21 Screening for Red and Yellow Flags

Screening for Red and Yellow Flags

Red flags are signs and symptoms that raise suspicion of serious underlying pathology, if a serious pathology is suspected a clinical decision should be made to refer the patient to an appropriate healthcare practitioner.

  • Red Flags for Back Pain – For patients with low back pain there are several serious spinal pathologies to be aware of, these are cauda equina syndrome, spinal fracture, malignancy, and spinal infection (Finucane et al., 2020).

Yellow flags are psychosocial and occupational factors that may affect patient presentation and treatment approaches and outcomes.

PhysioTutors: Screening for Red Flags


PhysioTutors: What are Yellow Flags and Why are They Important?

References and Sources

Artus, M., Campbell, P., Mallen, C. D., Dunn, K. M., & van der Windt, D. A. (2017). Generic prognostic factors for musculoskeletal pain in primary care: a systematic review. BMJ open, 7(1), e012901. doi:10.1136/bmjopen-2016-012901

Cook, C. E., George, S. Z., & Reiman, M. P. (2018). Red flag screening for low back pain: nothing to see here, move along: a narrative review. British journal of sports medicine, 52(8), 493–496. doi:10.1136/bjsports-2017-098352

Finucane, L. M., Downie, A., Mercer, C., Greenhalgh, S. M., Boissonnault, W. G., Pool-Goudzwaard, A. L., Beneciuk, J. M., Leech, R. L., & Selfe, J. (2020). International Framework for Red Flags for Potential Serious Spinal Pathologies. The Journal of orthopaedic and sports physical therapy50(7), 350–372. https://doi.org/10.2519/jospt.2020.9971

Galliker, G., Scherer, D. E., Trippolini, M. A., Rasmussen-Barr, E., LoMartire, R., & Wertli, M. M. (2020). Low Back Pain in the Emergency Department: Prevalence of Serious Spinal Pathologies and Diagnostic Accuracy of Red Flags. The American journal of medicine, 133(1), 60–72.e14. https://doi.org/10.1016/j.amjmed.2019.06.005

Green, D. J., Lewis, M., Mansell, G., Artus, M., Dziedzic, K. S., Hay, E. M., … van der Windt, D. A. (2018). Clinical course and prognostic factors across different musculoskeletal pain sites: A secondary analysis of individual patient data from randomised clinical trials. European journal of pain (London, England), 22(6), 1057–1070. doi:10.1002/ejp.1190

Hayden, J. A., Wilson, M. N., Riley, R. D., Iles, R., Pincus, T., & Ogilvie, R. (2019). Individual recovery expectations and prognosis of outcomes in non-specific low back pain: prognostic factor review. The Cochrane database of systematic reviews, 2019(11), CD011284. doi:10.1002/14651858.CD011284.pub2

Heck, A. & Sigel, K. (2019). The Assessment Book – Physiotutors Guide to Orthopedic Physical Assessment (3rd ed.). Physiotutors.

Kim, Y. J. (2019). Red flag rules for knee and lower leg differential diagnosis. Annals of translational medicine, 7(Suppl 7), S250. doi:10.21037/atm.2019.07.62

Parreira, P., Maher, C. G., Traeger, A. C., Hancock, M. J., Downie, A., Koes, B. W., & Ferreira, M. L. (2019). Evaluation of guideline-endorsed red flags to screen for fracture in patients presenting with low back pain. British journal of sports medicine, 53(10), 648–654. doi:10.1136/bjsports-2018-099525

Premkumar, A., Godfrey, W., Gottschalk, M. B., & Boden, S. D. (2018). Red Flags for Low Back Pain Are Not Always Really Red: A Prospective Evaluation of the Clinical Utility of Commonly Used Screening Questions for Low Back Pain. The Journal of bone and joint surgery. American volume, 100(5), 368–374. doi:10.2106/JBJS.17.00134

Protheroe, J., Saunders, B., Bartlam, B., Dunn, K. M., Cooper, V., Campbell, P., … Foster, N. E. (2019). Matching treatment options for risk sub-groups in musculoskeletal pain: a consensus groups study. BMC musculoskeletal disorders, 20(1), 271. doi:10.1186/s12891-019-2587-z

Shaw, B., Kinsella, R., Henschke, N., Walby, A., & Cowan, S. (2020). Back pain “red flags”: which are most predictive of serious pathology in the Emergency Department?. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society29(8), 1870–1878. https://doi.org/10.1007/s00586-020-06452-1

Thomas, L., & Treleaven, J. (2020). Should we abandon positional testing for vertebrobasilar insufficiency?. Musculoskeletal science & practice, 46, 102095. https://doi.org/10.1016/j.msksp.2019.102095

Tseli, E., Boersma, K., Stålnacke, B. M., Enthoven, P., Gerdle, B., Äng, B. O., & Grooten, W. (2019). Prognostic Factors for Physical Functioning After Multidisciplinary Rehabilitation in Patients With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. The Clinical journal of pain, 35(2), 148–173. doi:10.1097/AJP.0000000000000669

Tsiang, J. T., Kinzy, T. G., Thompson, N., Tanenbaum, J. E., Thakore, N. L., Khalaf, T., & Katzan, I. L. (2019). Sensitivity and specificity of patient-entered red flags for lower back pain. The spine journal: official journal of the North American Spine Society, 19(2), 293–300. doi:10.1016/j.spinee.2018.06.342


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