If you experience pain or discomfort that doesn’t ease or keeps returning, you may begin seeing a physiotherapist. Working with a physio may help to alleviate your pain, but in some cases, the pain persists.
As allied health professionals, physiotherapists are trained not only to address musculoskeletal concerns but also to recognise what we call ‘red flags’. But what are these red flags, and what might they mean?
This article examines the red flags in physiotherapy and what physiotherapists look out for. For personalised advice, contact our Canberra physiotherapy team at Powerhouse Physio today.
What is the Flag System?
In health settings, such as physiotherapy, a flag system with colours corresponds to specific medical concerns. While physiotherapists work with people with musculoskeletal complaints, they may find that a patient shows signs of a flag (or more than one). This prompts them to refer them to their GP, a specialist, or even the emergency room.
This flag system looks like:
- Red flag: Sign of serious pathology
- Orange flag: Sign of psychiatric symptoms such as depression and other mental health disorders
- Yellow flag: Potentially unhelpful beliefs about pain and coping strategies that may delay recovery
- Blue flag: Concerns about their work related to their pain
- Black flag: System or contextual obstacles such as family pressures, return to work legislation, injury claims and insurance concerns, and heavy work with little to no way to modify duties
While orange, yellow, blue, and black flags may not be potential signs of physical disease, they do play a role in recovery. Identifying factors such as mental health concerns, family issues, or workplace stress allows physiotherapists to further tailor treatment, supporting a more holistic approach to care.
Red Flags in Physiotherapy
When people think of physiotherapy, they usually think of addressing injuries, pain, and problems with movement. And while most patients have routine injuries or movement-related conditions, some may have symptoms that raise concerns about things like cancer, infections, or disease.
General Red Flags
A physiotherapist will screen for general red flags in every patient who comes to see them. These signs don’t automatically mean something is wrong, but they do serve as indicators that further investigation is warranted.
General red flags are known as systemic red flags and may point to infections, inflammatory conditions, or other systemic illnesses. General red flags include:
- Fevers, chills, or night sweats
- Rapid, unexplained weight loss
- Constant fatigue
- General malaise
- History of IV drug use
- Pain that doesn’t change with position or movement
- Symptoms that don’t improve with physiotherapy
Red Flags for Lower Back Pain
There are also red flags specific to certain parts of the body. For example, if a patient comes in with lower back pain, a physiotherapist will also screen for:
- Numbness or tingling in the saddle area, which is any area that would touch the saddle when riding a horse (groin, inner thighs, buttocks)
- Loss of bladder or bowel control
- Difficulty with urination and defecation
- Weakness or paralysis in the legs
- Severe or unrelenting night pain
- Unexplained weight loss
- History of cancer
- Recent significant trauma
Red Flags for Neck Pain
There are also specific red flags that physiotherapists look for in patients with neck pain. These include:
- Unsteady walking
- Coordination problems
- Weakness or clumsiness in the hands
- Changes in speech, vision, or swallowing
- Sudden, severe headaches
- Dizziness or blackouts
How Physiotherapists Screen for Red Flags
During your first consultation, your physiotherapist will ask you about your symptoms, medical history, and lifestyle. Your answers to these form part of the assessment, even if you don’t notice that’s what your physio is doing.
They may need to ask sensitive questions, such as about your bladder or bowel habits or sexual function, in order to get a clearer picture. Always be honest, even if it’s uncomfortable, as this is crucial in determining the potential causes of your pain.
They’ll also perform a physical assessment, including movement testing, strength evaluation, reflex checks, and sometimes nerve-related tests. If your symptoms raise any concerns, your physiotherapist may recommend pausing your sessions with them and seeing your GP or a specialist for further evaluation.
Looking for High-Quality Physio Services in Canberra?
At Powerhouse Physio, we may have a large team, but we pride ourselves on our community feel. To work with experienced physiotherapists who use an evidence-based approach, contact us today.
