Red Flags
If these signs are present, referral to a physician is necessary.
- Cauda Equnia syndrome, characterized by:
- Low back pain with or without sciatica
- Loss of sensation in the lower extremities
- Bowel and/or bladder changes (decreased anal sphincter tone, urinary retention, overflow incontinence)
- Perineal pain or loss of sensation (saddle anesthesia)
- Muscle weakness and atrophy
- Personal or family history of cancer
- Recent (last 6 weeks) infection (e.g., mononucleosis, upper respiratory infection [URI], urinary tract infection [UTI], bacterial infection such as streptococcal or staphylococcal; viral infection such as measles, hepatitis), especially when followed by neurologic symptoms 1 to 3 weeks later (Guillain-Barré syndrome), joint pain, or back pain
- Recurrent colds/flu with a cyclical pattern (i.e., the client reports that s/he just cannot shake this cold or the flu; it keeps coming back over and over)
- Recent history of trauma such as motor vehicle accident or fall (fracture; any age) or minor trauma in older adult with osteopenia/osteoporosis
- History of immunosuppression (e.g., steroids, organ transplant, HIV)
- History of injection drug use (infection)
- Weight loss
- Fever
- Bleeding in the urine
- Lump in the groin area
- Unexplained fatigue