Clinical evaluation and red flags of acute low back pain in primary care


  • Marwah Y. Abdullah Department of Family Medicine, East Jeddah Hospital, Jeddah, Saudi Arabia
  • Reem A. Bana Primary Health Care, Ministry of Health, Mecca, Saudi Arabia
  • Seham O. Aldogil Primary Health Care, Ministry of Health, Mecca, Saudi Arabia
  • Mutlaq A. Alsolami Department of Emergency Medicine, Anak General Hospital, Dammam, Saudi Arabia
  • Reem A. Alshihri College of Medicine, Ibn Sina National College, Jeddah, Saudi Arabia
  • Mohammed H. Alotaibi Primary Health Care, Ministry of Health, Albaha, Saudi Arabia
  • Shahd A. Alharbi College of Medicine, Ibn Sina National College, Jeddah, Saudi Arabia
  • Hisham H. Alqari College of Medicine, King Faisal University, Hofuf, Saudi Arabia
  • Reem M. Alsaadi Primary Health Care, Ministry of Health, Mecca, Saudi Arabia
  • Khulood A. Sindi Primary Health Care, Ministry of Health, Mecca, Saudi Arabia
  • Noor B. Alshamase Al Nahda Primary Healthcare, Ministry of Health, Jeddah, Saudi Arabia
  • Abdulrahman F. Albouq College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  • Hammad A. Alshaikh Department of Cardiology, King Salman Medical City, Medina, Saudi Arabia



Acute low-back pain, Clinical, Assessment, Diagnosis, Treatment, Red flags


Back pain has been reported as a common cause for various patients to present in an emergency or primary care settings. Besides, the management of back pain has been associated with a huge economic burden and remarkably impacts the quality of life of the affected patients. The diagnosis of acute low-back pain can be adequately achieved by conducting proper clinical evaluation and knowing the characteristics of each condition. The present review discusses the clinical evaluation and red flags for diagnosing patients presenting with acute low-back pain. An adequate examination of patients is conducted by obtaining a thorough history and successful physical examination. It should be noted that obtaining an adequate history might not be enough in some cases, and physical examination might not show any diagnostic clues. However, we also reported various red flags for detecting serious conditions, including malignancy, infections, inflammation, and others. These might help establish a further assessment of these patients, including imaging and laboratory studies. Therefore, these cases should be managed as early as possible to enhance the prognosis and intervene against any potential complications.



Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, et al. The rising prevalence of chronic low back pain. Arch Int Med. 2009;169(3):251-8.

Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013;13(1):99-116.

Verhagen AP, Downie A, Popal N, Maher C, Koes BW. Red flags presented in current low back pain guidelines: a review. Eur Spine J. 2016;25(9):2788-802.

Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA. 1992;268(6):760-5.

J MD, Nadi M. Lasegue Sign. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2021, StatPearls Publishing LLC. 2021.

Patel DR, Kinsella E. Evaluation and management of lower back pain in young athletes. Transl Pediatrics. 2017;6(3):225-35.

Dibas M, Doheim MF, Ghozy S, Ros MH, El-Helw GO, Reda A. Incidence and survival rates and trends of skull Base chondrosarcoma: A Population-Based study. Clin Neurol Neurosurg. 2020;198:106153.

Nguyen TM, Huan VT, Reda A, Morsy S, Nam Giang HT, Tri VD, et al. Clinical features and outcomes of neonatal dengue at the Children's Hospital 1, Ho Chi Minh, Vietnam. J Clin Virol. 2021;138:104758.

Thieu H, Bach Dat B, Nam NH, Reda A, Duc NT, Alshareef A, et al. Antibiotic resistance of Helicobacter pylori infection in a children's hospital in Vietnam: prevalence and associated factors. Minerva Medica. 2020;111(5):498-501.

Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012;85(4):343-50.

Downie A, Williams CM, Henschke N, Hancock MJ, Ostelo RW, de Vet HC, et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ. 2013;347:f7095.

Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best practice & research Clin Rheumatol. 2010;24(6):769-81.

Hollingworth P. Back pain in children. Br J Rheumatol. 1996;35(10):1022-8.

Feldman DS, Hedden DM, Wright JG. The use of bone scan to investigate back pain in children and adolescents. J Pediatric Orthop. 2000;20(6):790-5.

Son PT, Reda A, Viet DC, Quynh NXT, Hung DT, Tung TH, et al. Exchange transfusion in the management of critical pertussis in young infants: a case series. Vox Sang. 2021;116(9):976-82.

Pham TS, Reda A, Ngan Nguyen TT, Ng SJ, Huan VT, Viet DC, et al. Blood exchange transfusion in viral hepatitis in a small infant: a case report. Transfusion Apheresis Sci. 2020;59(6):102907.

Jarvik JG, Hollingworth W, Martin B, Emerson SS, Gray DT, Overman S, et al. Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial. JAMA. 2003;289(21):2810-8.

Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB, et al. ACR Appropriateness Criteria Low Back Pain. J Am Coll Radiol. 2016;13(9):1069-78.

Borchers AT, Gershwin ME. Transverse myelitis. Autoimmunity Rev. 2012;11(3):231-48.

Miller R, Beck NA, Sampson NR, Zhu X, Flynn JM, Drummond D. Imaging modalities for low back pain in children: a review of spondyloysis and undiagnosed mechanical back pain. J Pediatric Orthop. 2013;33(3):282-8.

Kujala UM, Kinnunen J, Helenius P, Orava S, Taavitsainen M, Karaharju E. Prolonged low-back pain in young athletes: a prospective case series study of findings and prognosis. Eur Spine J. 1999;8(6):480-4.

Wang H, Cheng J, Xiao H, Li C, Zhou Y. Adolescent lumbar disc herniation: experience from a large minimally invasive treatment centre for lumbar degenerative disease in Chongqing, China. Clin Neurol Neurosurg. 2013;115(8):1415-9.

McGhee JL, Burks FN, Sheckels JL, Jarvis JN. Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children. Pediatrics. 2002;110(2 Pt 1):354-9.

Reveille JD. HLA-B27 and the seronegative spondyloarthropathies. Am J Med Sci. 1998;316(4):239-49.

Gran JT, Husby G. HLA-B27 and spondyloarthropathy: value for early diagnosis? J Med Genetics. 1995;32(7):497-501.

Ejaz AA, Pourafshar N, Mohandas R, Smallwood BA, Johnson RJ, Hsu JW. Uric acid and the prediction models of tumor lysis syndrome in AML. PloS One. 2015;10(3):e0119497.

Casser HR, Seddigh S, Rauschmann M. Acute Lumbar Back Pain. Dtsch Arztebl Int. 2016;113(13):223-34.




How to Cite

Abdullah, M. Y., Bana, R. A., Aldogil, S. O., Alsolami, M. A., Alshihri, R. A., Alotaibi, M. H., Alharbi, S. A., Alqari, H. H., Alsaadi, R. M., Sindi, K. A., Alshamase, N. B., Albouq, A. F., & Alshaikh, H. A. (2022). Clinical evaluation and red flags of acute low back pain in primary care. International Journal Of Community Medicine And Public Health, 9(2), 1113–1117.



Review Articles