When visiting your chiropractor for a musculoskeletal complaint, a “Red Flag” refers to a symptom or sign that raises suspicion of a serious underlying condition presenting as a common complaint. Most of us, after suffering a strain or sprain tend to adopt a wait and see approach as many such injuries will recover with time and activity modification. However, in certain situation you should consult a medical professional as soon as possible.

Reassuringly, less than 1% of back pain cases are as a result of a serious underlying problem. As with most serious conditions, the sooner they are diagnosed the sooner appropriate treatment can start which usually improves outcomes.

If you have back pain and can identify yourself with one of the “Red Flag!” risks outlined below then you should see a medical professional and in cases of back pain no one is better equipped to advise you than your local chiropractor. Keep calm though, as research suggests that having one “Red Flag!” is reasonably common and is not a very reliable predictor of a serious underlying problem.

Anyone presenting aged over 55 falls into a “Red Flag!” area, with even greater emphasis applied if over 65. This is because increasing age raises the risk of being diagnosed with a serious pathology.

Take note of the nature of your pain. Constant pain that does not vary over 24 hours, or pain that is worse when lying down or during the night should be adequately investigated. As should pain of the thoracic spine or low back pain that occurs simultaneously with a change in bowel function and/or abdominal pain. If your pain progressively gets worse week by week or if it felt better after physical therapy but then quickly relapsed make an appointment. If you feel generally unwell and are experiencing a high temperature with musculoskeletal pain then further investigation may be necessary.

If your pain is as a result of significant trauma, such as a fall from a significant height or a major car accident and your pain is ongoing then referral for further diagnostic imaging might be appropriate.

A previous history of cancer experienced by a patient or having a direct relative that was diagnosed with cancer raises a patients “Red Flag!” status. Spinal metastasis most commonly occurs to the thoracic spine and most commonly originates from the breast, lung or prostate. Take note of any breast lumps, persistent coughs or changes in bladder habits. Together with a sudden, marked loss of weight, without any obvious reason for it, means it’s time to consult a professional.

Also follow up with your therapist if you experience loss of sensation (particularly when it is around your “saddle” area – perineum and buttocks), limb pins and needles on both-sides, or progressive weakness in your legs making walking difficult.

Similarly a previous history of tuberculosis, osteoporosis, use of immune suppressants or long term use of corticosteroids should be clearly communicated to your therapist. Intravenous drug users should also admit their use to their healthcare provider.

Remember, Red Flags! are there to assist your therapist to make the best decision they can regarding your care. It helps your therapist if you are aware of what certain symptoms mean even if they seem unrelated to your musculoskeletal complaint and you make your therapist aware of them.