Pattern Recognition

Three distinct patterns of low back pain symptoms can be recognized:

1. Nonspecific back symptoms

2. Sciatica (pain radiating to a leg)

3. Symptoms of a potentially serious spinal condition (eg, tumor, infection, spinal fracture) and major neurologic compromise as with the cauda equina syndrome, bowel or bladder dysfunction, or weakness.

The most important elements of the history are the characterization of the presenting pain and determination of the presence or absence of sciatica. Particular note should also

be made of any preceding trauma including strenuous lifting, prior attacks of pain, prior evaluations, prior and current treatment, and the duration and progression of symptoms. The use or abuse of drugs also should be noted, as well as the presence
of symptoms consistent with malignancy or infection. The patient should be asked about the presence and localization of weakness, numbness, dysesthesias and estheias, bladder, bowel and sexual dysfunction, which might indicate spinal cord compression; and about any accompanying abdominal or flank pain which might indicate an intra-abdominal or pelvic origin of the pain. The table 1 lists the "red flags" that should alert the physician of a more serious underlying condition


@Lyndeanw, United States

Im a 53 y/o healthy, weight appropriate female. I was diagnosed with degenerative lumbar spinal disease, including stenosis at the age of 38. I have a history of several low back injuries, including dislocation of my coccyx, due to falls from horseback riding
I've also worked as an EMT/Paramedic for over 32 years in several different ED units. Long hours on my feet in physically demanding situations.
I developed right hip pain with occasional leg weakness a few years ago, but managed to perform daily tasks without severe discomfort.
I've started to have increased (R) hip/glut pain in the past three months, radiating laterally through my thigh, calf and ankle. This frequently causes thigh and calf spasms that have been debilitating In all of my daily activities. I've seen my PCP, and an Orthopaedic surgeon, with negative findings on exam and MRI.
Any idea what the possible problem could be? Then, how to manage the pain and be able to work, sleep, clean my home and enjoy life again?
Thank you
Lyndean W

@md111, United States

i am unable to bend my knee without severe pain. Very difficult and painful. My lower back always has a stifness and throbing pressure.
I also have servere shooting pain across my back periodically.

@thersea, United States

I have been diagnosed with spinal stenosis & spondolylesis. I have pain radiating from my butt down leg top of foot. Sometimes bottom of foot & also in the groin area. 1 side or the other every day. The pain is horrible. Sometimes both sides. Can't sit can't stand hardly sleep. Help? Have had 2 cortizone shots in a 6mo. period.1st helped. 2nd to a small degree. Unable to take pain meds.

@colatulgupta, India

Very good material. I wonder if some photographs and radio graphs could be added. Dr Atul Gupta