When to Skip the Chiropractor and Head to the ER Instead
- Dr. Lucas Marchand
- Jul 22
- 3 min read
Why I’m Sharing This Story
As a chiropractor, I’m a huge believer in the power of conservative care. But I’m an even bigger believer in getting patients to the right provider at the right time. Chiropractic care is great for a lot of things—low back pain, joint issues, and muscle tightness. But it’s not a cure-all. Sometimes, the right call is to skip the chiropractor and get emergency medical care.
I recently had a real-world reminder of why this is so important. This blog is about knowing when not to book that chiropractic appointment and when you should head straight to the ER.
The Situation That Made Me Hit Pause
A Simple Twist That Turned Serious
A patient reached out after a minor daily activity triggered sudden back pain. Initially, I thought it might be a typical mechanical issue—maybe a muscle strain or a mild disc irritation. Happens all the time in my line of work.
The Big Red Flags That Changed Everything
But the more details I got, the more alarm bells went off:
Whole-body numbness
Severe, unrelenting back pain
Passing out for several minutes
Some abdominal discomfort
Those are not typical chiropractic cases. Those are red flags that scream “medical emergency.”
My Clinical Reasoning as a Chiropractor
When Back Pain Isn’t Just Back Pain
Back pain from a strained muscle or joint restriction usually improves with rest, changes with movement, and definitely doesn’t cause fainting. When someone passes out, especially for several minutes, it suggests the problem could be much more serious—neurological, vascular, or even internal organ-related.
Differential Diagnoses I Considered:
Cauda Equina Syndrome (CES): Compression of the lower spinal nerves, can cause numbness, weakness, and loss of bowel/bladder control.
Spinal Cord Compression: Rare but dangerous, especially with bilateral symptoms.
Abdominal Aortic Aneurysm (AAA): Back pain with abdominal discomfort and fainting—red flag for vascular emergencies.
Ectopic Pregnancy (if applicable): Considered in reproductive-aged females with abdominal and back pain.
Kidney Stone or Infection: Can present with back and abdominal pain, though less likely to cause syncope.
Vasovagal Syncope: Fainting due to pain, but generally short-lived and without whole-body numbness.
Why I Said “Go to the ER, Not Me”
This wasn’t about a sprain or a tweak. It was about patient safety.
I advised immediate ER care because:
The whole-body numbness suggested potential neurological involvement.
The prolonged syncope was beyond a simple vasovagal event.
The constant pain unrelieved by rest made mechanical causes less likely.
Abdominal pain opened the door to visceral or vascular emergencies.
Chiropractic clinics don’t have access to imaging beyond musculoskeletal X-rays. We can’t do EKGs, bloodwork, advanced neuro exams, or emergency imaging. The ER can.
Red Flags Everyone Should Know
Signs You Should Skip Chiropractic Care
Fainting or loss of consciousness after back pain onset
Whole-body numbness or bilateral limb weakness
Pain that doesn’t improve with rest or position changes
New abdominal or pelvic pain with back pain
Difficulty with bowel or bladder function
When Chiropractic Is Safe and Effective
Muscle tightness and strains
Joint fixations (subluxations)
Chronic, non-specific low back pain
Mild disc issues without neurological red flags
Postural problems
If your back pain is positional, moves with you, or feels better with rest, chiropractic might help. But if you have systemic symptoms, syncope, or nerve involvement, it’s time for emergency care.
Final Thoughts: Chiropractors Save Lives by Knowing Their Limits
I take pride in knowing when to treat and when to refer. In this case, the safest move was clear: the ER was the right choice.
Chiropractic care is powerful when it’s appropriate, but the number one rule in healthcare is “do no harm.” That means recognizing when something is outside my scope and getting the patient to the right level of care.
Remember, back pain is common—but serious red flags aren’t. Respect them, and you’ll never regret playing it safe.
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