Patient History

The general questions to be asked could be a combination of the following:

  • Age: different conditions occurring at different ages
  • Occupation: highly physical jobs resulting in a high incidence of injury
  • Sex: higher incidence in women
  • Mechanism of injury: lifting, with or without weight
  • How long has the problem existed: acute to chronic. Chronic low back pain may result in a deconditioning syndrome of the muscles
  • Where is the pain: specific or general, uni/bilateral or involving other areas like the SI joint
  • Radiation of pain: not necessarily a disc problem, consider referring patterns
  • Postures increasing or decreasing the pain: which structures are involved in those postures or movements
  • Movements increasing/decreasing the pain: postural and dynamic muscles, painful arcs
  • Weakness or decrease in strength: muscle, nerve, nerve supply
  • Patient’s usual pastimes and activities: what could be causing the pain or was out of the ordinary
  • Micturation problems: serious, and could involve more than the lumbar spine
  • Medications: what problems are already present, and if the patient has taken their medication, a true reading of their pain may not be presently possible.
  • Always be aware of red flags!
    • Age at onset (<20 or >55 years)
    • Significant trauma
    • Constant, progressive, non-mechanical pain
    • Thoracic pain
    • Previous history carcinoma, systemic steroids, drug abuse, HIV
    • Unexplained weight loss
    • Persisting severe restriction of lumbar flexion
    • Widespread neurological changes
    • Fever
    • Structural spinal deformity

(ICSI 2012, Magee 2006)

Along with red flags, there are also yellow, blue and black flags.

(Main et Williams, 2002)