Red Flags | Do I Have Something Serious?

Sue Dale

If you are reading this blog it is likely you have been pointed in this direction by your Physiotherapist to remind and reassure you. Alternatively, you may be concerned with symptoms you are experiencing and want to know more. If so, please read the information on red flags below and get in touch if you have any queries.

What Is A Red Flag?

Physiotherapists often work in primary care settings, meaning we are the first medical professional encountered by many patients. As a result we encounter a broad range of problems on a daily basis. 99% of the time these problems are not sinister but in a very small minority some symptoms may warrant cause for concern. When we do encounter concerning symptoms, we call these red flags or warning signs.

As a result it is essential we undertake a thorough assessment of each patient. This includes a detailed, subjective history and physical examination to establish the nature of the presenting problem.

Certain findings, particularly groups of signs and symptoms, may give us cause for concern as they can be suggestive of serious pathology and warrant further investigation.

Red flags symptoms can be generic in nature or highly indicative of a specific disorder. Either way, both would require onward referral and further investigation.

Examples of Generic Red Flags

Unexplained weight loss
Trauma
Night sweats
Systemically unwell (e.g. fever)
Previous history of specific pathology (e.g. cancer)
History of IV drug use
Unexplained deteriorating health and function/ failure to respond to conservative treatment

Generic red flags are not highly diagnostic, meaning they do not point to one specific condition themselves, but do warrant further investigation to get to the bottom of these symptoms.

What Do I Do If I Experience These Symptoms?

It is important to tell your Physiotherapist or GP if you experience any of the above symptoms so that we can act accordingly. Ultimately this will involve further investigations such as a blood test or scan.

Examples of Specific Red Flags

Lower Back – Symptoms Of Concern

Cauda equina syndrome is a collection of symptoms caused by pressure on the nerves at the lower end of the spinal cord, usually by a disc. If they are compressed for too long damage can occur. These nerves supply the legs, bladder and sexual organs so if damaged may result in the symptoms below:

Saddle anaesthesia

Numbness or altered sensation between your inner thighs
Numbness or reduced sensation around your genitals or back passage (eg less feeling when you wipe yourself after using the toilet)

Changes in sexual function

Altered ability to achieve an erection or ejaculate, or reduced sensation of your genitals
Usually occurs in addition to the changes above

Bladder or bowel disturbance

Difficulty urinating or when trying to control your flow of urine
Lack of control of your bladder or bowels (having ‘accidents’ or needing to wear pads)
Loss of sensation when you pass urine or open your bowels OR inability to recognise if your bladder is full or empty

Evidence suggests it may affect 1 to 3 people in every 100,000 (that’s somewhere between 0.00001 and 0.00003%). It is an extremely rare condition, nonetheless, if not addressed and treated urgently this can lead to serious injury and possible disability.

What Do I Do If I Experience Any Of These Symptoms?

It is important to know the warning signs so that you can act immediately. If you notice any new symptoms from the list above, or a combination of them, please seek urgent medical attention –

Call your GP or 111. Or visit A & E

Neck & Head – Symptoms Of Concern

As with the lower back, symptoms of concern in the head and neck are extremely rare but do require urgent attention.

Spinal Cord compression symptoms are a collection of symptoms caused by pressure on the nerves at the top end of the spinal cord. Below are some of the symptoms to look out for:

Altered sensation in both upper limbs and/or lower limbs
Widespread weakness or co-ordination issues/clumsiness

Cranial nerves and arteries around the neck and skull can also be compressed and result in some of the symptoms below

Dizziness
Diplopia (disturbed vision)
Dysarthria (disturbed speech)
Dysphagia (trouble swallowing)
Drop Attacks/Black Outs