Bio- Psychosocial Rehabilitation and Yellow Flags

Over the last decade, as our understanding of the importance of bio- psychosocial rehabilitation has increased, a lot of research has started to look at the effects of how we think and feel on our back pain. A number of thoughts, beliefs and behaviours have been identified that increase your chances of becoming distressed and disabled by chronic lower back pain. These are called yellow flags.

'Red flags' are indicators of serious back problems. Those red flags act a guide to screen out complex and serious back problems. These yellow flags allow us to screen and identify the psychosocial elements that put someone at risk of developing chronic low back pain.

These pages explain what yellow flags are and outline some of the features of a few of them, in particular fear avoidance, catastrophising or fear of the future, and beliefs about diagnosis and causes of pain. If these 'yellow flags' are not addressed with bio-psychosocial rehabilitation then treatment for lower back pain is often unsuccessful.

If you haven't yet I suggest you read the sections on pain and the bio- psychosocial rehabilitation model before reading on.

Yellow Flags and the Biopsychosocial Perspective

yellow falgs and the biospychosocial modelThere are many yellow flags; a long list of them is published in the guideline I mention above. They have been found to have a negative influence on the outcome from an episode of back pain. I am not going to list each one because the guideline gives a good comprehensive overview but I will talk in more detail about the yellow flags that I see most commonly and how they impact on people. Understanding and addressing these issues are vital to an effective bio - psychosocial rehabilitation programme.




New Zealand Acute Low Back Pain Guide, incorporating the Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain

This guideline helps us identify the psychosocial factors that put us at risk of developing chronic low back pain with its inherent disability and distress. This guideline was developed in New Zealand and has been endorsed by the New Zealand Guidelines group including doctors, physiotherapists and osteopaths. All these groups agree that it is a model for best practice. It can be found on the internet and can be downloaded for free.

Read more in the full New Zealand Acute Low Back Pain Guidelines document here.

There is also a newer research article (2011) reappraising yellow flags Early Identification and Management of Psychological Risk Factors (“Yellow Flags”) in Patients With Low Back Pain: A Reappraisal








This *book is the MOST helpful book on pain that I have ever read. It is simple to understand and very reassuring. I would highly recommend it to anyone who is dealing with back pain.


Fear Avoidance


Differing diagnosis and explanations for back pain

Lower Back Pain Toolkit Home Page





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