Full DDx

Red Flag

<aside>

Red Flag	Worried about
Motor/sensory loss at any level	‣
Triad of fecal incontinence, urinary retention, saddle anesthesia	‣
Significant trauma	Spine fracture
</aside>

<aside>

Yellow Flag	Worried about
Weight loss, Fever, HIV, IVDU, Steroid	Osteomyeolitis
Wide-spread neurological signs	Stroke
• < 20 (AD) and > 55 (AAA)
•Vascular Risk Factors	Vascular diseases
Constant and non-mechanical Pain: unaffected by movement or position	Bone Met
</aside>

Etiology	Red Flags	Next Step
Neurological	- Diffuse motor/sensory loss,

Progressive neurological deficits, ‣ (surgical emergency) | Urgent MRI indicated | | Infection | - Fever,
IV drug use,
immune suppressed
Recent or ongoing infection | X-ray and MRI | | Fracture | Trauma, osteoporosis risk/fragility fracture | X-ray and may require CT scan | | Tumor | - history of cancer, particularly in the past five years
unexplained weight loss,
significant unexpected night pain,
severe fatigue | X-ray and MRI | | Inflammation | - chronic low back pain > 3 months
age of onset < 20 and > 55
morning stiffness > 30 min
improves w/ exercise
disproportionate night pain | Rheumatology consultation and guidelines | | Vascular | - ‣
‣ | ‣ |

Screenshot 2025-05-24 at 12.43.17 PM.png

Screenshot 2024-09-08 at 2.43.27 PM.png

Screenshot 2024-09-12 at 8.09.26 AM.png

#1 predictor of whether treatment to mechanical pain will work is: whether they believe that the treatment will work
Patterns evolution
- Leg worse than back, constant worse than IM
- Pattern 1 PEP is fixable with exercise in 2-4 wks
- Pattern 1 PEN, Pattern 3 (Sciatica), and Pattern 4 FA can turn into PEP (3 - 6 mon.) ****→ Then it becomes fixable
- The rest (Pattern 2, Pattern 4 FR) tend to stay
Flexion-aggravated: Treat like Pattern 1 - FA
Extension-aggravated: Treat like Pattern 2 - EA