Hey guys. Welcome to PT Snacks podcast. This is Kasey, your host, and if you're tuning in for the very first time, what you need to know is that this podcast is meant for physical therapists and physical therapist students who are looking to grow your fundamentals in bite-size segments of time. Now we are gonna get into today's topic here in a second, but if you have listened to at least three episodes of this show and you find it beneficial, if you would do me the honor of leaving a review wherever you listen to podcasts, that would be an amazing help to me. And also if you are not following the show, make sure you're hitting follow so that you don't miss any upcoming episodes. Now, today we're gonna cover five red flags that you can't miss in low back pain. And I just think it is really important to make sure that we nail down also the things that we hope to not see in a physical therapist clinic, so that if these people walk in our door, we can quickly get them onto a specialist who is better equipped to handle their symptoms, whatever those may be. And we're gonna cover a few here in a second. But definitely very important. If you feel like you are a little rusty on those, this is the episode for you. We're gonna do just rapid review style, 'cause we've got five to cover. So number one, cauda equina syndrome. This is considered a red flag. Because ka aquina is a compression of the bundle of nerve roots at the end of the spinal cord. So remember that the l the spinal cord can end on average at L two. It can vary a little bit person to person. So below that those are the nerves that control are bowel, bladder, and sexual function. So when compressed, they stop sending normal signals. Fast. So some symptoms that can indicate that they have quad aquina would be saddle and anesthesia or loss of sensation in the perennial area because the sacral nerve roots, so S two and S through S four are being compressed. Urinary retention is an early sign of autonomic dysfunction. Bowel incontinence or sexual dysfunction because the same nerve roots are involved and then bilateral leg weakness. So unlike a herniated disc compressing a single root KA equina affects multiple roots. Now time is of the essence, so if it is not compressed quickly. We don't want there to be permanent damage. Okay, so ka a equina. Yes. There's more we could cover, but we're gonna move on to number two, cancer, or more specifically metastatic disease to the spine. Most cancers that affect the spine didn't start there. They can spread and metastasize most commonly from breast, prostate, lung, or kidney. PB Kettle is an acronym that I like to remember for the most common cancers to metastasize to the spine, so pb, prostate, breast, kettle kidney, thyroid, lung. Pee Kettle. The spine is a common site because it's got some awesome rich blood supply patients who potentially have metastatic disease to the spine could have unexplained weight loss, which is a systemic sign of cancer night pain. So tumors often hurt more at night when their cortisol drops and parasympathetic tone rises and pain unrelated by rest or movement. And that's because it's not mechanical, it's pathologic. So in our exam, we're probably not really reproducing their symptoms or creating a change to them. They might hurt. But it may not be a musculoskeletal cause, so they delayed referral can mean delayed diagnosis and progression to spinal cord compression or fracture, or just worse things. So they would really need a MRI for this. Now number three, spinal infection. Infections like discitis or epidural abscess can eat away at the vertebrae, invade the spinal canal and compress neural tissue. Does not sound great, does it? So symptoms can be fevers and chills from a systemic inflammatory response. Constant worsening pain. Inflammatory pain, doesn't really follow typical musculoskeletal patterns. And they might have. And they might have immunosuppression or IV drug use that has a higher risk of infection via Hema Hematogenous spread or bloodborne. These infections can be fatal or can cause permanent neurological deficits, if not cause caught early. So PT treatment would delay. So if we keep 'em in pt, it's gonna delay their, what they need would be, which would be antibiotics or surgery. Now fracture, vertebral compression fractures happen when the bone is too weak to handle normal forces, often due to osteoporosis, or it could be even chronic steroid use. So that person might have acute pain onset after a bend lift or twist, especially in older adults. They might have localized tenderness over vertebra which differentiates it from soft tissue pain and then minimal trauma history. So what seems like maybe a small movement to you might have fractured, weakened bone. Now this is actually something I've seen in the clinic before where a patient came to me after they had a vertebra blasty. They had gone to another therapist prior to their surgery because they had, their grandchild had jumped into their arms and they felt a little pop in their spine, and pain was very localized. And that patient said that the patient just kept treating her, giving her rose, all that kind of stuff. And she was not getting better until she finally went and got imaging and she had a compressed vertebrae. You think these things won't happen in your clinic, but you may not be seeing them. So this is not to shame anybody or anything like, because sometimes clinics are busy. But this is why I think it's important to remember these things because it's easy to get caught in our routine, right? That's why we're going over this now. Number five is abdominal aortic aneurysm or triple A. So a triple A is a bulging or rupture of the aorta. The major artery supplying blood to the whole lower body. So if it ruptures, it's life-threatening within minutes. So those symptoms can come across as de pulsating back or abdominal pain. If someone's saying they're, that kind of pain is pulsing, that's something we should assess. They might even have referred visceral pain from that aortic wall. That person might have dizziness or hypotension which could be signs of internal bleeding. And the biggest risk factors are age over 65, a male smoker hypertension, it's not just a different type of back pain if it's untreated. A ruptured triple A has a 90% mortality rate. So if your patient is pale, clammy and in distress, you need to call emergency servers immediately. So yes, this is a physical therapy podcast, but I think it's also very important for us to recognize symptoms that make someone not appropriate for physical therapy because the sooner that we can. Get someone help to somebody who actually specializes in treating those things, the sooner that patient has helped. We get to spend a lot of time with our patients. We, and regardless, I know that the clinic can be very busy sometimes. Our job is also to help to screen out and triage these patients at the same time, even to the point where it could save somebody's life. If you have any questions at all, feel free to reach out at pt Snacks podcast@gmail.com. Thank you for listening. And. If you would like to support the show, there is a link below in the podcast notes. And also speaking of things in the podcast notes, you might have noticed if you already looked a promo code for Med Bridge. They are a sponsor of the show and they actually are offering listeners over a hundred dollars off of a full year subscription to their services, which if you don't know who Med Bridge is they have. A huge library of online CEU courses. They have webinars they even have specialty exam prep courses. I use them for studying for my OCS, and it's not just for PTs, it's for OTs, speech therapists, all sorts of really good information there. So if you're interested. Might as well get a huge discount, right? But other than that, I hope you guys have a great rest of your day, and until next time.