When self-care is not enough: red flags and referral

Chest pain with breathlessness, sweating or nausea; sudden severe headache or headache with fever, neck stiffness or neurological signs; new weakness, loss of coordination or bladder and bowel changes; calf pain with swelling, warmth and redness; abdominal pain with fever or vomiting.

All of these can be mimicked by muscular pain patterns, which is exactly why they need excluding first rather than being palpated at home.

Unexplained weight loss, night pain that wakes you regularly, a history of cancer, fever with musculoskeletal pain, pain after significant trauma, progressive numbness or a foot that catches when walking.

Also book an assessment for anything that has not improved at all after three to four weeks of sensible self-care — not because it is dangerous, but because the working hypothesis is probably wrong.

A clinician can separate joint, nerve, tendon and muscular contributions, test strength and neurology properly, decide whether imaging changes anything, and apply techniques — needling among them — that are not available at home.

Bring what you have already tried and what changed. That history usually shortens the process more than any test.