Red Flags / Yellow Flags

Q. What are they? 

A. Signs and symptoms that indicate serious spinal pathology 

• Age > 55 (above this age, particularly above 65) the chances of being diagnosed with serious pathologies such as cancer increases

• PMHx or FHx of Ca  

• Unexplained weight loss (5% within a 4 week period not related to change in diet or exercise) 

• Constant / unremitting / progressive / non-mechanical pain (does not vary in a 24 hr period) 

• Night pain (due to increase bony lysis at night) 

• Generally unwell (fever / night sweats / signs of systemic illness) 

• Bilateral neurological signs 

• Ataxic gait (lack of muscle coordination / uncoordinated / jerky movements / poor balance) could indicate MS, stroke or TIA, head trauma, damage to cerebellum, spinal cord damage, brain tumour)

• Major trauma (fall from a height / RTA) 

• Minor trauma (in osteoporotic patients) 

• Thoracic pain (most common region for metastases) 

• Long term use of steroids 

Cauda Equina (require immediate referral to hospital for neurosurgical) 

• Saddle anaesthesia (perianal sensory loss) 

• Bladder or bowel dysfunction (urinary retention / incontinence or faecal incontinence) 

• Bilateral leg pain / sciatica / neurological signs 

Yellow Flags 

Q. What are they? 

A. Bio-psychosocial factors that may risk increase likelihood of chronicity 

• Pending compensation claim 
• Off word 
• Low work status 
• Anxiety 
• Depression 
• Inappropriate coping strategies 
• Passive dependent locus of control 

A - Attitudes 

Towards the current problem. Does the patient feel that with appropriate help and self management they will return to normal activities?

B - Beliefs 

The most common misguided belief is that the patient feels they have something serious causing their problem-usually cancer. 'Faulty' beliefs can lead to catastrophisation.

C - Compensation 

Is the patient awaiting payment for an accident/ injury at work/ RTA?

D - Diagnosis 

or more importantly Iatrogenesis. Inappropriate communication can lead to patients misunderstanding what is meant, the most common examples being 'your disc has popped out' or 'your spine is crumbling'.

E - Emotions

Patients with other emotional difficulties such as ongoing depression and/or anxietous states are at a high risk of developing chronic pain.

F - Family 

There tends to be two problems with families, either over bearing or under supportive.

W - Work

The worse the relationship, the more likely they are to develop chronic LBP.