To the Editor.
—I read with great interest the recent article in JAMA regarding the rational clinical examination of lower back pain.1 In the introductory remarks, numerous apparent causes of lower back pain were described, and the article goes on to discuss the serious causes of disease that create pain in the lower back. It is not surprising to read that up to 85% of patients cannot be given a definitive diagnosis using the criteria of the article and the diagnostic techniques.The authors make no mention of palpatory physical examination and motion testing to evaluate structural symmetry, limitations in normal joint motion in the facet joints, sacroiliac joints, and pubic symphysis articulation. I assume this is because the authors have never been trained to perform an adequate biomechanical and structural evaluation of the musculoskeletal system, and do not have the skills to localize and determine the cause of
Abromovitz AM. Back Pain: The History and Physical Examination. JAMA. 1993;269(3):354. doi:10.1001/jama.1993.03500030052018