The Importance of Red Flags – Must Read
Pain is a healthy and natural process of the body as it is alerting you to danger. There are many different causes for which we may experience pain and for most of us a musculoskeletal injury will heal in 6-8 weeks. If pain goes on for longer than 6-8 weeks, then for most of us there is still nothing to worry about. However, in the unfortunate instance that there is something sinister going on then it is likely that your body will tell you by producing non-musculoskeletal symptoms that we call red flags. Occasionally at an assessment or after a few therapy sessions then we refer individuals back to their GP for onward referral to a consultant or on a few occasions to A&E (suspicion of cauda equina). We may refer onwards if we suspect an individual has a fracture, infection or autoimmune problem as this would need a different management approach.
There are recognised Red Flags that a healthcare professional will ask you to screen for any symptoms that you may have that require immediate further investigations. Often physical therapists can help you once you have received a diagnosis. For example, you may have been diagnosed with rheumatoid arthritis and you have been given the correct medication to help manage your symptoms. Now a physical therapist can support you with a rehabilitation programme and advice.
We have provided you with a list of the screening questions that we ask our clients at an initial assessment. This will rule in or out any symptoms where we believe you may need to see a specialist before receiving a treatment programme from a physical therapist. If you do have any of the following symptoms or combined symptoms, then we’d strongly urge that you make an appointment with your GP or seek urgent medical attention for further advice. If you have suspicions, then it is better to check and to be reassured.
Red Flags checklist
- Night sweats – you are drenched in sweat and you must change your clothes and bed sheets
- Night pain – you are being woken up by the pain and you cannot get back to sleep or find that you must prop yourself up on multiple pillows so that you are sleeping upright due to the pain/symptoms
- History of malignant tumours – if you have developed pain without injury then you need to seek urgent medical assessment and advice
- Multiple joint pain – high levels of pain all over the body
- A first episode of back pain and you are aged 55 or under 20 years old – this requires medical assessment and if the pain doesn’t appear to be coming from movement then further investigations may be required
- Constant pain – You cannot relieve your pain – it is every second of the day
- Recent incidence of violet trauma – for example, a fall from a height could result in a broken bone and soft tissue damage
- Swollen, red joints and there has not been an injury or accident that may explain this
- Fatigue – you are unable to do your day-to-day activities due to complete exhaustion
- Eye issues – you are experiencing double vision or loss of vision (but you have had recent eye sight examinations)
- Significant muscle weakness either down one side of the body or both sides of the body
- Pins and needles (tingling) with or without numbness (like you have been sitting on your hand or feet for too long) during your day-to-day tasks – often this is a sign of nerve involvement which can be treated with Physical Therapy but will need assessing first
- Numbness – this could be facial or any part of the body
- Saddle Anaesthesia – this is numbness or a loss of sensation in the private parts between the legs (imagine the area if you are sitting on a horse saddle). This requires immediate urgent assessment.
- Bowel or Bladder changes when you have spinal pain – anything that is unusual or new for you – for example, finding that your body isn’t telling you when you need to go to the toilet resulting in accidents or not going to the toilet as is normal for you (a recent CHANGE that has developed with your symptoms) for example, you should be going to the toilet 6-8 times per day if you are drinking enough water.
- Saddle anaesthesia with bowel and bladder changes requires immediate medical attention – go to A&E
- Changes to your gait – for example, feeling unstable, walking with a wide base of support (have you had a head injury, or do you have spine pain, saddle anaesthesia or numbness?)
- Sexual difficulties – Erectile Dysfunction, pain during sex or a loss of sensation – urgent medical attention is required
- Constant Coughing – this could be something Lung-related
- Coughing up blood – this is likely to be something Lung-related and required urgent medical assessment
- A sudden and significant loss in weight loss for instance, you’ve lost 5% of your total body weight in a month for no explained reason
- A sudden loss in appetite – unusual for you
- A fever or temperature – when related with chest or upper back pain could require urgent medical assessment
- Fainting attacks
- Difficulty swallowing
- Difficulties speaking
- Nystagmus – unlikely to spot but someone may have told you that your eyes are moving involuntary
- Nausea or vomiting – for no specific reason, (if you’re female are you pregnant?)
Things to consider
- If you have taken corticosteroids for a long period of time, then you are at risk for bony breaks and so any high impact exercise or sports requires healthcare professional advice
- If you have been given a diagnosis of rheumatoid arthritis or Spondylolisthesis then you will require individual advice and exercise programme with initial supervision to ensure that you are supporting your spine properly
Note that this list is not limited to the above
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