Red flags in physiotherapy: When physiotherapy is NOT the solution

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People are getting more active now (this is actually good) and sometimes we can get injured during or after exercising. Physiotherapy is normally advised and is an effective treatment.

However, there are scenarios that can be more complex and physiotherapy is not the answer. We are talking about red flags in physiotherapy.

Red flags are prognostic signs and symptoms suggestive of serious pathology. They are RARE (many physios work the whole life and do not see any or just a few cases) but can be concealed as a “joint/ muscle pain” but in fact they are something else and more sinister.

See some red flags below:

-Neck pain is quite common BUT if your symptoms are…

• pain is getting much worse ( It can be individual and subjective due to multiple factors)
• lack of co-ordination – for example trouble with tasks like buttoning a shirt
• heaviness or weakness in your arms or legs
• pins and needles (normally both arms but can affect just one arm) in an arm as well as pain
• problems when walking
• loss of bladder or bowel control

These can be signs of a more severe condition (cervical myelopathy) which can cause permanent damage to the spine if left untreated.

-Lower back pain is quite common BUT if you are having…

• sciatica on both sides
• weakness or numbness in both legs that is severe or getting worse
• numbness around or under your genitals, or around your anus
• finding it hard to start peeing, can’t pee or can’t control when you pee – and this isn’t normal for you
• you don’t notice when you need to poo or can’t control when you poo – and this isn’t normal for you
• Gait can also be affected

Theses symptoms are related to cauda equina. Cauda equina syndrome is a rare and severe type of spinal stenosis where all of the nerves in the lower back suddenly become severely compressed.

Cauda equina syndrome requires emergency hospital admission and emergency surgery, because the longer it goes untreated, the greater the chance it will lead to permanent paralysis and incontinence.

Concussion

Concussion is a temporary injury to the brain caused by a bump, blow or jolt to the head. Very common in sports like martial arts, football, rugby. It can be mild or severe.Signs of a concussion usually appear within a few minutes or hours of a head injury. But occasionally they may not be obvious for a few days, so it’s important to look out for any problems in the days following a head injury.Symptoms include:

• a headache that doesn’t go away or isn’t relieved with painkillers
• dizziness
• feeling sick or vomiting
• memory loss – you may not remember what happened before or after the injury
• clumsiness or trouble with balance
• unusual behaviour – you may become irritated easily or have sudden mood swings
• feeling stunned, dazed or confused
• changes in your vision – such as blurred vision, double vision or “seeing stars”
• being knocked out or struggling to stay awake

Concussion can be harder to spot in babies and young children.

One of the main things to look for is a change in their normal behaviour after a head injury, such as crying a lot, a change in their feeding or sleeping habits, or a loss of interest in people or objects.

When to go to hospital

Go to your nearest accident and emergency (A&E) department if you’ve injured your head and have:

• woken up after being knocked out
• problems with your memory
• a headache that doesn’t go away
• been vomiting since the injury
• changes in your behaviour, such as becoming more irritable
• had an operation on your brain in the past or are taking blood-thinning medicine such as warfarin
• been drinking alcohol or taking recreational drugs

In these cases, you should be checked by a health professional trained in assessing head injuries. They’ll decide if you need a brain scan to rule out a serious brain injury.

When to an ambulance

Call for an ambulance if someone has injured their head and has:

• been knocked out and hasn’t woken up
• difficulty staying awake
• problems with understanding, speaking, writing, walking or balance
• numbness or weakness in part of their body
• problems with their vision
• clear fluid coming from their ears or nose
• bleeding from their ears or bruising behind one or both ears
• a black eye with no obvious damage around the eyes
• a fit (seizure)
• hit their head in a serious accident, such as a car crash

Also call for an ambulance if someone needs to go to hospital but you can’t get them there safely.

Cancer

It’s important to be aware of any unexplained changes to your body, such as the sudden appearance of a lump, blood in your urine, or a change to your usual bowel habits.

These symptoms are often caused by other, non-cancerous illnesses, but it’s important to seek medical support so they can investigate.

Bleeding

You should also see your GP if you have any unexplained bleeding, such as:

• blood in your urine
• bleeding between periods
• bleeding from your bottom
• blood when you cough
• blood in your vomit

Moles

See your doctor if you have a mole that:

• changes shape or looks uneven
• changes colour, gets darker or has more than 2 colours
• starts itching, crusting, flaking or bleeding
• gets larger or more raised from the skin

Any of the above changes means there’s a chance you have malignant melanoma, a form of skin cancer.

Unexplained weight loss 

You should also see your doctor if you’ve lost a lot of weight over the last couple of months that cannot be explained by changes to your diet, exercise or stress.

These symptoms can be related to cancer.

If you are not sure and have got any questions, please see your doctor for further examination.