Since PT school we have all been taught to be wary of serious pathology masquerading as musculoskeletal pain. We learn about the red flag, the 5 Ds, and the 3 Ns, etc. In fact, research has presented 163 possible signs and symptoms which can be reported as red flags for spinal pathology alone! There are some who disregard the screening for serious pathology as an unnecessary impediment to proving the intervention they prefer. Also, in their opinion, these signs and symptoms are so rare, they should not be a major concern for your average therapist. I would like to stress that even though these conditions are atypical for most patients, for those who have the pathology, the diagnosis is “devastating and life changing.” I call these patients the one-percenters, because although serious pathology is rare, they deserve appropriate screening.