Red Flag Questionnaire

The good news about red flags is that a question and answer format is generally agreed by emergency room experts as enough to tell whether or not you need additional testing, or they send you home with a Motrin prescription and the usual mediocre advice. The bad news is that none of the questions are definitive, and there is no consensus as to exactly what questions should be asked and how many of them need to be answered yes before you need an x-ray, CT-scan, MRI, blood, or other types of tests. So while there is no definitive list, there is a lot of overlap and being reasonably familiar with the literature, I’m doing my best to blend questions from multiple sources together, and what positive “yes” answers could mean. 

A few “yeses” probably should worry you. I expect an emergency room physician, or family practitioner would be best trained to get you appropriate additional tests or referrals, or verify if all’s well and you can safely proceed with Spinal Flow.

1: Have you ever had any kind of cancer?

By far the best predictor of current or future cancer is a past history of cancer. Thus, a yes to this question substantially raises that odds that current spine pain is from cancer as opposed to, or in addition to, typical spine pain caused by typical causes of poor posture, coordination, and fitness.

2: Have you recently and inexplicably lost weight?

Weight loss, for no apparent reason, is a known symptom of cancer, increasing the odds that spine pain is not typical. 

3: Does rest, or other postural adjustments, provide any relief of your spine pain?

While bed rest is generally considered a poor treatment for spine pain, if the pain is mechanical or postural, there are usually some positions that feel better than others, at least in the short term. Pain that is progressively getting worse, and/or is unchanging, or unrelenting regardless of rest and postural positions increases the odds that it could result from cancer or infection.

4: Have you had a recent onset of an inability to urinate at all, even when you have a full bladder?

Urinary retention can result from malignancy or cauda equina syndrome (an emergency condition, usually caused when an especially large herniated disc substantially impinges on a large number of nerves in the lumbar spine, and for which emergency surgery is indicated to lessen the risk of permanent disability).

5: Have you recently had an unexplained fever?

Typical spine pain does not cause a fever. A fever could indicate an infection which while rare in the spine, can and does happen.

6: Within the past 30 days have you been involved in significant trauma (e.g. a hard fall or car accident)?

At any age, even with healthy bone, a significant trauma increases the risk that the resulting pain is from a vertebral fracture.

7: Have you ever been diagnosed with osteoporosis?

Osteoporosis, diminished bone mineral density increases the risk of vertebral fractures resulting from moderate, and even mild traumas (falls or car accidents). If osteoporosis is advanced enough, compression fractures, common in the thoracic (middle) spine can happen even without apparent trauma, often resulting in the noticeable rounded or hunchback postures in frail elderly. Having osteoporosis or a compression fracture does not mean you can’t do Spinal Flow, but you almost certainly want it to have healed first. After which point Spinal Flow Yoga, initiated with SC5 before SF5, and progressed cautiously with the user rules, rigorously adhered to, should help slow or reverse osteoporotic changes in the body, lessening the risk of future fractures.

8: Are you over 50, or over 70 years of age?

Being over 50 years of age increases the risk of osteoporosis whether anyone has diagnosed you or not, and increases the likelihood of fractures from mild to moderate trauma. Over 70 years of age raises the risk yet again, as osteoporosis may be more advanced, such that mild, or even no trauma (just a cough or sneeze) can result in vertebral fractures.

9: Have you ever used corticosteroids for a prolonged duration?

Prolonged use of corticosteroids weakens bones, increasing risk of fractures from otherwise milder stresses.

10: Have you had a recent onset of urinary or bowel incontinence?

Loss of urinary or bowel control could indicate cauda equina syndrome. This is when nerves affecting each function, and more, are being pinched off in the low back, sometimes indicating a significant obstruction in the lumbar region requiring immediate surgery to decompress the nerves and prevent permanent disability. Cauda equina syndrome is a medical emergency!

11: Have you had a recent onset of numbness and/or tingling in your genitalia, anus, or perineum?

Numbness or tingling in the saddle region could also be indicative of cauda equina syndrome, described above. Cauda equina syndrome, though rare, is a medical emergency!

13: Do you have abdominal pain, and/or can you feel your heart beat throbbing in your abdominal region?

Back pain hurts in the back, and if it’s going to refer pain anywhere it is usually down the leg. If pain is referring to your side, or abdominal region there is reason to suspect a kidnery or bladder infection. particularly if you can feel a throbbing pulse of your heart beat there is a rare, but very much an emergency condition known as xxx.

14: Have you been diagnosed with rheumatoid arthritis, with associated neck pain?

Rheumatoid Arthritis weakens bone, cartilage, and ligaments throughout the body. Where this can be especially dangerous in relation to Spinal Flow Yoga and the neck is if the arthritis has weakened and destabilized the upper cervical spine, specifically C1-C2, in what is known as atlantoaxial subluxation. This can cause severe neck pain, headaches, numbness and weakness in the arms. What makes it especially dangerous is a portion of C2 can press up into the brain causing sudden death. While the exercises of Spinal Flow Yoga teach a neutral spine posture and strengthen the neck, which in theory should help with neck pain in those with RA, as with others, having getting testing with spine orthopedic or neurologist to clear before attempting the neck specific exercises, NeBrids, LoBrifs, and FloRos in particular would be prudent.

15: Do you have any redness, heat, swelling around the spine.

Typical neck and back pain can be very painful and can be inflammatory. However, that inflammation is usually deep and DOES NOT show on the outside body as either redness, heat, or swelling. Such signs could be indicative of something as serious as malignancy, but could be as simple as a skin infection. However, if it’s the latter you are probably going to want to see a physician for antibiotic treatment, not do exercises.

16: Have you tried Spinal Flow Yoga conscientiously for 4 weeks, with no beneficial effects? 

Depending how bad your original condition is, it can take a few, or many, weeks and sometimes months for pain to fully resolve. If you are too far down the degenerative cascade, pain may never fully resolve and you are doing your best to keep it manageable. In such case Spinal Flow can almost surely help, however, pain should at least lessen in a few weeks with Spinal Flow. Especially if you are taking the lessons learned in SC5 and incorporating them throughout your day.  So you aren’t continuing the same behavior that damaged your spine and caused your pain in the first place. If you have given Spinal Flow, or any spine treatment a shot for 4 or so weeks without any benefit, and especially if your symptoms are getting worse, that’s a red flag that something out of the ordinary is wrong and you should see your doctor.

UPCOMING EVENTS

November 14, 2018

Endurance in 5 minutes? Yes

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November 14, 2018

Strong Everything

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Spine Strength!

And a lot.

UPCOMING EVENTS

November 14, 2018

Arms

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November 14, 2018

Mindfulness is for the meek, strong minds focus

Read Ramana Maharshi, read the Buddha.

Measured Meditation

How to know if it's working...

UPCOMING EVENTS

November 14, 2018

Learn Causes of Injury

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PHYSICAL fitness

Form AND Function