Etiology
Lower back pain (LBP) is one of the most common presentations seen in practice. Whilst the majority of presentations will be of a non-specific muscular nature it is worth keeping in mind possible causes which may need specific treatment.
Red flags for lower back pain
The table below indicates some specific causes of LBP:
| Facet joint | May be acute or chronicPain worse in the morning and on standingOn examination there may be pain over the facets. The pain is typically worse on extension of the back |
|---|---|
| Spinal stenosis | Usually gradual onsetUnilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down. Pain may be described as 'aching', 'crawling'.Relieved by sitting down, leaning forwards and crouching downClinical examination is often normalRequires MRI to confirm diagnosis |
| Ankylosing spondylitis | Typically a young man who presents with lower back pain and stiffnessStiffness is usually worse in morning and improves with activityPeripheral arthritis (25%, more common if female) |
| Peripheral arterial disease | Pain on walking, relieved by restAbsent or weak foot pulses and other signs of limb ischaemiaPast history may include smoking and other vascular diseases |
Acute Back Pain
(Lumbar) Spinal Stenosis
A degenerative condition where the spinal canal is narrowed, resulting in compression of one or more of the spinal roots
most commonly seen in elderly with DJD (OA) and usually affects lumbar spine