Neurological Red Flags

Severe back pain with new leg weakness, radiating pain, sensory loss, and bladder dysfunction warrants urgent medical evaluation. Severe nerve compromise may require medical management, injections, or surgery rather than delayed conservative care. A concerning Hoffman's response may indicate cervical myelopathy, which the source treats as more serious than cervical radiculopathy. Reflex loss is treated as a concerning marker associated with worse outcomes and referral. Normal reflexes and some preserved hip or knee strength do not rule out serious neurological involvement when dorsiflexion, inversion, sensation, or bladder function are abnormal. Suspected cervical radiculopathy should be screened for serious neurological compromise before conservative movement treatment proceeds. Neurological screening should include Hoffman's test, sensation, reflexes, and muscle strength. A targeted neurological examination should be performed early in high-risk back pain presentations rather than waiting for lower extremity symptoms. Questions about red flag symptoms should be routine rather than only asked after symptoms escalate. Rapport can be necessary for patients to disclose sensitive red…