Hamilton Hall, MD, FRCSC,¹ Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH,² Yoga Raja Rampersaud, MD, FRCSC,³

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Abstract: In 1987, the Quebec Taskforce noted, "Distinct patterns of reliable clinical findings are the only logical basis for back pain categorization and subsequent treatment." Identifying these patterns begins with the patient's history: "Where is your pain the worst?" "Is your pain constant or intermittent?" "Has there been any change in your bowel or bladder function?" This questioning establishes the mechanical nature of the pain, and a physical examination verifies or refutes the pattern established in the history. The examination involves two essential tests to detect upper motor and low sacral root involvement. A failure of the results to fit into one of four syndromes—two back dominant and two leg dominant—suggests a non-mechanical or more complex problem.

Key Words:patterns of back pain, pain location, pain characteristics, history, physical examination.

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90% of Low Back Pain is not related to serious pathology and does not require surgical intervention.

Mechanical Low Back Pain can be categorized to patterns that are identified in history and confirmed in the physical examination.

Findings on radiological imaging including x-ray, CT scan and MRI have not been found to correlate to pain-generating pathology, can increase patient anxiety and detract from successful recovery.

A concise history starts with two questions: "Where is your pain the worst?" and "Is your pain constant or intermittent?"

The goal of physical examination is to verify or refute the diagnostic assumptions made on the basis of the history.

Managing low back pain is not a one-time event. Low back pain is a chronic condition that demands ongoing care and follow-up.

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Dr. Clarfield, MD, FRCSC, is the Chief of Academic Affairs at the Herzog Hospital in Jerusalem, Director of Geriatrics in the Ministry of Health, and on staff in the Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, PQ.

Geriatrics, the medical specialty which deals with the old, is still relatively young. Although not all Canadian medical schools offer a comprehensive approach to teaching this subject, progress has been made especially in the last two decades. There are now more clinical units, more research is being carried out, and certainly more attention is being paid to the subject of the elderly than ever before.

The roots of geriatrics can be traced back to the beginning of this century, and two of its pioneers hail from opposite sides of the Atlantic: Dr. Ignatz Nascher, an American whose medical career began at the end of the 19th century;¹ and an English physician, Dr. Marjory Warren, who reached the zenith of her influence in the 1940s.²

Dr. Nascher was born in Vienna in 1863 and was brought up in New York. In 1882, aged 19, he graduated in pharmacy and several years later completed his MD and began private practice. Little is known about his early years, but Dr. Nascher's first paper on geriatrics ("Longevity & Rejuvenesence," New York Medical Journal, 1909) was to have a profound influence on the discipline simply by giving us its name.