Asking The Right Red Flag Questions For Lower Back Pain Patients

Posted By: Andy Barker

Red flag questions are a non-negotiable when dealing with any lower back pain patient.

Before you get your hands-on and start your objective assessment you need to screen for any serious pathology… 

To make sure you don’t treat something you shouldn’t.

The importance of these red flag questions is clear and that us why your University lecturers and placement educators banged on about them so much!

After all the last thing you want to do is miss something big and start treating a patient that has symptoms that need A & E and not physio!

But as you may well have worked out, a positive red flag does not mean immediate and urgent referral to A & E. 

But it should raise suspicion.

Red flag questions are screening questions.

As such a positive red flag answer to any of your questions does NOT mean an instant referral or a rush to ring 999…

But something that will likely need further questioning.

Then you can make a reasoned decision as to what is the best thing to do for your patient.

But what questions are important?

Let’s take a look!

If you look at the literature these are the questions you need to ask any patient you assess with lower back pain to attain they have any of these symptoms;

  • Thoracic pain
  • Fever and unexplained weight loss
  • Bladder or bowel dysfunction
  • History of cancer
  • Ill health or presence of other medical illness
  • Progressive neurological deficit
  • Disturbed gait, saddle anaesthesia
  • Age of onset <20 years or >55 years

Remember these questions act to ‘screen’ for some of the sinister issues you might see associated with lower back pain.

It is impossible to screen for every possible sinister pathology that could cause lower back pain.

As such, no subjective history, how ever many questions you ask, is going to be able to rule out every possible sinister cause of lower back pain.

But what the above questions will do is help you to identify the most common sinister pathologies…

And heighten your suspicion which would prompt you to ask more questions.

One key thing to add…

Just because a patient has one or more red flags does NOT mean you can’t treat them.

The context of your patient and their symptoms is key.

Take for example, the history of cancer.

This is clear red flag.

We know a history of cancer raises the risk of further episodes of cancer, hence you ask the question.

Also the presence of active cancer contraindicates certain interventions, including certain hands-on techniques. 

However, even with a history of cancer you might still be able to treat this patient.

If the same patient presented with lower back pain following a fall, here there is a clear mechanism of injury.

This is very different to a patient presenting with a previous history of cancer and then just starting with insidious onset back pain and having other symptoms..

Like night pain… 

Or symptoms that are not aggravated with movement or position.

Such symptoms might raise suspicion of something sinister…

And would require further questioning. 

Finally, trying to remember all these questions can be tough.

If you struggle to remember these type of things, write them down.

Have a list or a ‘cheat sheet’ that has your red flag questions on it and place it somewhere where you can quickly refer to.

Maybe even add these questions to your assessment sheets so you don’t have to remember them off by heart.

Doing this will ensure you don’t miss any of these important questions and possibly miss something with your patients that is really important.

I also ask one more important question with every lower back pain patient I see.

It is one question that quickly helps you identify what your patient thinks is going on with their back…

And ensures you can dampen down any fears or misconceptions your patient may have regrading their injury which is so important…

Because it is usually this fear and poor patient understanding that results in patients not trusting your diagnosis and not buying in to your rehab plan.

Want to know what this key question is?

I’ll be revealing it on my upcoming FREE lower back pain webinar…

How To Make Sense of Lower Back Pain So You Are Safe & Feel Confident Even With More Complex Cases

Alongside red flag questioning I’ll also be covering this…

  • How To Easily Differentially Diagnose Lower Back Pain Patients & Without Having To Complete #101 Special Tests!
  • Why You Need To Rule Out The Hip (& Rib-Cage) With EVERY Lower Back Pain Patient Or Risk Treating The Wrong Thing & Your Patient Not Improving


  • Why Most Lower Back Exercises (And Treatments) Do NOT Work & What You Need To Do Differently If You Actually Want To See Your Patient Progress & Not Flare Them Up

The webinar is happening next week…

Wednesday 23rd February 2022 at 7 PM (UK Time).

It’s just 60 minutes long…

And I’ll be staying on at the end to answer any of your questions.

Book your FREE place here.


The New Grad Physio Mentor

P.S. Please note this is a live event and no recording will be made available outside of my new grad physio membership.

You must be registered if you want to watch this webinar for FREE.

So move quick and secure your seat right now!

>>>Book My Free Place Now <<<