2: Multi-professional management of lower back pain (physiotherapy)

Question 1

Where is low back pain felt?

Answer 1

Lower back

Buttocks

Thighs

Question 2

Who tends to get low back pain?

Is it mechanical or inflammatory?

Within how long does it usually resolve?

Answer 2

People aged 20-55 i.e younger patients

Mechanical

Around six weeks

Question 3

Where is nerve root pain felt?

What is associated with it?

How long does it take to improve?

Answer 3

Usually legs and lower back

Motor and sensory dysfunction (pain, anaesthesia in dermatomes and muscle weakness in dermatomes)

Months (longer than low back pain)

Question 4

Which nerves are compressed in cauda equina syndrome?

Answer 4

L4/5 and sacral nerves of the cauda equina

Question 5

What are the cardinal symptoms of cauda equina syndrome?

Answer 5

Any of:

Saddle anaesthesia

Changes in bowel function

Changes in bladder function

Loss of anal tone (you must do a PR)

Question 6

Who should cauda equina patients be referred to?

Answer 6

Neurosurgeons

Question 7

What are some red flag presentations of back pain?

Answer 7

Age < 20 or > 50

Non-mechanical pain

Severe night pain

PMX cancer, unexplained weight loss

Steroid use and PMX infection

New onset neuro symptoms