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Low Back Pain Care Pathway

Date of last update: November, 2024

8. Diagnostic Criteria for LBP Amenable to Conservative Care

 

  • Overview: Diagnosis requires a thorough understanding of the patient's condition, integrating their history, clinical findings, risk factors, and the physical, psychological, social, and environmental aspects of pain.

 

Common LBP Categories

Common LBP encompasses a broad spectrum of cases seen in primary care, often lacking a clearly identifiable nociceptive source. Categorizing these cases facilitates tailored treatment and better management of patient expectations.

 

Sacroiliac Joint Dysfunction

  • Accounts for 15-30% of LBP cases.

  • Presents as low back and buttock pain, potentially radiating to the groin or thighs.

  • Symptoms often worsen with prolonged sitting, standing, or weight-bearing activities and improve when lying down.

  • Exam findings include tenderness over the sacroiliac joint and positive SI joint tests, with no significant neurological deficits.

 

Myofascial Pain Syndrome

  • Common in individuals with sedentary lifestyles or repetitive motion activities.

  • Characterized by chronic low back muscle pain, often with referred pain patterns.

  • Associated with taut muscle bands and trigger points causing localized and referred pain upon compression.

  • Neurological deficits are typically absent.

 

Osteoarthritis

  • More common in older adults due to degenerative changes.

  • Presents as localized or radiating low back pain, often involving the hips, with episodic flare-ups.

  • Pain worsens with activity and improves with rest; morning stiffness may be present.

  • Examination reveals reduced range of motion, joint tenderness, and possible crepitus or swelling, generally without neurological deficits unless advanced.

 

Facet Joint Irritation

  • Common in middle-aged and older adults.

  • Presents with localized low back pain that may radiate to the buttocks or thighs.

  • Symptoms are exacerbated by movements like extension, twisting, or prolonged standing.

  • Exam findings include tenderness over the facet joints, with pain provoked by extension and rotation movements, typically without significant neurological deficits.

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CCGI is funded by provincial associations and regulatory boards, and national associations including the Canadian Chiropractic Association

and Canadian Chiropractic Protective Association. CCGI maintains editorial independence from funders.

All content and media on the Canadian Chiropractic Guideline Initiative (CCGI) website is created and published online for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. Always seek the guidance of a qualified health professional with questions, concerns or management regarding your health.

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