The RCGP - Clinical and Special Projects, Clinical Guidelines, Acute Low Back Pain. Contents, Index page


Figure 1

Diagnostic Triage including 'Red Flags'


    Presentation between ages 20-55
    Lumbosacral region, buttocks and thighs
    Pain "mechanical" in nature
      varies with physical activity
      varies with time
    Patient well
    Prognosis good
    90% recover from acute attack in six weeks


    Unilateral leg pain worse than low back pain
    Pain generally radiates to foot or toes
    Numbness and paraesthesia in the same distribution
    Nerve irritation signs
      reduced SLR which reproduces leg pain
    Motor, sensory or reflex change
      limited to one nerve root
    Prognosis reasonable
    50% recover from acute attack within six weeks


RED FLAGS for Possible Serious Spinal Pathology

    Presentation under age 20 or onset over the age of 55.
    Violent Trauma: eg fall from a height, RTA
    Constant, progressive, non-mechanical pain
    Thoracic pain
    PMH - Carcinoma
    Systemic steroids
    Drug abuse, HIV
    Systemically unwell
    Weight loss
    Persisting severe restriction of lumbar flexion
    Widespread neurological signs and symptoms
    Structural deformity


    Difficulty with micturition
    Loss of anal sphincter tone or faecal incontinence
    Saddle anaesthesia about the anus, perineum or genitals
    Widespread (>one nerve root) or progressive motor weakness in the legs or gait disturbance
    Sensory level

INFLAMMATORY DISORDERS (Ankylosing spondylitis and related disorders)

    Gradual onset before age 40
    Marked morning stiffness
    Persisting limitation spinal movements in all directions
    Peripheral joint involvement
    Iritis, skin rashes (psoriasis), colitis, urethral discharge
    Family history
List of Figures

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