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Orthopedics – Low Back Pain
Whiteboard Animation Transcript
with Simon Harris, MD
https://medskl.com/Module/Index/low-back-pain


Low back pain will occur in 75% of people at some point in their lives. Thankfully, 90% of episodes are benign and self limiting.

We can group low back pain into four types dependent on the main site of pain and positions of exacerbation:

Mechanical low back pain dominant; Worse with flexion. These patients typically have worn-out discs as the source of their pain, so it hurts when they bend to lift things.
Mechanical low back pain dominant; Worse with extension. These patients typically have osteoarthritis of their facet joints and are more comfortable slouching forward
Leg pain dominant – Constant and worse with flexion. These patients are your typical sciatica patients, which comes from a disc herniation pushing on a nerve root.
Leg pain dominant – Intermittent and relieved by flexion. These are your classic neurogenic claudication patients. They are comfortable at rest but because they have spinal stenosis, when they stand up and walk they get leg pain which improves if they push a shopping cart!

It is important that the doctor rules out anything dangerous first! Check the patient’s bowel and bladder are working well, that their legs are strong and they have no numbness in the perineal region.

If they have a fever, are immunosuppressed or a history of cancer or weight loss then the patient needs more urgent investigations.

Otherwise the management is simple: education and exercise. Low back pain is a chronic disease which will have flares of symptoms that can be managed with simple pain killers, anti-inflammatories, physiotherapy, stretches, chiropractic manipulations, acupuncture, weight loss, smoking cessation and reassurance.

If the patient’s symptoms last for longer than 6 weeks, the physician can consider an MRI and referral to a spine surgeon or chronic pain physician for assessment.