According to Koes et al. (2010), the following summary can be made regarding LBP diagnosis.

Beginning with physical examination, perform an examination with the following elements:

  • Inspection
  • ROM
  • Posture – kyphosis and lordosis
  • Palpation
  • Mobility

The guidelines from Europe, Australia and Spain explain to use caution when testing ROM, posture and inspection due to their low reliability and validity.


Testing should first begin with identification of red flags and exclusion of specific diseases (Koes et al. 2010). These red flags indicate specific low back pain and could include:

  • Age at onset (<20 or >55 years)
  • Significant trauma
  • Unexplained weight loss
  • Widespread neurological changes
  • Fever
  • Thoracic pain
  • Structural spinal deformity

Special tests


Testing of pain and functional limitations should also be tested, using valid and reliable tests.

Quebec back pain disability scale: It is most reliable with a sufficient scale to identify improvements or worsening in most subjects (Davidson et al 2002), valid, reliable and responsive (KNGF, 2003).
Oswestry low back pain disability questionnaire: It has “strong qualities” in regards to content and construct validity, feasibility, linguistic adaptation and international use, with good psychometric qualities (Calmels et al. 2005), most reliable with a sufficient scale to identify improvements or worsening in most subjects (Davidson et al 2002).
Patient specific functional scale: This questionnaire is recommended by the KNGF (2003), valid, reliable and responsive in populations with acute and chronic low back pain (Horn et al. 2012), ICF activity component was most commonly represented by patient-nominated PSFS items; the PSFS complements impairment-based clinical outcome measures (Fairbairn et al. 2012).
4DSQ: It has a good criterion validity and diagnostic accuracy with respect to depressive and anxiety disorders (Langerak et al. 2012), a valid self-report questionnaire to measure distress, depression, anxiety and somatization in primary care patients (Terluin et al. 2006). Score form.

Diagnostic Imaging

The abnormalities in X rays and MRI and the occurrence of non-specific low back pain seem not to be strongly associated, as abnormalities found when imaging people without back pain are just as prevalent as those found in patients with back pain (Koes et al. 2006).

Differential Diagnosis

According to this initial examination, a neurological screening should be performed with the following elements:

  • Strength
  • Reflexes
  • Sensibility
  • SLR
  • Lasegue


Patient History