Therapists and Back Pain

Question 1

How common is lower back pain?

Answer 1

90% of people will experience it at some point, 45% will have flare ups

Question 2

How is back pain inconsistent?

Answer 2

Site will vary, more than 80% of cases will have a non-specific cause

Question 3

What are some professionals involved in treating lower back pain?

Answer 3

Manual therapists = physio, osteopath, chiropractor
Medics = GP, orthopaedic surgeon, neurosurgeon, pain clinic
Employer = manual handling, ergonomic assessment, occupational health
Radiologist and pharmacist

Question 4

What are the four option when triaging back pain?

Answer 4

Simple back pain = 90% better in 6 weeks
Nerve root pain = 50% better in 8 weeks
Cauda equina syndrome = needs urgent referral
Serious spinal pathology = needs urgent referral

Question 5

What are some features of simple back pain?

Answer 5

Patient aged 20-55 and is otherwise well
Back, buttock or thigh pain
Normal neurology
Pain changes with position or movement

Question 6

What are some features of nerve root pain?

Answer 6

Unilateral leg pain, paraesthesia in same distribution
Leg > back pain
Abnormal neurology
Weakness, reflex changes, sensory changes, nerve stretch pain

Question 7

What are some features of cauda equina syndrome?

Answer 7

Saddle anaesthesia
Altered bladder control and faecal incontinence
Gait disturbance

Question 8

What are some features of serious spinal pathology?

Answer 8

Unexplained weight loss, constant unremitting pain, unable to lie supine or sleep, marked morning stiffness
Age < 20 or > 55

Question 9

What are some risk factors for serious spinal pathology?

Answer 9

Past history of cancer, TB, HIV or IVDA

Osteoporosis, long term steroid use, premature menopause or recent trauma

Question 10

What should be covered in a subjective patient history?

Answer 10

When and how?
Treatment and medication
Site and nature of pain
Previous episodes 
Social history

Question 11

What are some special questions that should be asked?

Answer 11

Red and yellow flag screening

Cauda equina screening

Question 12

What should be examined in a patient?

Answer 12

Posture, willingness and ability to move, overall ROM and effect on pain
Neurological examination = motor, sensory, reflexes, nerve stretch

Question 13

What are some treatment options for simple back pain and nerve root pain?

Answer 13

Education and reassurance
Encourage general activity
Nerve root pain may require further imagine and/or orthopaedic referral

Question 14

What are some exercise that can be given to reduce pain provocation in simple back and nerve root pain?

Answer 14

Flexion provoked pain = extension in standing and lying, lying prone in extension
Extension provoked pain = flexion in standing and lying, crook lying