Acute/Chronic(> 12 weeks) back pain HPI Onset: • Activity at onset: • Location of pain: • Radiation: • Quality: • Provoking factors: • Alleviating factors: • Neuropathic symptoms: • Core Red flags: ALL NEGATIVE -Weakness: No -Loss of bowel control: No -Inability to void: No -Fevers: No -Immunocompromised: No -Prev history of cancer: No -Prev history of IVDU: No »«YES - Pt requires urgent imaging with MRI!
Yellow Flags -Do you think your pain will improve or worsen? -Do you think you would benefit from activity,movement or exercise? - How are you emotionally coping with your back pain? - What treatments or activities do you think will help you recover?
O: Gait: antalgic«, otherwise normal»«, •» L-spine: No SEADs, pain with palpation of • Flexion: • Extension: • Lateral flexion: • Rotation: •
S2/S3: deferred to due to lack of clinical concern Babinski: «negative» SLR: «positive»«ipsilateral pain»«negative»
A: «Back-dominant»«Leg-dominant» mechanical back pain; likely • P: Reassurance that symptoms improve in 1-2 weeks Conservative mgmt while acute: heat, massage, stretching (demonstrate or handout given), staying active Physiotherapy consult if no improvement in 1-2 weeks «Imaging not indicated at this time» «Rx given: •» Advised of red flags; f/u if no improvement after physio or PRN