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.
BACK PAIN
(^)
PATHOLOGICAL CAUSE
NO PATHOLOGICAL
RED FLAGS^
BUT NO RED FLAG^ CAUSE^
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