Back pain: clinical assessment

Background: Low back pain accounts for approximately 5% of all general practice consultations. Although the majority of patients will have somatic low back pain of musculoskeletal origin, vigilance in excluding 'red flag' conditions is paramount. The identification of 'yellow flags', ie. psychosocial stress factors, becomes important in patients not making a rapid recovery, and these factors need to be identified and rectified early, lest they lead to chronic pain and disability. Objective: This article presents a simple examination of the lower back designed with general practice in mind. It is based on the 'look, move, feel' paradigm of clinical orthopaedic examination. Discussion: A thorough and conscientious physical examination is not time consuming. It reassures the patient that the practitioner is interested and concerned about their problem. In acute low back pain, this is the springboard to a simple effective management program and improved outcomes. It also confirms the site of pain, and is important in monitoring disability. However, there are no clinical signs, either singly or in multiples, which allow a valid anatomico-pathological diagnosis to be made