International framework for red flags for potential serious spinal pathologies

Review written by Dr Mary O'Keeffe info

Key Points

  1. Most single red flags are red herrings: most lack evidence, are not good at spotting serious disease, and are misleading when used in isolation.
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Early identification of serious spinal pathologies is critically important considering their potentially devastating consequences. Red flags are often used by therapists to help identify serious spinal pathology, however there is a lack of high quality evidence for their diagnostic accuracy. This paper outlined a comprehensive framework to provide physiotherapists, as well as other healthcare professionals, with a standardized and consistent approach to the assessment of serious spinal pathology in the musculoskeletal setting.

There is a lack of high quality evidence for the diagnostic accuracy of red flags.
While serious pathology is rare, quick referral and management is crucial to successful outcomes.


The development of the framework was led by The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT). It was informed by the available research on red flags in collaboration with researchers and clinicians with expertise in the management of musculoskeletal

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