​Red Flags and Acute Low back Pain

What are Red Flags?

Red flags are clinical findings that increase the level of suspicion that there is a serious medical condition presenting as a common non-serious MSK pathology. While red flag symptoms are very rare it is essential to identify these early to ensure effective management. This can sometimes include onwards referral for investigation or emergency surgery.

What is the role of your Physiotherapist?

Your physiotherapist’s role includes assessing you for any potential red flags. This involves detailed questioning – occasionally these questions can feel quite personal but it is the responsibility of your physio to undertake a thorough assessment. Physical tests are also an important part of the assessment, this often includes watching how you move, checking reflexes, sensation and muscle power.

What kind of questions might you be asked?

  • Any self or family history of Cancer?
  • Sores that do not heal?
  • Nagging cough, chest pain or breathlessness?
  • Unremitting night pain?
  • Unusual bleeding or discharge?
  • Unexplained weight loss?
  • Thoracic pain or pain on the rib cage?
  • Abdominal pain or changes to bowel function?
  • Bladder disturbances?
  • Any numbness or pins and needles?
  • History of trauma?
  • Any history of steroid use or immunosuppresants?
  • Are you a smoker?

While any of these symptoms can be present in the absence of any serious pathology, it is vitally important to have these symptoms assessed and checked by a healthcare professional.

Common Back Pain

Many patients have a combination of back pain, leg pain, leg numbness and weakness. These symptoms can be distressing for you but don’t necessarily require emergency medical attention. A rare but serious condition, Cauda Equina Syndrome, can lead to permanent damage or disability and will need to be seen by an Emergency Specialist Spinal team. 

WARNING SIGNS OF CAUDA EQUINA SYNDROME

  • Loss of feeling/pins and needles between your inner thighs or genitals.
  • Numbness in or around your back passage or buttocks.
  • Altered feeling when using toilet paper to wipe yourself.
  • Increasing difficulty when trying to urinate.
  • Increasing difficulty when you try to stop or control your flow of urine.
  • Loss of sensation when you pass urine.
  • Leaking urine of recent need to use pads.
  • Not knowing when your bladder if full or empty.
  • Inability to stop a bowel movement or leaking.
  • Loss of sensation when you pass a bowel motion
  • Change in the ability to achieve an erection or ejaculate
  • Loss of sensation in genitals during sexual intercourse

ANY COMBINATION OF THESE SYMPTOMS SEEK HELP IMMEDIATELY. Cauda equina in seen as a medical emergency so if you are unable to speak to a medical practitioner immediately then it is advised to attend Accident and Emergency to be assessed.

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