Clinical pearls on lower back pain

  • What is the greatest predictor of LBP? A study in Utah showed that having a first-degree relative with LBP gives you a 4.15 relative risk. Of course, things like occupation and advanced age are risk factors, too.
  • The posterior iliac crest is the best physical marker of L4-L5
  • How to evaluate for disc herniation on physical exam:
    • Most sensitive test: direct straight leg raise
    • Most specific test: crossed straight leg raise
    • To test the femoral nerve, have the patient lie on their side and hyperextend their hip.
  • You should always encourage your patients to do exercises for lower back pain: pelvic tilt, rotations, bird-dog, knee to chest, piriformis. Ordering physical therapy is almost always the right answer.
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