Assessment of Low Back Pain in Physiotherapy

Assessment of Low Back Pain in Physiotherapy: Understanding Red Flags, Neuropathic Pain, and Instability

• Low back pain (LBP) affects 70-85% of adults at some point in life and is the most common cause of disability.
• Diagnosing the cause of LBP remains a challenge for doctors, and 28-65% of patients still experience pain 12 months after onset.
• Clinical assessment of LBP includes history, general inspection, palpation, range of motion, and special tests.
• Global diagnostic triage guidelines help identify serious pathology (red flags), radicular syndrome, and non-specific or mechanical LBP.
• Specific red flags include spinal fractures, malignancy, cauda equina syndrome, infection, and myelopathy.
• Neuropathic pain is a type of LBP caused by a nerve root injury or disease, affecting 8-80% of patients depending on the location and signs.
• Mechanical compression of the nerve root causes mechanical neuropathic root pain, which can be diagnosed through subjective assessment and associated sensory or motor signs.
• Sacroiliac joint pain occurs in 15-30% of LBP patients and can be diagnosed through 3 or more positive tests with high sensitivity and specificity.
• Discogenic pain affects 26-42% of LBP patients and can be treated with the McKenzie method, which uses spinal movements to centralize symptoms.
• Lumbopelvic instability is caused by dysfunction in one or more of the stabilizing subsystems of the spine and can be diagnosed through clinical instability and functional instability tests.
• Myofascial pain syndrome (MPS) is a common contributing factor to LBP, and trigger points can be identified through palpation.
• Assessment of LBP includes measuring active range of motion through inclinometry, Shober test, lateral bending test, and rotation. Disability and avoidance questionnaires like the Oswestry Low Back Disability Questionnaire, Roland Morris Disability Questionnaire, and Fear Avoidance Belief Questionnaire can also be used.

Assessment of Low Back Pain in Physiotherapy: Understanding Red Flags, Neuropathic Pain, and Instability

• Low back pain (LBP) affects 70-85% of adults at some point in life and is the most common cause of disability.
• Diagnosing the cause of LBP remains a challenge for doctors, and 28-65% of patients still experience pain 12 months after onset.
• Clinical assessment of LBP includes history, general inspection, palpation, range of motion, and special tests.
• Global diagnostic triage guidelines help identify serious pathology (red flags), radicular syndrome, and non-specific or mechanical LBP.
• Specific red flags include spinal fractures, malignancy, cauda equina syndrome, infection, and myelopathy.
• Neuropathic pain is a type of LBP caused by a nerve root injury or disease, affecting 8-80% of patients depending on the location and signs.
• Mechanical compression of the nerve root causes mechanical neuropathic root pain, which can be diagnosed through subjective assessment and associated sensory or motor signs.
• Sacroiliac joint pain occurs in 15-30% of LBP patients and can be diagnosed through 3 or more positive tests with high sensitivity and specificity.
• Discogenic pain affects 26-42% of LBP patients and can be treated with the McKenzie method, which uses spinal movements to centralize symptoms.
• Lumbopelvic instability is caused by dysfunction in one or more of the stabilizing subsystems of the spine and can be diagnosed through clinical instability and functional instability tests.
• Myofascial pain syndrome (MPS) is a common contributing factor to LBP, and trigger points can be identified through palpation.
• Assessment of LBP includes measuring active range of motion through inclinometry, Shober test, lateral bending test, and rotation. Disability and avoidance questionnaires like the Oswestry Low Back Disability Questionnaire, Roland Morris Disability Questionnaire, and Fear Avoidance Belief Questionnaire can also be used.