Low Back Pain and Red Flags
Most low back pain is non-specific and improves with activity and self-management, but every assessment must identify cauda equina syndrome, fracture, infection, malignancy and inflammatory disease that require a different pathway.
Definition
Low back pain is pain between the lower ribs and the buttock creases, with or without leg pain. Most cases are non-specific; the clinical priority is to identify serious underlying pathology, neurological emergencies, inflammatory disease and risk factors for persistent disability.
First principles
The diagnosis is usually non-specific, not a precisely identified structure
Pain may arise from several spinal and paraspinal tissues, and imaging abnormalities are common in people without symptoms. For most presentations, the useful diagnosis is non-specific low back pain or sciatica rather than a speculative disc or facet lesion. The important clinical task is to identify serious pathology, neurological deficit, inflammatory disease and psychosocial barriers to recovery.
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