Fast, Efficient Diagnosis of Low Back Pain
In this article, two family medicine physicians offer a prescription for conducting a quick (10-minute) exam of the low back. The target population is adults with acute low back pain (LBP). This information is helpful since the majority of patients with LBP don't have a clear cause of their painful symptoms. And most physicians don't have the luxury of keeping hour-long appointments with their patients.
There are about a dozen key screening questions that can be used to identify the presence of a serious pathology. Quickly identifying infection, tumor, or fracture as the cause of the problem is important. If there are no red flags suggesting a significant problem, then a time-efficient exam can be completed in about 10 minutes.
The physician uses a four-part physical examination. This includes observing simple actions like moving and walking. Palpation of tender or painful areas and assessment of range of motion are next. The sciatic nerve can be tested for signs of compression, which might point to a disc problem. Muscle testing for gross strength helps identify nerve involvement.
If the LBP appears to be from a mechanical problem, then a treatment plan can be determined. Mild to moderately strong pain relievers may be needed to help break the pain-spasm cycle. The physician can prescribe Tylenol®, nonsteroidal antiinflammatory drugs (NSAIDs), muscle relaxants, or any combination of these.
Patients must be counseled and educated about resting, working, and driving. Anyone taking medications with a sedative effect should not be driving or operating heavy or potentially dangerous equipment. Resting in bed, inactivity, and taking time off from work is discouraged. The patient should remain as active as possible.
If no improvement is reported within three to five days, then the second part of the treatment plan takes effect. Referral to a Physical Therapist, chiropractor, or osteopathic physician is the next step.
Some patients seem to respond better to a combination of techniques. It may take a little time to sort this all out. The physician should plan a follow-up visit with the patient within three days to two weeks. Further testing may be needed for the patient who gets progressively worse rather than better.
Louis Kuritzky, MD, and David B. Feller, MD. The 10-Minute Examination for Low Back Pain. In The Journal of Musculoskeletal Medicine. April 2008. Vol. 25. No. 4. Pp. 162-168.