Approach to Patients with Low Back Pain
Objectives
- Assess the patient presenting with acute back pain
- Identify red flag symptoms to exclude serious disease
- Recognize yellow flag symptoms for psycho-social aspects of backache
- Examine appropriately a patient with back pain in primary care
- Conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories:
- nonspecific low back pain
- radiculopathy
- specific spinal cause
Recognize Importance of People with Low Back Pain
- Disabling long-term back pain, and so
- Reduce the personal, social and
- Economic impact of low back pain
- Identify the limitation of images for
- the diagnosis of back pain
- Act as a gate-keeper and not waste
- valuable health resources
- Identify preventive strategies
- available for back pain
- Recognize when to refer
- appropriately
Case Scenario
- A 28-year-old married auto mechanic with
- no prior history of back problems reports that he experienced sudden onset of back pain while bending forward and to the side as he was picking up a tire yesterday morning.
- Bed rest slightly improved his pain and he returned to work today.
- However, his back pain progressively
- increased throughout the day, and by the end of the day he was unable to bend and
- had to leave work.
musculoskeletal nonspecific
Medical Examination Summary
- He denies any radiation of back pain down either leg. His past medical history is unremarkable.
- Physical examination reveals markedly limited bending forward and right lateral flexion.
- Palpation of the right para-spinal muscle revealed spasm and tenderness but no loss of lumbar lordosis.
- Straight leg raising (SLR) test is negative.
- Motor, sensory and reflex tests are normal.