Aetiology

• Most back pain is innocent and self-limiting

Risk factors for simple back pain

• Previous back pain
• Heavy lifting/frequent bending
• Repetitive work with exposure to vibration

Clinical features

Signs

• Back examination
  • Gait
  • Look - from side and back
  • Feel - SPs, steps, SI joints
  • Move - flexion, extension, lateral bending, rotation
• Other tests: SLR, muscle strength, sensation, deep tendon reflexes

When to investigate - red flags

General

• Failure to improve after 4-6 weeks of conservative therapy
• Unrelenting night pain or pain at rest
• Progressive motor or sensory deficit

Cancer

• Age > 50 years
• Unintended weight loss
• History of cancer
• Pain at night and in recumberncy