10-minute consultation: chronic low back pain.

Symptoms—Discuss the likely causes. Show him a diagram or model of the lumbar spine indicating the vertebrae, discs, and nerve roots. Explain that his leg pain is due to irritation of the nerve roots and that effective treatment should alleviate both his back pain and his leg pain. History—When taking a history, be alert to: x Any recent trauma, which may raise the possibility of a fracture x “Red flag” signs (see box), which may indicate serious spinal pathology x “Yellow flag” signs, which are factors recognised as having an influence on long term disease outcomes and which may cloud assessment and treatment. Examination—Look for reduced range of spinal movement, reduced straight leg raise, positive neural stretch tests, neurological deficit (sensory, motor, reflex impairment), distribution of paraesthesias or sensory loss, reduced ankle and great toe dorsiflexion, knee and ankle reflexes. Risk factors—Overweight, a sedentary lifestyle, smoking, heavy physical work, repetitive lifting, twisting, and prolonged standing in an awkward posture can all cause or exacerbate back problems. What you should do