low back pain

onset

hours days weeks months years
sudden gradual

new?

new issue previously known issue

intensity

mild mild-moderate moderate moderate-severe severe

frequency

single episode constant intermittent daily few times a week few times a month

duration

few minutes less than an hour few hours most of the day few days

status

improving unchanged resolved gradually worsening significant worsening

context

trauma/fall yes no repetitive movement yes no

location

back/buttock dominant leg dominant
lumbar spine midline more on right side more on left side iliac crest

radiation

none entire spine left buttock right buttock left leg right leg

quality

debilitating dull pressure superficial sharp throbbing stabbing

timing

daytime upon awakening night time

aggravated by

nothing flexion extension all movements walking/standing lying down

relieved by

nothing flexion extension walking/standing lying down stretching OTC meds prescription meds massage heat ice

red flags

all reviewed, negative

inspection

normal

palpation

normal

gait

heel walking (L4-5) toe walking (S1) antalgic

standing

kneeling

ankle reflex (S1)

supine

passive SLR passive hip ROM

prone

femoral nerve stretch (L3-4)

glute maximus power (S1)

saddle sensation (S2-4)

passive back extension

other

Assessment:

mechanical back pain non mechanical back pain

acuity

acute chronic acute on chronic

red flags

no red flags

details

medication

tylenol topical NSAIDs PO NSAIDs opioids

physiotherapy

self referral MFP physio

- private coverage

yes no

other therapy

massage therapy

off work

yes (1-2 weeks) no

follow-up

2-4 weeks PRN only

RTC

instructions given

other

LOW BACK PAIN

S/

O/

A/

P/