Which physical exam finding is considered a red flag for lower back pain?

Urinary retention is considered a red flag for lower back pain because it may indicate a serious underlying condition, such as cauda equina syndrome. This syndrome occurs when there is compression of the cauda equina, a bundle of nerve roots located at the lower end of the spinal cord. Symptoms of cauda equina syndrome can include severe lower back pain, urinary retention, bowel incontinence, and lower limb weakness. It is a surgical emergency that requires immediate medical intervention to prevent permanent neurological damage.

Other findings, such as worsening pain with rest or intermittent leg pain, may suggest a need for further evaluation but do not typically indicate an urgent medical condition. Similarly, flexibility impairment can be a result of musculoskeletal strain or other less severe issues. Although these findings can contribute to the overall assessment of lower back pain and guide management, urinary retention stands out as a critical symptom that necessitates immediate attention and further investigation to rule out life-threatening conditions.