an introduction tot he Assessment and Management of undifferentiated back pain from the NHS Modernisation Agency

1. Back Pain

2. Introduction
• Common causes
• Symptoms
• Examination
• Management and advice.

3. Back Pain
• Back pain is a common condition which can occur without clear cause
• Most cases are mechanical
• It tends to occur in the most mobile areas
• It is often chronic and good back care will reduce the potential for back
pain
• Few cases are serious
• Bed rest is not the answer.

4. Contributory Factors
• Poor posture
• Repeated twisting / stretching activity
• Poor lifting technique
• Sedentary position for long periods
• Altered gait due to lower limb pain / injury.

5. Examination
• Look: swelling, bruising, posture, systemic symptoms (sweats,
temperature)
• Feel: alignment. Bony / muscular tenderness, limb strength, sensation
(peripheral and perineal)
• Examine: flexion / extension, lateral movement, sciatic stretch test,
plantars normal.

6. Management
• Simple analgesia (diazepam for muscle spasm if severe)
• Good back care: change position every 20 minutes
• Alternative therapy: osteopath, chiropractor, acupuncture
• If red flag signs present refer to appropriate acute care pathway

7. Red Flag Signs
Cauda equina / spinal cord lesion:
• loss of bowel / bladder control
• plantars abnormal
Mechanical lesion or nerve root pain:
• unilateral leg pain and numbness
• sensory and motor nerves to foot reduced
• increasing neurological deficit or pain.
• perineal numbness
• bilateral neurological signs

8. Red Flag Signs
Neoplasm or mechanical lesion:
• unwell
• night sweats
• weight loss
• age less than 20 or greater than 55
• constant pain / pain at night.