Red Flag and Yellow Flag

Question 1

What are the Cervical Red Flags (DNA)?

Answer 1

• Dizziness
• Diplopia (Double Vision)
• Dysphagia (Swallowing)
• Dysarthria (Talking)
• Drop Attacks
• Nausea
• Nystagmus (Eyes Flickering)
• Facial Numbness
• Ataxia (Unsteady and Uncontrolled Gait)

Also could be:
- History of cancer
- Recent dramatic weight loss
- Recent Trauma

Question 2

What are Yellow Flag signs?

Answer 2

This is when a Patient mental blocks that can hinder the rehab process (e.g., depression, anxiety, fear of movement, passive in treatment)

Question 3

What does the Biopsychosocial model mean?

Answer 3

• Bio – Stiffness, weakness
• Psycho – Depression, fear, Catastophisation
• Social – Workplace stress, support network

Question 4

What are you looking for with a red flag?

Answer 4

Does the athlete have subjective symptoms suggestive of serious pathology

Question 5

What pathology could a patient have with these red flag signs and symptoms?
* Persistent lower back pain and stiffness
* Erectile dysfunction
* Saddle anesthesia
* Impaired bladder function
* Impaired bowel control
* Bi-lateral dermatomal changes
* Bi-lateral myotomal changes

Answer 5

Cauda Equina Syndrome

Question 6

What pathology could a patient have with these red flag signs and symptoms?
* Systematically unwell/fever/chills/fatigue/malaise
* Unremitting, non-mechanical night pain
* Change in bladder and bowel habits
* Sores that do not heal
* Unexplained weight loss (<5% in a four-week period)
* Thoracic spine pain
* Lifestyle factors

Answer 6

Spinal malignancy/metastatic cancer

Question 7

What pathology could a patient have with these red flag signs and symptoms?
* Morning stiffness >30 minutes (eased with movements and NSAIDS
* FH of inflammatory conditions
* Alternating sacroiliac joint pain
* Possible Uveitis (eyes)
* Possible Crohn’s/Colitis (digestive)
* Possible Psoriasis (skin)
* Possible Enthesitis (tendon)
* Dactylitis (swollen fingers)
* Pitting and clubbing (nails)

Answer 7

Axial spondylarthritis

Question 8

What factors can play a part in the increased suspicion and raise of concern to red flags?

Answer 8

• Age: 20< or >50 years old
• Trauma
• Previous medical history of cancer
• Family history of cancer
• Steroid use
• General health and lifestyle
• Sudden onset of thoracic pain (potential for spinal fracture)

Question 9

How do you measure someone Biopsychosocial factors?

Answer 9

STarT Back Tool.
A 9 question questionnaire that have a mixture of bio, psycho and social questions.

This is how it is scored:
* 3 or less – low risk of chronicity
* 4 or more and sub-score of 3 or less – medium risk of chronicity
* 4 or more and sub-score of 4 or more – high risk of chronicity

Question 10

What does SINSS stand for?

Answer 10

Severity
Irritability
Nature
Stage
Stability

Question 11

What is the Subjective assessment protocol?

Answer 11

First impressions
Seating arrangements
Manage expectation
Getting started
Conduct your questioning
Assess need for onward referral
Get your patients impression
set some goals
Form your hypothesis
Plan your objective assessment