As physiotherapists have evolved from practising as technicians under the guidance of medical professionals to being autonomous first contact professionals, greater stress has been placed on exclusion of serious pathologies, which cannot be treated with physiotherapeutic interventions. This is to decide whether physiotherapy or manual therapy is unsuitable and not recommended and can even be harmful.
Initially, it was Mennel and Cyriax who promoted manual therapy, but recognised the need for a cautious approach in certain conditions. More recently, Clinical Skills Advisory Group (1994) and Agency for Health Care Policy and Research (1994) have provided information on potentially serious conditions presenting as spinal pain. Grieve (1994) in his classic paper, ‘Masqueraders’ has provided ample example of systemic conditions mimicking spinal pain.
The following is a list of red flags which needs to be considered in assessment of each patient.
Thus it is imperative that each physiotherapist understands and recognises these red flags and the need for referral to appropriate consultant for further assessment and management. It is important that these red flags are seen in the context of the presentation and used with appropriate reasoning.