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Low Back Pain Care Pathway

Date of last update: November, 2024

8. Diagnostic Criteria for LBP Amenable to Conservative Care

 

  • Overview: Diagnosis requires a thorough understanding of the patient's condition, integrating their history, clinical findings, risk factors, and the physical, psychological, social, and environmental aspects of pain.

 

Common LBP Categories

Common LBP encompasses a broad spectrum of cases seen in primary care, often lacking a clearly identifiable nociceptive source. Categorizing these cases facilitates tailored treatment and better management of patient expectations.

 

Sacroiliac Joint Dysfunction

  • Accounts for 15-30% of LBP cases.

  • Presents as low back and buttock pain, potentially radiating to the groin or thighs.

  • Symptoms often worsen with prolonged sitting, standing, or weight-bearing activities and improve when lying down.

  • Exam findings include tenderness over the sacroiliac joint and positive SI joint tests, with no significant neurological deficits.

 

Myofascial Pain Syndrome

  • Common in individuals with sedentary lifestyles or repetitive motion activities.

  • Characterized by chronic low back muscle pain, often with referred pain patterns.

  • Associated with taut muscle bands and trigger points causing localized and referred pain upon compression.

  • Neurological deficits are typically absent.

 

Osteoarthritis

  • More common in older adults due to degenerative changes.

  • Presents as localized or radiating low back pain, often involving the hips, with episodic flare-ups.

  • Pain worsens with activity and improves with rest; morning stiffness may be present.

  • Examination reveals reduced range of motion, joint tenderness, and possible crepitus or swelling, generally without neurological deficits unless advanced.

 

Facet Joint Irritation

  • Common in middle-aged and older adults.

  • Presents with localized low back pain that may radiate to the buttocks or thighs.

  • Symptoms are exacerbated by movements like extension, twisting, or prolonged standing.

  • Exam findings include tenderness over the facet joints, with pain provoked by extension and rotation movements, typically without significant neurological deficits.

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