Surfing and Back Pain: Could It Be Something Serious?

Part 2 of the Complete Guide to Back Pain in Surfers: Red Flags and When to Seek Medical Assessment

Back Pain Red Flags: When Should a Surfer Actually Worry? Photo by Milada Vigerova

First things first.

The vast majority of low back pain is not caused by a serious medical condition.

That's probably the single most important message to take away from this article.

In fact, around 95% to 99% of people who seek help for low back pain do not have a serious underlying spinal condition.

I know. Low back pain can be incredibly painful and frustrating. It can stop you from doing the things you love, and it can be frightening. It's easy to think something must be seriously wrong.

But most episodes improve over time without requiring urgent medical treatment.

And yes, the same applies to surfers. Chances are, you'll be back in the water before too long.

I wrote this article to help you cut through the noise and understand when back pain really deserves a closer look.

After all, that's what most of us want to know when we're in pain.

Red Flags

So, how do healthcare professionals identify the small number of people who may need further investigation?

They start by looking for red flags.

Most of these can be identified through a thorough medical history and clinical assessment.

The term red flag may sound alarming.

But don't let the name fool you.

A red flag isn't a diagnosis. It's simply a clue that helps healthcare professionals decide whether your low back pain needs a closer look.

Fortunately, serious underlying conditions are uncommon, and having one red flag doesn't automatically mean something serious is going on.

Red Flags for Serious Low Back Pain

Most people with low back pain will never experience any of the situations below.

Even so, it's important to know what they are, just in case.

When to Seek Urgent Medical Assessment

• New loss of bladder or bowel control.

• Numbness around the groin or inner thighs (sometimes called saddle numbness).

• Progressive weakness in one or both legs.

Although uncommon, these symptoms may suggest a condition called cauda equina syndrome.

These symptoms don't confirm the diagnosis, but they do require urgent medical assessment.

When to Arrange a Medical Assessment

• Your pain started after a significant fall, accident, or other major trauma.

• You have a previous history of cancer.

• You have fever, chills, or other signs of infection together with low back pain.

• You've lost weight without trying and there's no obvious explanation.

Remember, red flags are never interpreted in isolation.

They're simply one part of the bigger clinical picture.

In the overwhelming majority of cases, you'll be back in the water, doing what you love, before too long.‍ Photo by Austin Schmid

Frequently Asked Questions About Low Back Pain

What Does It Mean If My MRI Shows a Disc Bulge or Herniation?

Probably the most common question of all.

Fortunately, these findings are generally not what healthcare professionals mean when they talk about serious spinal conditions.

Disc bulges, disc herniations, and age-related changes are extremely common.

In fact, many people who have no back pain at all have these findings on MRI.

That doesn't mean they can never cause pain.

They certainly can, sometimes causing severe pain.

But, on their own, they're usually very different from the serious conditions we discussed earlier.

In other words, seeing "disc bulge" or "degenerative changes" on an MRI isn't, by itself, a reason to panic.

Does Severe Low Back Pain Mean Something Serious?

Not necessarily.

Pain intensity and the seriousness of an underlying condition are not the same thing.

Some of the most painful episodes of low back pain are caused by conditions that improve over time without surgery or other major medical interventions.

Why Can't I Stand Up Straight With Low Back Pain?

It may feel alarming, but it's actually something healthcare professionals see quite often.

During an acute episode of back pain, muscles may become very protective, making it difficult to stand upright or move normally.

Fortunately, this doesn't automatically mean you've seriously damaged your spine.

If this happens without any of the red flags discussed earlier, it usually improves as the pain settles.

What Does It Mean If Pain Shoots Down My Leg?

Pain travelling into the buttock, thigh or leg is often related to irritation of a spinal nerve.

It can be extremely uncomfortable.

But, by itself, it isn't considered a red flag or a medical emergency.

However, if leg pain is accompanied by progressive weakness, numbness around the groin, or changes in bladder or bowel function, urgent medical assessment is recommended.

What If My Low Back Pain Doesn't Go Away?

Some episodes of low back pain settle within a few weeks. Others improve more gradually over several months.

Persistent pain doesn't automatically mean something serious has been missed.

Sometimes recovery simply takes longer. In other cases, the nervous system remains more sensitive, or factors such as sleep, stress, general health and physical conditioning continue to influence pain.

If your symptoms aren't improving, they're getting worse, or they're preventing you from returning to the activities that matter to you, it's worth seeking assessment rather than simply hoping they'll disappear.

Is Recurring Low Back Pain Normal?

Unfortunately, yes.

Many people experience more than one episode of low back pain during their lifetime.

That doesn't necessarily mean your spine is becoming weaker or more damaged each time.

Like many other health conditions, low back pain can come and go.

Understanding why it recurs, and learning how to reduce the chances of future episodes, is often more useful than searching for a single permanent fix.

Do I Need an MRI for Low Back Pain?

Not necessarily.

An MRI should answer a clinical question, not simply satisfy curiosity.

Most people with low back pain don't need an MRI during the early stages, especially if no red flags are present.

In many cases, a careful history and physical examination provide much more useful information than a scan.

That said, MRI can be extremely valuable when serious conditions are suspected, significant neurological symptoms are present, or when symptoms persist despite appropriate management.

If you're ever unsure about your symptoms, it's always worth speaking to a qualified healthcare professional.

Or, if you'd like my help understanding your symptoms or managing your return to surfing, feel free to get in touch.

Can I Surf with Low Back Pain?

Often, yes.

Many surfers assume they need to stop surfing as soon as back pain appears.

Sometimes that's the right decision. If surfing causes a large increase in pain, your symptoms continue to worsen after each session, or simply isn't tolerable, taking a short break may be the most sensible approach.

But that's not the case for most surfers.

If surfing causes only a small increase in pain that settles reasonably quickly afterwards, there's often no reason to stop altogether.

Instead, it may simply mean adjusting how you surf for a while. Shorter sessions. Fewer waves. Less intensity. Giving your back a chance to recover while still doing something you enjoy.

In fact, modern clinical guidelines generally recommend staying active and continuing the activities that matter to you whenever possible.

Surfing is one of those activities..

The better question isn't "Can I surf?"

It's "When should I stop?"

When Should I Stop Surfing?

There isn't a single rule that applies to everyone.

In general, it makes sense to stop surfing temporarily if:

• your pain becomes substantially worse during a session;

• it continues to worsen over the following day or two;

• you're unable to surf with reasonable technique because of pain;

• or you develop any of the red flags discussed earlier in this article.

On the other hand, if your symptoms remain manageable and settle reasonably quickly after surfing, continuing to surf is often a reasonable option.

Should I Stretch My Back?

Stretching isn't good or bad. It depends on what feels helpful for you.

Some people find that gentle stretching reduces stiffness and helps them move more comfortably. Others find it makes little difference or even temporarily aggravate their symptoms.

The good news is that you don't have to stretch if it doesn't help.

There's no strong evidence that stretching, on its own, speeds up recovery from low back pain or prevents future episodes.

If it feels good, do it.

If it doesn't, don't feel like you're missing an essential part of recovery.

Your back isn't stiff because it "needs stretching". More often, muscles become protective when they're painful, and that protective response usually settles as your back recovers.

In practice, many people find that gentle movement helps more than holding long stretches. Sometimes a few dynamic movements are enough. Other times, a short walk is all it takes to help the back feel less stiff.

The goal is to explore movement, gradually regain confidence, and discover what feels helpful for your body.

If you're unsure where to start, or every movement seems to make things worse, working with a qualified healthcare professional can help.

For most surfers, staying active, gradually returning to normal movement, and progressively rebuilding strength are likely to have a much bigger impact than stretching alone.

Low back pain often raises more questions than answers. The goal of The Surfer's Health is to help you cut through the noise and make sense of what the science actually says. Photo by Emily Morten

What's Next?

In this article, we've focused on recognising when back pain deserves further medical assessment.

But what about recovery?

How do you build a body that's better prepared for surfing, recovers more effectively, and reduces the chances of future episodes?

That's exactly what we'll explore in Part 3: Foundations of Recovery.

Want a practical plan?

The Strong & Resilient Back Program turns the science from this series into a step-by-step system you can actually follow.

References

Cook CE, George SZ, Reiman MP. Red flag screening for low back pain: nothing to see here, move along: a narrative review. British Journal of Sports Medicine. 2018;52(8):493-496.

Downie A, Williams CM, Henschke N, Hancock MJ, Ostelo RWJG, de Vet HCW, Macaskill P, Irwig L, van Tulder MW, Koes BW, Maher CG. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ. 2013;347:f7095.

Han CS, Hancock MJ, Downie A, Jarvik JG, Koes BW, Machado GC, Verhagen AP, Williams CM, Chen Q, Maher CG. Red flags to screen for vertebral fracture in people presenting with low back pain. Cochrane Database of Systematic Reviews. 2023;(8):CD014461.

Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CWC, Chenot JF, van Tulder M, Koes BW. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal. 2018;27(11):2791-2803.

Verhagen AP, Downie A, Popal N, Maher CG, Koes BW. Red flags presented in current low back pain guidelines: a review. European Spine Journal. 2016;25(9):2788-2802.

Verhagen AP, Downie A, Maher CG, Koes BW. Most red flags for malignancy in low back pain guidelines lack empirical support: a systematic review. Pain. 2017;158(10):1860-1868.