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August 12, 1992

What Can the History and Physical Examination Tell Us About Low Back Pain?

Author Affiliations

From the Health Services Research and Development Field Program, Seattle (Wash) Veterans Affairs Medical Center (Drs Deyo and Kent); the Departments of Medicine (Drs Deyo and Kent) and Health Services (Dr Deyo), University of Washington, Seattle; and the Department of Rehabilitation Medicine, Tufts University School of Medicine, Boston, Mass (Dr Rainville).

JAMA. 1992;268(6):760-765. doi:10.1001/jama.1992.03490060092030

BACK pain ranks second only to upper respiratory illness as a symptomatic reason for office visits to physicians.1 About 70% of adults have low back pain at some time, but only 14% have an episode that lasts more than 2 weeks. About 1.5% have such episodes with features of sciatica.2,3 Most causes of back pain respond to symptomatic and physical measures, but some are surgically remediable and some are systemic diseases (cancer or disseminated infection) requiring specific therapy, so careful diagnostic evaluation is important. Features of the clinical history and physical examination influence not only therapeutic choices but also decisions about diagnostic imaging, laboratory testing, and specialist referral.

ANATOMIC/PHYSIOLOGIC ORIGINS OF FINDINGS IN THE LOW BACK  Low back pain may arise from several structures in the lumbar spine, including the ligaments that interconnect vertebrae, outer fibers of the annulus fibrosus, facet joints, vertebral periosteum, paravertebral musculature and fascia,