RED AND YELLOW FLAG.pptx red and yellow flag for low back pain

red and yellow flag for low back pain, red flag assessment, physiotherapy

1. RED AND YELLOW FLAG Pratigya deuja

2. DEFINITION YELLOW FLAG :- It is a cautionary or warning signs and symptom that signals “slow down” and think about the need for screening. RED FLAG :- It is a warning sign where a patient needs an immediate attention. In red flag, individual’s medical history and clinical examination thought to be associated with a high risk of serious disorders s uch as i nfection, inflammation, cancer, or fracture.

3. RED FLAG In red flag, the therapist looks for a pattern that suggests a viscerogenic or systemic origin of pain and/or symptoms. The therapist proceed with the screening process, depending on which symptoms are grouped together. Next step, therapist conduct a risk factor assessment and look for associated signs and symptoms.

4. RED FLAG contd .. ASSESSMENT Past Medical History Personal or family history of cancer Recent (last 6 weeks) infection like, URTI, UTI Recurrent colds or flu Recent history of trauma, such as RTA, fracture, or minor trauma in older adult with osteopenia / osteoporosis History of immunosuppression ( e.g , steriods , organ transplant, HIV History of injection drug use

5. RED FLAG contd … ASSESSMENT Risk factors Risk factors vary depending on the family history, previous personal history, and diseases, illness or conditions present. Tobacco use Age, Gender, BMI Exposure to radiation Occupation Race/ethnicity Hysterectomy/ oophorectomy

6. RED FLAG contd … ASSESSMENT Clinical Presentation Unknown etiology Symptoms that are not relieved by physical therapy intervention are a red flag Symptoms sometimes get worse Significant weight loss or gain (more than 10% client’s body weight in 10 to 21 days) Unrelieved by rest or change in position A growing mass (tumor) Postmenopausal bleeding Bilateral symptoms and change in muscle tone or ROM

7. RED FLAG… contd ASSESSMENT Pain pattern Referred back and shoulder pain Pain accompanied by full and painless ROM Pain that is not consistent with with emotional or psychological overlay Night pain constant and intense Pain accompanied by signs and symptoms associated with a specific viscera or system ( e.g , GI, GU, GYN, Cardiac etc) Change in musculoskeletal symptoms with food intake or medications use.

8. RED FLAG… contd ASSESSMENT Associated signs and symptoms Recent report of confusion Presence of constitutional symptoms or unusual vital signs Proximal muscle weakness, especially accompanied by change in DTR Joint pain with skin rashes, nodules Unusual menstrual cycle symptoms Any cluster of signs and symptoms observed during the review of the system.

9. Predictors of chronicity within the first 6 to 8 weeks (YELLOW FLAGS) Nerve root pain or specific spinal pathology Reported severity of pain at the acute stage Beliefs about pain being work related Psychological distress Psychological aspects of work Compensation Time off work The longer someone is off work with back pain, the lower the probability that they will return to work

10. RED FLAG FOR LOW BACK PAIN Presentation age < 20 years or onset > 55 years Violent trauma, such as a fall from a height, car accident Constant, progressive, non mechanical pain Thoracic pain Previous history of carcinoma, systemic steroids, drug abuse, HIV Systematically unwell, weight loss Widespread neurology Structural deformity Investigations when required , ESR >25, plain x-ray; Vertebral collapse or bone destruction

11. References Differential Diagnosis for Physical therapists, 5th edition, by; Catherine Cavallaro Goodman and Teresa E. Kelly Snyder Clinical Orthppaedic Rehabilitation, 2 nd edition, by; S.Brent Brotzman and Kevin E. Wilk Orthopaedic Physcial Assessment, 4 th edition, by; David J. Magee