Lower Back pain

1. 80% if the back pain is lumbar strain, mostly seen in ages 30-60, associated with overuse. 

If shooting down the leg, consider pinch nerve due to herniated disc (3-4%); 

If >70 yr female with osteoporosis, consider compression fracture (3-4%); 

If worse walking upright, consider spinal stenosis (3%); 

If in ages 20-30 and better with activity, consider spondyloarthritis (<1%); 

If losing weight with history of cancer, consider cancer; 

If developing fever in immunocompromised patient, consider infection/abcess.

2. Red Flags: Age>50, history of cancer, fever, pain worse at night or lying down, morning stiffness, urinary symptoms, bilateral sciatica, numbness in the pelvis, steroid use, injection drug use. 

3. Localizing lesion based on symptoms

    L3 - anterior thigh and knee;

    L4 - anterior shin;

    L5 - dorsum of the foot;

    L5/S1 - lateral and posterior calf

    S1 - heel.

4. Localizing lesion based on physcial exam

    L4 nerve root - decreased patellar reflex, weak rising from squat

    L5 nerve root - weak great toe dorsiflexion, weak heel walk

    S1 nerve root - decreased ankle reflex, weak toe walk

1. Female much easier to get infected

2. Typical symptoms: lower belly pain, burning pain when peeing, urinary urgency, and frequency

3. Watch for fever and flank pain for a complication of kidney infection (pyelonephritis)

4. Usually improving fast with appropriate antibiotics