B4

Low back pain psychosocial flags (Beliefs)?

Beliefs: "The worst". Pain is harmful/uncontrollable. Pain needs to be eliminated before returning to activity/work.

Low back pain psychosocial flags (Social & Work)?

Social: history of abuse, lack of support, overprotective family. Work: expectation pain will increase, pending litigation, poor job satisfaction.

Low back pain Red flags (Infection risk)?

Systemic signs: fever, chills, weight loss. Symptoms of UTI. IV drug use, immunosuppression.

Low back pain Red flags (Cancer signs & Age)?

Systemic signs (fever, chills, weight loss). Increased pain at night or in supine position. History of cancer. Age

Low back pain Red flags (Vertebral fracture)?

Major trauma (MVA, fall). Minor trauma if osteoporosis risk. Chronic corticosteroid use.

Low back pain Red flags (Cauda equina syndrome)?

Progressive/bilateral neuro deficits. Saddle anesthesia. Decreased anal sphincter tone. Bowel/bladder retention and/or incontinence.

Low back pain Red flags (Abdominal aortic aneurysm)?

Abdominal pulsating mass. Atherosclerotic vascular disease. Pain at rest or nocturnal pain.

Low back pain Red flags (Physical examination)?

Painful spinal deformity. Severe/symmetrical spinal deformity. Saddle anesthesia. Progressive neurological signs/muscle weakness. Tenderness over body of vertebrae.

Back pain history taking associated symptoms (Systemic & MSK)?

Constitutional: fever, weight loss, night pain. MSK: joint pain, skin rash, skin & hair changes.

Back pain history taking associated symptoms (Neuro & Cardiorespiratory)?

Neurological: numbness, weakness, pain (esp. LL), pseudoclaudication. CVS: chest pain, palpitation, SOB. RS: cough.

Back pain history taking associated symptoms (GI & Urinary)?

GI: abdominal pain, N&V, change in bowel habit. Urinary: change in urinary habit or urine physics.

Back pain history relevant specific points?

History of trauma. Recent travel. Infection.

Features suggesting nerve root problems (Pain distribution)?

Unilateral leg pain > low back pain. Pain radiates to foot or toes (below the knee).

Features suggesting nerve root problems (Neuro & Clinical tests)?

Numbness or paresthesia in the same distribution. Straight leg raising test induces more leg pain. Localized neurological deficits.

Back pain physical exam palpation elements?

Tenderness over spine ± paraspinal muscles. Peripheral pulses.

Back pain physical exam forward flexion metrics?

At least 80 degrees. Ask patient to try to touch toes (may compensate by flexing hips). Observe lumbar spine movement.

Back pain physical exam lateral flexion metrics?

Ask patient to bend sideways, sliding hands down outer thighs. Compare both sides.

Back pain physical exam extension metrics?

At least 15 degrees. Ask patient to lean backward (may compensate by bending knees).