Red Flags in Manual Therapy

[inphysio]

Hi

Could anyone provide me with the list of common red flags which are important in manual therapy.

Thank you

[lamaj545]

- unexplained deformity or swelling
- significant weakness not due to pain
- suspected malignancy
- fever
- sensory / motor deficit



Ajit

[inphysio]

Hi Ajit,

Thanks for your reply.

[sdkashif]

Red flags are indicators of increased risk of serious pathology — but they do not always indicate a specific condition.

Further investigation and referral are indicated if one or more red flags are present.

Red flags for spine fracture

Flags from medical history
Major trauma such as vehicle accident or fall from a height
Minor trauma, or even just strenuous lifting, in people with osteoporosis


Red flags for cancer or infection

Flags from medical history
Age over 50 years and new back pain, or age under 20 years
History of cancer
Constitutional symptoms, e.g. fever, chills, unexplained weight loss
Recent bacterial infection (e.g. urinary tract infection)
Intravenous drug abuse
Immune suppression
Pain that worsens when supine; severe night-time pain; thoracic pain

Flags from physical examination

Structural deformity

Red flags for cauda equina syndrome or rapidly progressing neurological deficit

Flags from medical history

Saddle anaesthesia
Recent onset of bladder dysfunction (e.g. urine retention, increased frequency, overflow incontinence)
Recent onset of faecal incontinence

Flags from physical examination

Severe or progressive neurological deficit in the lower extremities
Unexpected laxity of the anal sphincter
Perianal/perineal sensory loss
Major motor weakness: knee extension, ankle plantar eversion, foot dorsiflexion

[inphysio]

Dear sdkashif,

Thanks a lot for the list of red flags.

[sdkashif]

Thanks for your comments.