1. BACK PAIN... What else could it be?
Martin Melbye PT Dip MDT

2. Possible diagnoses?

3. ABDOMINAL
gall stone
kidney stonesVisceral causes
infections
tumours
GYNECOLOGY
cysts/tumours
fibroma
infections
ectopic pregnancy

4. rED FLAGS
Age < 20 or >55
Non-mechanical pain
Night pains
Previous cancer, steroid use
Weight loss
Bad general condition
Thoracic pain
Trauma

5. “Harry”
68 year old
Back and bilateral leg
pain
Symptoms for 12
months

6. Spinal Stenosis

7. Spinal stenosis
Likelihood of stenosis after a Likelihood of stenosis after a
Subjective history finding negative response negative response
Stenosis prevalence 2% Stenosis prevalence 13%
1) Pain below the buttock? 0,67 % 4,97 %
2) Age over 65 years? 0,22 % 1,7 %
3) Symptoms relieved by
sitting?
0,06 % 0,48 %
4) Symptoms provoked by
walking?
0,02 % 0,16 %

8. “Victor”
24 years old
Low Back and bilateral
buttock pain

9. Spondylolisthesis

10. Spondylolisthesis
21 out of 936 asymptomatic individuals had
spondylolistesis (Libson 1982)
Spondylolisthesis associated with 25% greater risk of
LBP (Grosser 1996)

11. Spondylolisthesis
X-Ray to exclude
Functional X-Ray to determine instability
MRI to examine nerve root affection

12. “Matt”
37 years old
Severe back pains
Disturbed sleep, wakes up towards the
morning.
Difficult to take care of work as a banker
Back feels stiff
Very tired
Slow onset
Improves when gardening

13. Inflammatory Back pain
4 out of 5:
Onset of back pain before the age of 40.
Insidous onset.
Improves after activity.
No improvement with rest.
Night pains that eases when the patients gets out of bed.
Family history
Psoriasis
Crohns/Collitis

14. Inflammatory Back pain
Less than
10/12 cm

15. Inflammatory Back pain
STIR MRI

16. “lizzy”
78 years old
Acute onset back pain 4
days ago while
gardening
Constant pain
Radiating into the thigh

17. Osteoporotic fracture
Sudden onset
Direct pain on vertebrae
Worse with walking,
standing, sitting, moving
XRAYS - DEXA-scan

18. Osteoporisis - Risk
Woman (every 3rd woman, every
8th male)
Early menopause (<45 years)
Family history
Steroid treatment >5 mg daily
and/or more than 3 months
Tobacco/alcohol use
Low body weight

19. “Eric”
52 year old cab driver
Sharp back pain for 1 month
Radiating into left thigh
Constant pain

20. “Eric”
Pain on percussion of vertebrae
Bad general condition
Severe pain in left groin
Sweating

21. Infection
Generally unwell
Previous infection or
surgical procedure
Discitis or Epidural
abcess
PSOAS ABCESS

22. “Eliza”
70 years old
Low Back Pain 4 months ago
Slow onset, no specific cause
No previous back pain episodes
WHATS YOUR PLAN?

23. Age
Previous history
General health

24. Blood tests
Infection, inflammation
Affection of kidney or urinary system
Bones (fracture, inflammation, cancer)
Prostate
Other

25. Spinal tumours
Most often metastases 25:1
Chest, prostate, lungs, kidney, colon.
Thoracic pain
Night pains
Constant pain
Weight loss 5-10% over 3-6 months

26. Xrays - MRI
Individuals WITH NO symptoms
Stenosis 21 %
Spondylolisthesis 2 %
Disc prolapse 36 %
“Degenerative changes” 80 %

27. Remember this...