This chapter will focus on acute low back pain, which will be defined as activity intolerance due to lower back or back related leg symptoms of less than 3 months duration. Nearly 90 percent of patients spontaneously recover from low back pain symptoms and resume normal daily activities within 3 months. Initial Assessment A focused medical history and physical examination are sufficient to assess the patient with acute or recurrent limitations due to low back symptoms less than 4 weeks of duration. Major trauma such as vehicle accident, aircraft mishap, or fall from height. Look for any history of cancer.
Constitutional symptoms can include recent fever, chills, or unexplained weight loss.
A pattern of worsening back pain at night, worse when supine. Evaluate for saddle anesthesia, bladder dysfunction, such as urinary retention, increased frequency, or overflow incontinence. Also assess for a severe or progressive neurologic deficit in the lower extremities. Back related lower limb symptoms suggesting lumbosacral nerve root compromise or compression. These occur primarily in the back and suggesting neither nerve root compromise nor a serious underlying condition.