Spine

Low back pain

Mechanism

In the great majority of cases no identifiable structure produces the pain. The guideline therefore speaks of low back pain without a specific cause, and focuses on limitations in physical functioning rather than on a tissue.

Recognition

The guideline asks you to check the red flags first: features suggesting a fracture, infection, tumour or inflammatory disorder, or a neurological emergency. Urinary retention, incontinence or severe motor loss are emergencies.

Course

The guideline lets prognostic factors determine the course, not the duration of the complaint. Previous episodes, high pain intensity, leg pain, fear of movement, catastrophising and work-related factors predict persisting complaints.

What the guideline recommends

The guideline stratifies by risk of persisting complaints and selects a treatment profile accordingly. At low risk, education and promoting activity suffice; at high risk the psychosocial factors belong explicitly in the treatment.

Structures

• Multifidus, lumbar part
• Longissimus Thoracis
• Iliocostalis Lumborum (Lumbar Part)

Joints involved

• Facet joints (artt. zygapophysiales)
• Intervertebral disc (symphysis intervertebralis)
• Sacroiliac joint

Clinical tests

• Posteroanterior pressure
• Prone instability test
• Straight leg raise

Sources

• Swart NM, Apeldoorn AT, Conijn D, Meerhoff GA, Ostelo RWJG (red.). KNGF-richtlijn Lage rugpijn en lumbosacraal radiculair syndroom. Koninklijk Nederlands Genootschap voor Fysiotherapie / VvOCM. Amersfoort. 2021 https://www.kngf.nl/kennisplatform