Travell and simons sciatic
The brief examination should incorporate: inspection, palpation, brief neurological examination and an assessment of function.
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Asking the patient to confirm how they have been managing the condition.Establish whether there has been malignancy that metastasises to bone (lung, breast, prostate, thyroid, kidney) or myeloma. Asking the patient to confirm what they think caused the pain.Noting the patient's occupation, what it involves and hobbies or sport.Confirming whether the patient has had this problem previously.Establishing whether there are aggravating or relieving factors.Enquiring whether there is pain radiation to anywhere else.Confirming whether pain was sudden or gradual in onset.Other risk factors include psychosocial work-related stress and family history. Highly demanding jobs, prolonged standing and awkward lifting are the most consistent factors predisposing to low back pain.For most people, low back pain is nonspecific and serious specific causes are rare.The one-year prevalence of chronic low back pain is about 1%. A UK population-based cross-sectional study of people aged 25 years and older found the one-month period prevalence of low back pain to be around 30%, peaking at age 41-50 years.
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About 60% of people in the UK report back pain at some time in their lives. Low back pain may be classified as acute (present for less than six weeks) or chronic (present for more than six weeks).It tends to have an insidious onset and follows a chronic course. It tends to present with pain and stiffness on waking and is improved by movement. Inflammatory low back pain is caused by rheumatoid conditions such as ankylosing spondylitis affecting the spinal joints.Nonspecific low back pain is diagnosed when lower back pain cannot be attributed to a specific cause.A specific cause such as intervertebral disc prolapse, vertebral fracture or facet joint injury may be identified in some cases.Mechanical back pain arises from the spinal joints, vertebrae or soft tissues and characteristically it varies with posture and is exacerbated by movement.