RED FLAGS are clinical indicators of possible serious underlying conditions requiring further medical intervention.

Red Flags help identify potentially serious conditions. They include: * Features of Cauda Equina Syndrome * Severe worsening pain, especially at night or when lying down * Significant trauma * Weight loss, history of cancer, fever * Use of intravenous drugs or steroids * New onset of pain in persons over 50 years old or younger than 16.

RED FLAGS for Potentially Serious Conditions 1.FRACTURE 2.TUMOR OR INFECTION 3.CAUDA EQUINA SYNDROME FROM MEDICAL HISTORY MAJOR TRAUMA, such as vehicle accident or fall from height. MINOR TRAUMA or even strenuous lifting (in older or potentially osteoporotic patient). NEW ONSET Age over 50 or under 16. History of CANCER. CONSTITUTIONAL symptoms, such as recent fever or chills or unexplained weight loss. Risk factors for spinal INFECTION: recent bacterial infection (e.g., urinary tract infection); IV drug abuse; or immune suppression (from steroids, transplant, or HIV). Pain that worsens when supine; severe nighttime pain. Saddle anesthesia. Recent onset of bladder dysfunction, such as urinary retention, increased frequency, or overflow incontinence. Severe or progressive neurologic deficit in the lower extremity. Loss of strength and/or sensation.

THE INCIDENCE OF THE RED FLAGS IS VERY LOW. IF YOU EXCLUDE TRAUMA,CANCER, AND INFECTION THE INCIDENCE IS MINISCULE. IN 35 YEARS OF PRACTICE,SEEING THOUSANDS OF PATIENTS,I HAVE ENCOUNTERED THE RED FLAGS FEWER THAN A DOZEN TIMES!!

YELLOW FLAGS are psychosocial indicators suggesting increased risk of progression to long-term distress, disability and pain. Yellow flags were designed for use in acute low back pain.

ATTITUDE - towards the current problem. Does the patient feel that with appropriate help and self management they will return to normal activities? BELIEF - The most common misguided belief is that the patient feels they have something serious causing their problem-usually cancer. 'Faulty' beliefs can lead to catastrophisation. COMPENSATION- Is the patient awaiting payment for an accident/ injury at work/active litigation? DIAGNOSIS - or rather “non diagnosis”. Inappropriate communication can lead to patients misunderstanding what is meant, the most common examples being 'your disc has popped out' or 'your spine is crumbling'. EMOTIONS - Patients with other emotional difficulties such as ongoing depression and/or anxiety are at a high risk of developing chronic pain. FAMILY - There tends to be two problems with families, either over bearing or under supportive. Work - The worse the relationship, the more likely they are to develop chronic LBP.

BUT I SEE THE YELLOW FLAGS EVERY DAY!! THESE PATIENTS ARE THE MOST CHALLENGING TO TREAT. THEY DO POORLY WITH ALL TREATMENT MODALITIES. THEY ARE BEST TREATED IN A MULTI- DISCIPLINARY SETTING WITH PSYCHOLOGICAL SUPPORT.