Important History and Physical Examination Pearls of Athletic Back Pain
Author: Clay Guynn, DO FAAPM&R/Sports Medicine
A) Pain radiating down the left leg
B) Trouble initiating urination
C) Exquisite tenderness to paraspinal muscles
D) Antalgic gait
Correct answer is B. There are red flags for back injuries that all physicians should know. This includes new onset of back pain at extremes of age (< 20 years or > 50 years), history of cancer, constant, non-mechanical back pain, or pain worse when lying down, presence of neurologic symptoms including weakness and numbness, bilateral symptoms, immunosuppression (i.e. HIV/AIDS, corticosteroids, immunomodulating drugs), IV drug use, change in bowel/bladder function, erectile dysfunction, fever or night sweats, anticoagulant use. Radicular pain, paraspinal tenderness and antalgic gait are not red flags and can be seen following in patients with mechanical back pain as in this case or other non-surgical cases.
Verhagen, Arianne P., et al. “Red flags presented in current low back pain guidelines: a review.” European spine journal 25.9 (2016): 2788-2802.