This will include a detailed medical history, clinical examination and possibly
investigations such as a blood test, X-ray, CT or MRI scan.
Physician evaluation may indicate that the back pain:
- Is due to a serious spinal or other disorder that requires immediate specialist
attention and surgical management. These are known to the physician or
orthopod as “Red Flags.” Remember that ONLY 1% of all back pains come under
this category - Is due to a spinal or other disorder but is not serious enough to warrant
immediate specialist attention and can be managed with conservative treatments.
It accounts for 10 – 15% of back pain cases. For example, it is possible that a
spinal disorder such as mild to moderate osteoarthritis or a partly degenerated
disc may have been discovered on investigations but these have not progressed to
such a stage or do not cause symptoms that require immediate surgery - Does not have an identifiable spinal or other cause. Most back pains (85 – 90%)
fall in this category
These categories may be represented as an algorithm. Let us build this algorithm
gradually so that we understand what to do when back pain strikes us.
I am not too fussed if orthopods and physicians complain that my approach would lead
to a lot more investigations. In the first place that is the job of the physician – to sort out
from the medical history and physical examination those who require immediate
medical and/or surgical attention from those who complaints appear less severe and/or
RED FLAGS PATHOLOGICAL CAUSE
BUT NO RED FLAGNO PATHOLOGICAL
CAUSE