Clinical and Diagnostic Evaluation of Low Back Pain

The clinical and diagnostic evaluation of patients with low back pain can be an extremely challenging and frustrating task. Fortunately, most episodes of low back pain are self-limiting and do not require extensive evaluation or treatment. Clinicians must search for “red flags,” which may indicate more serious pathology, during their evaluation. The presence of one of these may trigger a more extensive work-up. Physical examiniation, imaging modalities, including plain radiographs, bone scans, and magnetic resonance imaging, diagnostic injections, and provocative discography, can all be utilized in the evaluation of low back pain. Unfortunately, no one test or any combination of these tests can pinpoint the exact anatomic source of pain in each patient. Therefore, clinicians formulating treatment plans based upon these tests should do so with caution.