag symptoms can indicate infection or damage to the spinal nerves and require urgent diagnosis and treatment to prevent permanent deficits. Call 911 or have someone drive you to the ER if you experience these symptoms.
When are shoulder pain and discomfort worrisome?
Like the back, the shoulder joint is prone to strains and injuries that cause pain but resolve on their own over days to weeks. However, shoulder pain can sometimes indicate an underlying problem needing prompt medical care. See your doctor if shoulder pain does not improve after 1-2 weeks of home treatment or you notice any of the following:
– Difficulty lifting your arm overhead or reaching behind your back
– Pain at night that disrupts sleep
– Swelling or significant bruising around the joint
– Numbness or tingling down the arm
– Severe pain that interferes with daily activities
– Popping, clicking or grinding noises in the shoulder
– Joint instability – feeling like the shoulder might “go out” or “pop out of place”
– Prior shoulder dislocation or injury
– Age over 60 years old
Possible causes requiring treatment
Some conditions that can lead to worrisome shoulder pain include:
– Rotator cuff tear – tear in a tendon around the shoulder joint
– Impingement – irritation of rotator cuff tendon by overlying bones
– Adhesive capsulitis (frozen shoulder) – inflammation causing stiffness
– Osteoarthritis – wear and tear damage to joint cartilage
– Rheumatoid arthritis – shoulder joint inflammation
– Bone fracture – more common after a fall onto an outstretched arm in older adults
– Referred pain from the neck – disc herniation or nerve impingement in the neck can radiate pain to the shoulder and arm
Getting an accurate diagnosis is important for proper treatment to relieve pain, restore function, prevent complications and avoid progression. X-rays, MRI and physical examination are used to determine the cause.
Home remedies for back and shoulder pain relief
Mild back and shoulder pain often responds well to home treatment measures while waiting to see if symptoms resolve or medical care is needed. Try the following:
Rest and avoid aggravating activities
Avoid strenuous physical activities, heavy lifting, and repetitive motions that worsen pain. Take frequent breaks during extended sitting or driving. Get adequate rest.
Ice packs
Apply ice wrapped in a thin towel for up to 20 minutes several times per day to reduce inflammation and ease pain.
Heat therapy
Use a heating pad on low setting or warm shower spray to relax tight muscles and increase blood flow.
Over-the-counter (OTC) medications
Anti-inflammatories like ibuprofen (Advil, Motrin) or naproxen (Aleve) can help ease swelling, pain and stiffness in muscles and joints. Acetaminophen (Tylenol) also reduces pain.
Massage
Gentle massage by a therapist or at home with a tennis ball against a wall can help loosen tight shoulder and back muscles.
Physical therapy exercises
Specific stretches and exercises prescribed by a physical therapist can strengthen muscles, improve flexibility and posture, and decompress joints.
Topical pain relievers
Creams containing menthol, capsaicin or other ingredients can provide soothing relief when applied to sore muscles.
When to see an orthopedic doctor or spine specialist
For back and shoulder pain not improving with home care or that indicates a possible serious condition, make an appointment to see your primary care physician for initial evaluation. They may recommend you follow up with an orthopedic doctor or spine specialist for further testing and treatment. See a specialist promptly if initial x-rays or exam suggest issues like:
– Herniated or compressed disc in the spine
– Narrowed spinal canal or nerve impingement
– Shoulder instability or torn rotator cuff
– Severe osteoarthritis/degeneration in spine or shoulder joints
– Compression fracture in a vertebra
– Bone spurs or impingement syndromes
Orthopedic doctors and spine specialists have advanced training to accurately diagnose the source of persistent or severe back and shoulder pain using:
– Detailed medical history and physical exam
– Imaging tests – x-ray, MRI, CT scan, ultrasound, bone scan
– Discography – injecting dye into a spinal disc to assess damage
– Electromyography – evaluating electrical activity in muscles
– Nerve conduction studies – measuring how well electricity travels through a nerve
They can then provide specific treatments tailored to the problem, which may include:
– Prescription anti-inflammatory or pain medications
– Epidural steroid injections into the spine to reduce inflammation pressing on nerves
– Physical therapy – special exercises to improve strength, mobility and function
– Orthotics – shoe inserts or braces to improve alignment and support
– Surgery – procedures like disc repair, decompression, shoulder stabilization or joint replacement
Early intervention from a specialist often leads to better outcomes and can prevent small problems from worsening over time.
Prevention of back and shoulder injuries
You can help avoid back and shoulder pain episodes by:
Improving posture
Stand and sit upright without slouching or hunching forward to maintain the spine’s natural curves.
Watching your weight
Excess weight puts extra pressure on the back and joints. Losing weight helps reduce pain.
Exercising regularly
Low-impact, core strengthening exercises improve back and shoulder muscle strength to support joints.
Avoiding lifting strain
Use proper lifting form – bend at the knees, keep back straight, lift with legs. Avoid lifting heavy objects above shoulder height.
Being mindful of ergonomics
Ensure your workstation is ergonomically positioned to avoid neck and shoulder strain from computer use.
Quitting smoking
Smoking impairs bone healing and increases osteoporosis risk.
Managing chronic conditions
Follow treatments for medical problems like arthritis, osteoporosis and endocrine disorders.
When to seek emergency shoulder and back pain care
While most back and shoulder discomfort improves with home remedies and primary care, some rare symptoms require ER evaluation, including:
– Inability to walk/move legs due to back pain or weakness
– Loss of bladder or bowel control
– Fever over 102°F with back or shoulder pain
– Sudden, severe pain after fall or accident
– Numbness in arms or legs
– Uncontrolled pain despite medication
– Signs of dislocation or broken bone – severe bruising, obvious deformity
Call 911 or go to the nearest ER if you experience these alarming symptoms to determine if there is damage to nerves or bones requiring immediate treatment.
Conclusion
Back and shoulder discomfort are extremely common but typically resolve quickly on their own. However, severe, persistent or worsening pain that limits normal daily activities requires medical attention to check for serious underlying causes like fractures, nerve compression or infections requiring prompt treatment. Red flag symptoms include radiating pain, weakness in arms/legs, bowel or bladder changes, fever, trauma history or unremitting pain. Home remedies like ice, heat, rest, OTC medications and massage can provide relief while monitoring mild symptoms. Preventive measures like weight control, proper exercise, ergonomics and mindful movements are key to avoiding most back and shoulder injuries. But always seek emergency medical care for symptoms like inability to walk or loss of bowel/bladder control to prevent permanent damage to the nerves and spine.