Diagnosis enhances, not impedes, boundaries of physical therapy practice

Boissonnault and Bass (1-3) contribute an excellent and stimulating description of several "red flag" conditions that should alert physical therapists (PTs) to the presence of nonmechanical sources of pain. They provide an important reminder that pain has many etiologies, and that despite physician referral, patients may have visceral pathologies whose symptoms cannot be remediated by PTs. Their sobering anecdotes motivate us to take more careful histories and to make more precise patient observations. We believe, however, that when such "red flag" conditions appear to exist, the scope of physical therapy practice includes referral to other practitioners - be they MDs, PTs, RNs, or DPMs. We do not believe that scope of practice norms permit PTs "...to determine whether the symptoms are a result of...visceral pathology or other diseases". J Orthop Sports Phys Ther 1991;13(5):218-219.