Red Flag findings are symptoms or conditions that may require immediate attention and

supersede the PT being the primary provider of service. Red flag findings are typically indicative
of non-mechanical (non-neuromusculoskelteal) conditions or pathologies of visceral origin.

Medical History
• History of Cancer (personal or familial)
• Unwarranted general fatigue/malaise
• Recent Infection, Illness, or Constitutional symptoms
• Immunosuppression
• Injection drug use
• Altered Vital Signs (BP, HR, PR, body temp)
• Fever/Night Sweats

Clinical Presentation
• Unknown etiology with insidious onset
• Symptoms unaltered by examination or intervention (for better or worse)
• Symptoms unaltered or inconsistent with specific positions or postures
• Diminishing symptomatic relief value from previously effective remedies
• Disproportionate symptoms
• Symptoms do not fit in typical or recognizable pattern
• Unexplained symptoms (swelling, paraesthias, weakness, tone alteration)
• Significant, unintended weight loss or Gastrointestinal Disturbances
• Palpable, growing mass
• Skin/Nail Changes
• Cardiovascular Changes (shortness of breath, chest pain, pulsatile findings)
• Bowel/Bladder Change or Dysfunction

Abnormal Pain Symptoms Neuro Presentation

• Pain despite full passive ROM
• Pain inconsistent with emotional or psychological status
• Nocturnal pain (sleep interruption)
• Constant and/or poorly localized pain
• Severe, unremitting, or unusual pain
• Altered mental status
• Altered attentiveness (drowsy, lethargic, sleepy)
• Blurred vision, altered speech, hearing deficits
• Difficult swallowing
• Headache
• Balance/Coordination Deficits or altered DTRs

Yellow Flag (Risk Factors) findings are potential confounding variables that may be
cautionary warnings regarding the patient’s condition and that could have an impact on the
patient’s prognosis and/or outcome. These findings should alert the PT to slow down or
monitor the influence of the finding.

• Substance abuse (alcohol, tobacco, drugs, medications)

• Age
• Somatotype (BMI, % body fat, body shape)
• Gender – Race – Ethnicity
• Lifestyle (sexual, travel, exercise)
• Occupational Status
• Attitude/Medical Prejudice/Compliance-Interest

This is not a comprehensive list of findings that should concern the physical
therapist during the initial evaluation or medical screening. Other findings could
also indicate the need for additional medical evaluation. No single finding
automatically requires an immediate response but the cluster of findings should
be judged in the context of the patient’s overall presentation and current health
concerns.

d://epm/UTSW/forms/Flags ! Ed Mulligan, PT, DPT, MS, SCS, ATC – DPT 5330 MPM I
from Sizer PS, Brismee, JM, Cook C. Medical Screening for Red Flags in the Diagnosis and Management of
Musculoskeletal Spine Pain. 2007, Pain Practice Volume 7, Issue 1, pgs. 53-71

d://epm/UTSW/forms/Flags ! Ed Mulligan, PT, DPT, MS, SCS, ATC – DPT 5330 MPM I