Disclaimer: Please consult with your doctor before performing new movement exercises program to ensure safety. All of my patients are evaluated and monitored during their course of treatment for safety. I advise that everyone do the same.

As a physical therapist, one of the first things that must be done is to make sure patients are safe to participate in our treatments. Red flags are signs or symptoms of a possible serious causes of pain. Red flags include (but not exclusively) the following items listed below and indicate that a phone call to a physician is mandatory before continuing. Contacting a physician to be cleared to participate in a new program is recommended.

Here is the list:

Unrelenting night pain: Pain does not let up and is much worse at night.

Constant pain: Pain is present all the time and does not change with positioning.

Sudden loss of bowel or bladder control

Loss of bowel and bladder when bending forward or squatting

Sudden or recent changes in sensation especially in the groin or saddle region

Sudden or recent changes in symptoms when coughing or sneezing

Sudden or recent changes in strength/weakness

Sudden changes or loss of balance and falls without a specific reason

Previous history of cancer

Unexplained weight loss or gain

Recent history of trauma

Uncontrolled blood pressure

References:

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Downie A, Williams CM, Henschke N, Hancock MJ, Ostelo RW, de Vet HC, Macaskill P, Irwig L, van Tulder MW, Koes BW, Maher CG. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ. 2013 Dec 11;347:f7095. doi: 10.1136/bmj.f7095. Review. PubMed PMID: 24335669; PubMed Central PMCID: PMC3898572. Free full text

Fraser S, Roberts L, Murphy E. Cauda equina syndrome: a literature review of its definition and clinical presentation. Arch Phys Med Rehabil. 2009 Nov;90(11):1964-8. doi: 10.1016/j.apmr.2009.03.021. Review. PubMed PMID: 19887225.

Ferguson F, Holdsworth L, Rafferty D. Low back pain and physiotherapy use of red flags: the evidence from Scotland. Physiotherapy. 2010 Dec;96(4):282-8. doi: 10.1016/j.physio.2010.01.001. Epub 2010 Mar 30. PubMed PMID: 21056162.

Henschke N, Maher CG, Ostelo RW, de Vet HC, Macaskill P, Irwig L. Red flags to screen for malignancy in patients with low-back pain. Cochrane Database Syst Rev. 2013 Feb 28;2:CD008686. doi: 10.1002/14651858.CD008686.pub2. Review. PubMed PMID: 23450586.

Underwood M. Diagnosing acute nonspecific low back pain: time to lower the red flags? Arthritis Rheum. 2009 Oct;60(10):2855-7. doi: 10.1002/art.24858. PubMed PMID: 19790072.