Compulsory examinations — special interventions and non-neurological examinations — in lower back pain

1. Big picture

Lower back pain is extremely common, but the examiner does not want only “back pain = disc herniation.” The important exam task is to separate:

1. Simple mechanical low back pain / lumbago

2. Radicular pain / sciatica due to nerve root irritation

3. Dangerous spinal disease: cauda equina syndrome, conus lesion, tumor, infection, fracture, spinal canal stenosis

4. Non-neurological mimics: hip disease, renal colic, urinary infection, gynecological disease, abdominal aortic aneurysm, retroperitoneal bleeding, pelvic malignancy

So, in lower back pain, the compulsory examination is not only neurological. You must examine the spine, nerve roots, lower limbs, bladder/bowel/sexual function, vascular system, abdomen, urinary system, hip, pelvis, and decide whether imaging is needed.

A modern practical point: routine imaging is not recommended for uncomplicated low back pain without red flags, but imaging is required when serious pathology is suspected or when the result will change management. NICE specifically advises against routine imaging in non-specialist settings and recommends considering imaging in specialist care only if it changes management.