red and yellow flag for low back pain, red flag assessment, physiotherapy

1. RED ANDYELLOW
FLAG
Pratigya deuja

2. DEFINITION
 YELLOW FLAG :- It is a cautionary or warning signs and
symptom that signals “slow down” and think about the
need for screening.
 RED FLAG :- It is a warning sign where a patient needs an
immediate attention. In red flag, individual’s medical
history and clinical examination thought to be associated
with a high risk of serious disorders such as infection,
inflammation, cancer, or fracture.

3. RED FLAG
 In red flag, the therapist looks for a pattern that
suggests a viscerogenic or systemic origin of pain and/or
symptoms.
 The therapist proceed with the screening process,
depending on which symptoms are grouped together.
 Next step, therapist conduct a risk factor assessment
and look for associated signs and symptoms.

4. RED FLAG contd..
ASSESSMENT
Past Medical History
Personal or family history of cancer
Recent (last 6 weeks) infection like, URTI, UTI
Recurrent colds or flu
Recent history of trauma, such as RTA, fracture, or minor
trauma in older adult with osteopenia / osteoporosis
History of immunosuppression (e.g, steriods, organ
transplant, HIV
 History of injection drug use

5. RED FLAG contd…
ASSESSMENT
Risk factors
Risk factors vary depending on the family history, previous
personal history, and diseases, illness or conditions present.
Tobacco use
Age, Gender, BMI
Exposure to radiation
Occupation
Race/ethnicity
Hysterectomy/oophorectomy

6. RED FLAG contd…
ASSESSMENT
Clinical Presentation
 Unknown etiology
 Symptoms that are not relieved by physical therapy
intervention are a red flag
 Symptoms sometimes get worse
 Significant weight loss or gain (more than 10% client’s body
weight in 10 to 21 days)
 Unrelieved by rest or change in position
 A growing mass (tumor)
 Postmenopausal bleeding
 Bilateral symptoms and change in muscle tone or ROM

7. RED FLAG…contd
ASSESSMENT
Pain pattern
Referred back and shoulder pain
Pain accompanied by full and painless ROM
Pain that is not consistent with with emotional or
psychological overlay
Night pain constant and intense
Pain accompanied by signs and symptoms associated with a
specific viscera or system (e.g, GI, GU, GYN, Cardiac etc)
Change in musculoskeletal symptoms with food intake or
medications use.

8. RED FLAG…contd
ASSESSMENT
Associated signs and symptoms
 Recent report of confusion
 Presence of constitutional symptoms or unusual vital
signs
 Proximal muscle weakness, especially accompanied by
change in DTR
 Joint pain with skin rashes, nodules
 Unusual menstrual cycle symptoms
 Any cluster of signs and symptoms observed during the
review of the system.

9. Predictors of chronicity within the first 6 to 8 weeks
(YELLOWFLAGS)
Nerve root pain or specific spinal pathology
Reported severity of pain at the acute stage
Beliefs about pain being work related
Psychological distress
Psychological aspects of work
Compensation
Time off work
The longer someone is off work with back pain, the lower
the probability that they will return to work

10. RED FLAG FOR LOW BACK PAIN
Presentation age < 20 years or onset > 55 years
Violent trauma, such as a fall from a height, car accident
Constant, progressive, non mechanical pain
Thoracic pain
Previous history of carcinoma, systemic steroids, drug abuse, HIV
 Systematically unwell, weight loss
Widespread neurology
Structural deformity
Investigations when required , ESR >25, plain x-ray; Vertebral collapse
or bone destruction

11. References
Differential Diagnosis for Physical therapists, 5th
edition, by; Catherine Cavallaro Goodman and Teresa
E. Kelly Snyder
Clinical Orthppaedic Rehabilitation, 2nd edition, by;
S.Brent Brotzman and Kevin E. Wilk
Orthopaedic Physcial Assessment, 4th edition, by;
David J. Magee