Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physiotherapist.

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What Is A Red Flag When Assessing Back Pain?

In Physical Therapy, we use the term “red flags” to determine a potentially serious symptom of back pain that can indicate a dangerous underlying cause. If a red flag is present during an examination, patients are usually referred to medical specialists for immediate thorough assessment and treatment. When examining the lumbar spine (lower back) there are many red flags to look out for, these symptoms include:

  • Previous history of malignancy (Cancer): A history of cancer and also family history of cancer should be established, particularly a close relative, such as a parent or siblings. The most common forms of metastatic cancer are: breast, lung and prostate.
  • Unexplained weight loss (Cancer or other metabolic disease): A weight loss of of 5% or more over a 4 week period is a rough indicator of when unexplained weight loss should cause alarm.
  • Recent infection
  • Saddle anaesthesia (numbness when wiping bottom) (Cauda Equina)
  • Progressive spinal deformity: Deformity of the spine with an associated muscle spasm and/or severe limitation of movement are suggested to be key indicators of serious spinal pathology.
  • Urinary and faecal incontinence (Cauda Equina)
  • Bilateral leg pain (Cauda Equina)
  • Hyper-reflexia (Spinal cord compression)
  • Erectile Dysfunction (Cauda Equina)
  • Traumatic event (Fracture)
  • Night sweats and fever (infection)

Causes Of Red Flags!

Cauda Equina Syndrome: Cauda Equina syndrome is the compression of the nerve roots caudal to the level of spinal cord termination. It can be caused by herniation of the lumbar disc, infection, trauma and spinal tumours. A thorough neurological examination should be performed in order to locate the problematic area. The best method is to use an MRI scan to find the issue, and should be performed immediately the Cauda Equina is suspected. Surgeons can then decompress the spine to prevent permanent damage to the nerve.
Direct trauma to the lumbar spine can cause one or more fractures within the vertebrae and consequently compress the spinal cord, a vertebral fracture is associated with significant pain and disability. Fractures are very common within the elderly population due to degenerative changes such as osteoporosis, however they can occur in the younger population due to traumatic injuries such as car accidents.
Infection: An infection to the lumbar spine can affect the disc (discitis), the bone (osteomyelitis), or the structures within the spinal canal. The most common form of infection that occurs at the lumbar spine is TB.