Low Back Pain Assessment – 1

This is the first of our three part blog on low back pain assessment, stay tuned for parts two and three!

Given that 85% of chronic LBP cases have no exact diagnosis the assessment of the condition needs to cover all potential aspects set out by O’Sullivan (2005).The local mechanical structures must be assessed for their quality of movement as well as their ability to absorb stress. Neurological signs must be fully covered starting with assessment of peripheral neuropathy, to central causes of pain and clearance of lesions to the higher centres. On top of this the therapist must be sensitive to biopsychosocial issues; what is the state of mind of the patient? Are there other factors involved in the maintenance of their symptoms?

The initial stages of an assessment are subjective in nature. The history of an injury, and patient should allow for a reasonable theory of diagnosis to be developed, which can often allow an objective assessment to be more succinct and accurate. It is during the subjective history taking that signs of psychological stress will be first picked up. It is also the point at which the therapist may develop a knowledge of what are known as SIN factors; Severity, Intensity and Nature of the symptoms. This will guide the therapist as to how aggressive any objective assessment may be. Such questions will include, how long have you had the symptoms? How did they start? Is the pain constant? How severe out of 10 is it? Are you having pain at night?

Further special questions must be asked that may give a clue to more serious pathology eg loss of bladder control may be a sign of impingement of the spinal cord that may require emergency surgery. Pain on coughing or sneezing may also be a sign of discogenic injury.

We cannot forget that patients presenting to physiotherapy practises may not be suffering from neuromusculoskeletal problems at all. It is therefore imperative that the therapist has an understanding of when to refer back to a GP or Consultant for medical opinion. This includes an in-depth knowledge of ‘red flags’. A sense of an issue not being neuromusculoskeletal in nature will be picked up at the subjective stage; we cannot try to pigeon-hole all cases into our own understanding of the body. An understanding of medical pathology, or at the very least when a case simply ‘doesn’t fit’ is crucial if we are to provide the best possible care for our patients.

 

References:

Ferreira M L, Ferreira P H, Latimer J, Herbert R D, Maher C, Refshauge K. Relationship between spinal stiffness and outcome in patients with chronic low back pain. Manual Therapy 2009: 14;61-67

O’Sullivcan P. Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism. Manual Therapy 2005: 10;242-255

Wand B M, Parkitny L, O’Connell N E, Luomajoki H, McAuley J H, Thacker M, Moseley L. Cortical changes in chronic low back pain: Current state of the art and implications for clinical practice. Manual Therapy 2011: 16(1);15-20

Instagram

Book an Appointment

Pass This Post On

Share on facebook
Facebook
Share on google
Google+
Share on twitter
Twitter
Share on linkedin
LinkedIn

Book an Appointment

Don’t Stop Here

More To Explore

5 Benefits of Physiotherapy for Athletes

Here are five great benefits of using physio that athletes, whatever their level should know about. 1. Enhance Physical Strength Training can take a toll on the body, straining the muscles, joints, bones, and ligaments. Physiotherapy will be able to help increase the strength in your body. 2. Help To De-Stress Your Body Physiotherapy can be used to destress your

Opening a Clinic After Covid

We are finally open! It’s been a tough few months but we see a little light at the end of the tunnel. We are still offering online appointment for anybody not able to travel, however for those of you that feel you need a face to face appointment we are now opening our clinics for 1:1 appointments. There will be

Changing Times

These are changing times for all of us, Co-Vid 19 has literally stopped the world. As a small business we are going through the most challenging time of all and we are desperately trying to keep our head above water. Our clinics have shut, however we have not!! We believe with the entire nation working from home we are not