How to Recognise Red Flags in Musculoskeletal Pain

Recognising red flags in musculoskeletal pain is a critical skill for manual therapy practitioners. While most clients present with common, non-threatening conditions, certain symptoms can indicate serious underlying pathology that requires urgent medical referral. Understanding and identifying these signs helps protect client safety and supports your professional responsibility.

A woman in a navy shirt holds a clipboard, explaining how to recognize red flags in musculoskeletal pain to a seated man against a blue background.

What Are Red Flags in Musculoskeletal Pain?

In manual therapy, red flags are warning signs that suggest a client’s pain may not be due to a simple mechanical or soft tissue cause. These signs often indicate potentially serious conditions such as fractures, infections, neurological disorders, or malignancy.

Common examples include:

• Unexplained weight loss

• Night sweats or fevers

• Severe, unremitting pain not relieved by rest

• Sudden onset of severe pain after trauma

• Progressive neurological deficits (e.g., weakness, numbness, loss of bladder/bowel control)

Recognising these symptoms early is crucial, as manual therapy is not appropriate for conditions requiring urgent medical management.

Why Red Flag Recognition Matters for Manual Therapy Practitioners

As a manual therapist, your role is to support clients’ musculoskeletal health within your scope of practice. Identifying red flags ensures you:

• Avoid inappropriate treatment that could cause harm.

• Facilitate timely referral to a GP or specialist.

• Build client trust through clinical professionalism.

While most clients will not present with red flag symptoms, having the confidence to identify and act on them reinforces your credibility as a healthcare professional.

Key Red Flags Manual Therapists Should Be Aware Of

Certain red flags are especially important in musculoskeletal practice:

Spinal pain red flags:

• History of cancer

• Unexplained weight loss

• Immunosuppression or infection signs

• Progressive neurological deficits

• Severe, unrelenting night pain

Peripheral joint red flags:

• Hot, swollen joint with fever (possible septic arthritis)

• Sudden joint swelling after trauma (possible fracture or ligament rupture)

• Persistent swelling with no clear cause

Neurological red flags:

• Bilateral neurological symptoms

• Loss of coordination or balance

• Changes in bladder or bowel function

Responding to Red Flags in Clinical Practice

When you suspect a red flag:

1. Stop treatment immediately.

2. Gather a brief, focused history and note your clinical observations.

3. Refer the client to their GP or the emergency department without delay.

4. Document your findings and referral clearly in your records.

It’s important to communicate your concerns to the client calmly and professionally, explaining that further investigation is needed to ensure their safety.

Conclusion

Recognising red flags in musculoskeletal pain is an essential part of safe and effective manual therapy practice. By staying alert to warning signs and referring appropriately, you protect your clients’ wellbeing and strengthen your professional integrity. To expand your knowledge of clinical assessment and client safety, explore our online CPD courses designed for manual therapy practitioners.