RED FLAGS

We are always taught about red flags and told that we will probably not encounter too many in our time as physios, but on my musculoskeletal placement I was very thankful that we learnt about red flags.
I had a patient who was coming to me with severe hip pain that had been getting progressively worse for about 3 weeks. There did not seem to be any pattern to his pain provocation. He was what i would consider to be elderly and he had decreased ROM globally in his (R) hip, with Flex and Add being the most limited. He also had decreased glut strength on the (R) > (L) and had tight ITB and hip flexors bilaterally. He had no Hx of hip pain, no Hx of Lx pain and on examination of his lumbar spine he had good ROM and was not particularly stiff on PPIVMs and PAIVMs.
The thing that made me most concerned was that the pain was waking him at night, but he was able to decrease the pain with heat pack and painkillers.
I began treating his decreased ROM, gave him strengthening exercises for his glutes and stretches for his ITB and hip flexors, but after a week his pain had got a little worse.
As I was concerned that his obj findings did not correlate with his pain levels and was concerned that subj it was waking him at night i sent him back to the doctor. On the last week of my placement I received a letter back from the doctor saying that my patient had an osteo carcinoma. It was a very sad experience for me, but also very rewarding because it meant that my patient could now receive Rx for the cancer and would hopefully recover well. It made me realise how important it is to pick up on red flags and to seek further advice if our Rx is not progressing as we would expect.