Should you see a doctor or a physio first? Red flag signs and symptoms
Jan 11, 2023Have you ever seen a physio and been confused as to why they are asking you about your bladder and bowel control?
In Australia, physiotherapists are primary healthcare practitioners. Meaning, you do not need a referral to see us. We have the responsibility to ask screening questions to make sure that the symptoms you come in with are caused by a musculoskeletal injury and not a medical condition.
While this can feel like a frustrating use of your appointment time, early detection of a disease like cancer could save your life.
Now before I go through and list of some of the signs and symptoms, keep in mind that having one or a few of these will not necessarily mean that you have something horribly wrong with you. These questions just fill in the clinical picture and may raise the level of suspicion that there could be something in need of medical attention.
Please do not read this and assume the worst. But, take it seriously and use it as a prompt to seek medical attention if appropriate.
If there is a star (*) next to it, please seek urgent medical attention at the emergency department.
Here a list of conditions and the corresponding signs and symptoms that may make a physio refer you to see a doctor before exploring musculoskeletal causes.
If you would like more guidance and you do not believe you need urgent medical attention, you can book in to see me at my North Sydney physio practice or for an online physio consultation at www.adpt.physio/bookonline
If you did not know already, there is a corresponding podcast episode that you can listen to it here.
Cardiorespiratory condition:
- Pain on increased exertion — e.g. walking up stairs leading to increased mid back or chest pain*
- Chest discomfort or pain*
- Dizziness, light-headedness, feeling faint or feeling anxious
- Nausea, indigestion, vomiting
- Shortness of breath or difficulty breathing — with or without chest discomfort*
- Sweating or a cold sweat
Stroke:
- Sudden numbness or weakness in the face, arm or leg (especially on one side of the body)*
- Sudden confusion or trouble speaking or understanding speech*
- Sudden vision problems in one or both eyes*
- Sudden difficulty walking or dizziness, loss of balance or problems with coordination
- Severe headache with no known cause*
Cancer:
- Past history of cancer
- Pain at rest or at night that does not go away with positional adjustment*
- Pain not corresponding to movement or load*
- General malaise — feeling unwell without a clear cause
- Unexplained weight loss of ~5kg in 2 weeks*
- No improvement in 4 weeks
- Problems with swallowing*
- Headaches
- Vomiting
- Lower back pain relieved by going to the toilet*
Infection:
- Fever*
- Night sweats*
- Pain at rest or at night that does not go away with positional adjustment*
- Pain not corresponding to movement or load*
- General malaise — feeling unwell without a clear cause
- Recent open wounds
- IV drug use
- Recent travel
- Exposure to infected person or animal
- Immunosuppressants
Fractures:
- Trauma moment present — fall, motor vehicle accident, whiplash, crush, etc
- Not improving severe pain
- Pain at rest or at night that does not go away with positional adjustment
- History of prolonged corticosteroid use
CNS Problems:
- Widespread changes of sensation*
- Loss of strength in legs/arms*
- Dizziness (vertigo, light-headedness, giddiness)*
- Diplopia (double vision)*
- Drop attacks (sudden falls)8
- Dysarthria (trouble with speaking)*
- Dysphagia (trouble with swallowing)*
- Ataxia (trouble with walking)*
- Nausea
- Numbness
- Nystagmus (shaking eyes on turning head)*
- Fixed, dilated pupil/s*
- Bilateral radiculopathy — diminished strength, sensation and reflexes*
- Subjective sphincter problems (bladder & bowel)*
- Objectively reduced sphincter function (bladder & bowel)*
- Subjective perineal sensory changes (groin area)*
- Saddle anaesthesia (loss of sensation groin and surround areas. Areas that would be touching a saddle)*
- Complete loss of bladder and bowel sphincter function*
- Retention of urine*
Osteoporotic vertebral fracture:
- Recent (<2y) history of previous vertebral fracture
- <60kg bodyweight or BMI <20
- Older person with hip fracture
- Prolonged use of corticosteroids
- Decrease in height and increase in thoracic kyphosis (mid back hunch)
Ankylosing spondylitis:
- <20yo, male
- Iridocyclitis - eye redness, pain, blurred vision, photophobia, and shrinking of the pupil
- Peripheral arthritis, inflammatory bowel disease
- Night pain, morning stiffness for over one hour
- Decrease in pain lying down or exercising
- Good response to NSAIDS (non-steroidal anti-inflammatory medication)
Vertebral fracture:
- Severe pain after traumatic incident. E.g., fall, motor vehicle accident, whiplash, crush, etc.
Systemic diseases: (e.g., herpes zoster, inflammatory arthritis, rheumatoid arthritis, etc)
- Headaches
- Fever
- One sided skin rash
- Itching
- Burning pain
Visceral referred pain:
- Pain in specific areas that are not related to movement or loading
- Pain when utilising specific organ — e.g., pain increases after a high fat meal.
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Cras sed sapien quam. Sed dapibus est id enim facilisis, at posuere turpis adipiscing. Quisque sit amet dui dui.
Call To Action
Stay connected with news and updates!
Join our mailing list to receive the latest news and updates from our team.
Don't worry, your information will not be shared.
We hate SPAM. We will never sell your information, for any reason.
