As a physiotherapist, we see all sorts of aches, pains, and injuries. Most of the time, they’re nothing too sinister, just a sprain, strain, or a bit of overuse. But sometimes, certain symptoms set off alarm bells in our heads. These are what we call red and yellow flags, signals that something more serious might be going on.
Red Flags: When to Be Concerned
Red flags are warning signs that a condition might be serious and need urgent medical attention. They don’t necessarily mean something is wrong, but they tell us to dig a little deeper and possibly refer the patient to a doctor (1).
Here are some big red flags:
• Unexplained Weight Loss – Could indicate cancer or systemic illness.
• Severe, Unrelenting Pain – If pain doesn’t ease with rest or medication, it might be more than just a musculoskeletal issue.
• Night Pain or Pain at Rest – Sometimes linked to infections, tumours, or inflammatory conditions.
• Bowel or Bladder Changes – A huge red flag for cauda equina syndrome, a medical emergency.
• Progressive Weakness or Numbness – Could indicate nerve compression or neurological disorders like multiple sclerosis.
• History of Trauma – Especially in older adults, trauma could mean fractures or serious soft tissue injuries.
Conditions Associated with Red Flags
• Cauda Equina Syndrome – Needs emergency treatment, often surgery, to prevent permanent damage (2).
• Fractures – Require medical imaging and possibly immobilisation or surgery (3).
• Cancer (e.g., Bone Tumours, Metastases) – Needs oncological assessment and treatment.
• Infections (Osteomyelitis, Discitis) – Treated with antibiotics and sometimes surgery.
If we spot red flags, our job as physios is to stop and refer the patient ASAP. No messing around!
Yellow Flags: The Psychological Side of Pain
Yellow flags are a bit different. They don’t point to a serious physical problem but indicate that psychological and social factors might be making pain worse or prolonging recovery. Basically, they highlight the risk of someone developing chronic pain or disability.
Some common yellow flags:
• Fear of Movement (Kinesiophobia) – If a patient is scared to move, they might avoid activity and become deconditioned.
• Catastrophising – When someone assumes the worst (“My back pain means I’ll never walk properly again”).
• Depression or Anxiety – Mental health conditions can amplify pain perception.
• Work-Related Stress – High stress or job dissatisfaction can slow recovery from injuries.
• Passive Coping Strategies – Relying too much on medication or waiting for pain to ‘just go away.’
Conditions Often Influenced by Yellow Flags
• Chronic Low Back Pain – Often worsened by fear and avoidance behaviours (4).
• Whiplash-Associated Disorders – Psychological factors can impact recovery after an accident.
• Fibromyalgia – Strongly linked to stress and emotional wellbeing (5).
How Physiotherapists Manage These Flags
• Red Flags → Referral! If we suspect something serious, we send patients straight to the appropriate medical professional.
• Yellow Flags → Education, reassurance, and movement! We help patients understand pain, encourage graded exposure to activity, and sometimes work with psychologists or pain specialists (6).
At the end of the day, our goal is to keep people moving safely. Red flags help us catch serious conditions early, while yellow flags remind us that pain isn’t just physical, it’s emotional and social too. Spotting these early means, we can get the right help, whether it’s medical intervention or just a bit of reassurance and movement.
So, if you’re struggling with pain and wondering if it’s something more, don’t hesitate to check in with your physiotherapist. We’re trained to spot the warning signs and guide you towards the best path to recovery!
Our Barnet, Cockfosters & Enfield Physio’s have tons of experience and are specialists in spotting serious pathologies. Have confidence that our specialist Physiotherapists will closely assess, diagnose & treat you in the correct & evidence-based way for all injuries. You can book an appointment here.
Blog By: Emre Oz (Musculoskeletal Physiotherapist at Crouch Physio).
References
- Cooney, Fran, et al. “Documentation of spinal red flags during physiotherapy assessment.” British Journal of Healthcare Management 23.12 (2017): 574-580.
- Fraser, Stuart, Lisa Roberts, and Eve Murphy. “Cauda equina syndrome: a literature review of its definition and clinical presentation.” Archives of physical medicine and rehabilitation 90.11 (2009): 1964-1968.
- Court-Brown, Charles M., and Ben Caesar. “Epidemiology of adult fractures: a review.” Injury 37.8 (2006): 691-697.
- Nicholas, Michael K., et al. “Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: a reappraisal.” Physical therapy 91.5 (2011): 737-753.
- Häuser, Winfried, et al. “Fibromyalgia.” Nature reviews Disease primers 1.1 (2015): 1-16.
- Stearns, Zachary R., et al. “Screening for yellow flags in orthopaedic physical therapy: a clinical framework.” Journal of Orthopaedic & Sports Physical Therapy 51.9 (2021): 459-469.
