Acute Lower Back Problems in Adults - Assessment

Initial Assessment Methods

The initial assessment of a patient with activity intolerance due to low back symptoms consists of a focused medical history and physical examination. The primary purpose is to seek medical history responses or physical examination findings that suggest a serious underlying spinal condition such as fracture, tumor, infection, or cauda equina syndrome. These responses or findings are referred to as "red flags." The history and physical examination should also assess for nonspinal conditions (vascular, abdominal, urinary, or pelvic pathology) causing referred low back symptoms.

Once the clinician has ruled out red flags and nonspinal pathology, the symptoms can be categorized as either sciatica or nonspecific back pain. In the absence of red flags, neither routine nor special testing is required in the first month of symptoms for either category. Most of these patients will recover spontaneously from their activity limitations within 1 month.

Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults.
Clinical Practice Guideline No. 14. AHCPR Publication No. 95–0642.
Rockville, MD: Agency for Health Care Policy and Research, Public Health
Service, U.S. Department of Health and Human Services. December 1994.