therapists approach to back pain

Question 1

what are the categories you would put patients in , in a diagnostic triage

Answer 1

• simple backache
• nerve root pain
• serious spinal pathology (including Cause Equina Syndrome)
• widespread neurological disease

Question 2

when does simple backache usually present?

Answer 2

20-55 years

Question 3

where does simple backache usually present?

Answer 3

• lumbosacral region
• buttocks
• thigh

Question 4

how may simple backache pain be described?

Answer 4

mechanical pain (varies with time and activity)

Question 5

what is the prognosis for simple backache?

Answer 5

prognosis is good (90% better in 6 weeks)

Question 6

how does nerve root pain differ from simple backache?

Answer 6

• it is unilateral and more intense than back pain
• the pain may radiate to foot or toes
• will often feel numbness and parasthesia
• there may be motor, sensory or reflex changes in one nerve root

Question 7

what is the prognosis for an acute attack of nerve root pain?

Answer 7

50% recover from acute attack in 6 weeks

Question 8

what is an example of an emergency serious spinal pathology?

Answer 8

• Cauda Equina Syndrome

- recent onset flacid foot

Question 9

what are examples of urgent spinal pathology?

Answer 9

• tumours
• spinal infection
• inflammatory
• deformity

Question 10

how may patients with serious spinal pathology be triaged?

Answer 10

• emergency patients

- urgent patients

Question 11

what are some red flags for back pain?

Answer 11

• constant, progressive, non mechanical pain
• worse on supine position
• severe at night
• age <20 or >55
• thoracic pain not gone away with physiotherapy
• pre existing cancer
• systemic steroids
• premature menopause
• DMARDs
• TB
• IV drug abuse
• HIV
• unexplained weight loss
• widespread neurological changes
• structural deformity
• systemically unwell

Question 12

how does someone with cause equina syndrome present?

Answer 12

• saddle anaesthesia = reduced sensation in area that would be in contact with saddle if sitting on one (anus, perineum or genitals)
• difficulty urinating
• loss of anal sphincter tone or faecal incontinence
• widespread or progressive motor weakness in legs or gait disturbance

Question 13

management for general back pain?

Answer 13

• try walk for 30 mins a day
• NSAID= first line
• add on weak opiates (co codamol) if still in pain/distressed