Screening for Red Flags in Low Back Pain: A Guide for Pilates Teachers 🚩

Low back pain is a common issue among Pilates clients, and as instructors, we often play a role in helping them manage discomfort through movement.

However, it's crucial to recognize when low back pain may indicate a more serious medical condition.

This blog post outlines key takeaways from my latest workshop inside the Pilates Teachers Community membership, focusing on how to screen for "red flags"—symptoms that signal the need for medical referral.

Understanding Low Back Pain

Low back pain is defined as pain, muscle tension, or stiffness localized below the rib margin and above the gluteal folds, with or without leg pain. It can be categorized into the following 3 kinds:

• Red Flag pathologies (1% of cases) – Requires immediate medical attention.

• Radicular syndrome (5-10% of cases) – Involves nerve-related symptoms and guidelines recommend conservative management.

• Non-specific low back pain (90-95% of cases) – The most common and usually not serious and should also be managed conservatively.

Recognizing Red Flags

While most back pain is non-specific and improves with movement and time, some cases require urgent medical referral. Pilates teachers should be aware of key red flags, these are some of them:

1. Vertebral Fractures

• Age over 70

• History of significant trauma

• Long-term corticosteroid use

• Osteoporosis

• Action: If two or more of these factors are present, refer the client to the emergency room.

  
  

2. Spinal Cord Injury

• Neurological symptoms in both arms or legs

• Loss of muscle function

• Bowel/bladder dysfunction

• Action: Immediate emergency referral is needed.

  
  

3. Cauda Equina Syndrome

• Loss of bowel/bladder control

• Numbness around the saddle area

• Sexual dysfunction

• Action: Requires emergency medical attention.

  
  

4. Ankylosing Spondylitis

• Chronic back pain

• Psoriasis, inflammatory bowel disease, or eye symptoms

• Family history of similar conditions

• Action: Referral to a doctor for further investigation.

How to Approach a Client About Their Back Pain

It's important to ask your clients with back pain routine screening questions in a calm and supportive way. You can simply say:

"Would it be okay with you if I ask you some questions to rule out any causes for your back pain which would be reason for you to have it checked with a doctor? Just so we can make sure we are moving in a way which is safe and beneficial to you."

Most often, the answers will be reassuring, allowing you to confidently proceed with appropriate exercises. However, if a red flag is present, staying calm and guiding the client toward medical attention is essential.

The Role of Pilates Teachers

Pilates instructors are not doctors, but by being aware of red flags, we can serve as an important first line of awareness. Our role is to:

• Identify potential concerns early.

• Refer clients to medical professionals when necessary.

• Provide reassurance when no red flags are present.

• Focus on movement strategies that promote strength and function.

  
  

By screening for red flags, we improve client safety and foster our client's sense of trust in us.

Once we can rule out red flags we will also feel extremely reassured that we can safely continue to work with our clients improving their strength, mobility, and helping them get back to the activities they love.

If you want to learn more watch the full recording of the workshops inside the Pilates Teachers Community membership, where we cover all the red flags we need to screen our clients for. 

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