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Parcours de soins pour les lombalgies

Date de la dernière mise à jour : février 2024

Signs or Symptoms of Pathology (Red Flags)


Clinical Cornerstone: Consider asking additional questions that help evaluate for the presence of red flags in low back pain. Red flags are symptoms or signs that may indicate a serious pathology and should be deliberated in the clinician’s differential diagnosis.

  • Spinal fracture

    • Red flags: history of osteoporosis, corticosteroid use, severe trauma, female sex, older age, history of spinal fracture, history of cancer, history of falls.

    • Action: Refer to appropriate provider for imaging especially if pain is sudden in onset and pain is severe.


  • Spinal malignancy

    • Red flags: history of cancer, unexplained weight loss, unexplained significant night sweats, pain worse at night.

    • Action: Refer to an appropriate provider.

  • Spinal infection

    • Red flags: intravenous drug use, poor living conditions, immunosuppression, recent surgery/invasive interventions, history of TB (tuberculosis)/born in TB-endemic country, recent infection, unexplained constitutional symptoms (e.g., fever/chills).

    • Action: Immediate referral to emergency care.

  • Cauda equina syndrome

    • Red flags: saddle anesthesia, bladder/bowel dysfunction, bilateral radicular signs.

    • Action: Immediate referral to emergency care.

  • Neurological disorders

    • Red flags: upper/lower motor neuron findings, clonus.

    • Action: Refer to appropriate provider.

Orange Flags


Clinical Cornerstone: Orange Flags are symptoms or signs that may represent the presence of serious psychiatric disorder (e.g., major depression, major personality disorders, post-traumatic stress disorders [PTSD], substance addiction and abuse). In the event such disorders are present, referral to a psychiatric specialist would be indicated over usual care in the presence of non-major disorders such as anxiety. Screening can include:

Conduct patient assessment

Red flags present

Red flags present

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Refer to appropriate emergency or healthcare provider

Non-specific LBP or LBP with radiculopathy:

  • Education

  • Self-care

  • Exercise

  • Manual therapy

  • Medicines

  • Psychological therapy

  • Social support

  • Mind-body interventions

  • Needling therapies, electrotherapies*

  • Mobility assistive devices

  • Multicomponent biopsychosocial care

  • Topical ceyenne pepper

Additionally for LBP with radiculopathy:

  • Medical/surgical consultations

Other specific LBP:

  • Refer to appropriate emergency or healthcare provider

Major symptom/sign change

Goals not achieved


Adjust treatment and management plan or refer

References or links to primary sources

Contact information for further inquiries or feedback


These care pathways are intended to provide information to practitioners who provide care to people with musculoskeletal conditions. The care pathways on this website are 'living' documents, reflecting the state of clinical practice and research evidence to our best knowledge at the time of development. As knowledge and healthcare practices evolve, these pathways may be updated to ensure they remain current and evidence driven. These pathways are not intended to replace advice from a qualified healthcare provider.

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