Getting it wrong with lower back pain patients can be easy…

And that’s not good! 

If you are like most new grads the lower back is an area of the body your fear, worrying that you might miss something serious…

Or flare up patients symptoms with your hands-on treatments or rehab.

There are so many possible differential diagnoses in the lumbar spine and this adds to your confusion.

You lack confidence in your diagnosis, so you keep it safe, out of worry that you might make things worse.

So you prescribe low key rehab… 

Or even rest at that start.

But this doing nothing or ‘resting’ approach is usually not the best approach…

Not just for the lower back but for any injury.

The problem with doing very little is that patients do not progress.

And this results in patients losing faith in your rehab plan, so they stop doing their rehab exercises.

With any lower back injury you need to be mindful of serious pathology, but by using your red flag questioning you can rule these out quickly in the subjective assessment. 

However, even when you have done this do you sometimes feel worried about getting your hands on and getting your patient moving?

To make things a little easier with your assessment try to approach things this way…

When you first assess a patient with lower back pain the first thing I want you to do is this…

Identify if your patients main problem relates to FLEXION or EXTENSION.

This helps you to simplify your diagnosis and put in short, put your patient in a ‘bucket.’

Either they are in your ‘flexion’ bucket or your ‘extension’ bucket.

So your patient that tells you that driving or sat at their desk at work makes their back pain worse would go in your ‘flexion’ bucket.

And that patient that tells you prolonged standing, walking or running makes their back pain worse would go in your ‘extension’ bucket.

Some patients may have problems with various different activities, or as you might call, have a mixed pattern…

But almost in all cases they will have one dominant movement issue.

This simple method allows you to identify your patients biggest problem and helps you to direct your hands on treatments and rehab in improving this problem first.

Focus on the big problems first…

And you will often find the smaller issues clear up at the same time. 

Keep things simple and do the basics things well and you can make a big impact with patients lower back pain…

Even with trickier cases…

And even if you have not had a lot of experience seeing patients with lower back problems.  

Andy

The New Grad Physio Mentor

P.S. Want to know more about how to better manage patients with lower back pain?

Send me an email to andy@newgradphysio.com or a DM on my Instagram [ https://www.instagram.com/newgradphysio/ ] with the words ‘lower back’ and I’ll be happy to try help you out and get to the bottom of why you find these injuries tricky…

And give you some strategies to build your knowledge, skills and confidence in treating any patient with lower back pain.