I took my 16-year old daughter in to the clinic for back and leg pain. I was expecting to see her regular pediatrician but we saw the physical therapist instead. When I asked about this, the therapist told me she was trained to spot any red flags that would suggest we see the doctor. What are these red flags?
More and more patients first contact for muscular, joint, or other skeletal problems is with a physical therapist (PT). When you see a PT first without seeing a doctor, it's called direct access. There are direct access laws in almost every state of the United States. This gives the consumer the right to choose who you want to see first.

As a result of the change in the law, PTs are now trained at the doctorate level. They learn how to screen all patients for potential medical problems before beginning an exercise or rehab program. The use of red flags is a common method used to identify patients with serious problems requiring medical evaluation.

The presence of any constitutional symptoms in anyone with low back pain (LBP) is always a red flag. This may include fever, chills, sweats, nausea, or vomiting. Rapid, unexplained weight loss, blood in the urine or stool, or skin rashes are some other obvious red flags.

The therapist will ask about a previous history of cancer or recent urinary tract (or other) infection. These are also red flags. Back pain accompanied by abdominal, pelvic, or hip pain raises concern that something else might be going on.

When a patient has one or two red flags, the therapist knows to conduct a more thorough exam and to ask additional questions. The presence of three or more unexplained red flags usually requires medical referral.

It makes sense to see a PT when you have LBP since more than 80 per cent of all cases of LBP are musculoskeletal in nature. Their advanced training in screening ensures that patients with serious conditions will see the physician right away.