Lumbar spine

Acute low back injuries

Dr. Vic Weatherall
April 2019

Treating acute low back injuries and pain is a very common challenge encountered by chiropractors and other health care professionals. The following article is based on the Ontario Workplace Safety and Insurance Board (WSIB) Low Program of Care.

To schedule an appointment, contact Dr. Vic Weatherall.

Initial assessment

Initial assessment includes

  • Obtaining patient health history and history of the presenting complaint
  • Completing standardized symptom and abilities questionnaires
  • Performing a physical and functional examination and objective evaluation

The objectives of the initial assessment is to rule out “red flags” (indicators of potentially serious problems and to identify “yellow flags” (psychological risk factors that may have an impact on behaviour, expectations, and recovery from back injury).

Red flags

Red flags include the following potentially serious signs and symptoms:

  • Neurological deficit: major motor weakness or disturbance of bowel or bladder control.
  • Infection: fever, urinary tract infection (UTI), intravenous (IV) drug use, or immune suppression.
  • Fracture: significant trauma.
  • Tumour: history of cancer, weight loss, fever, or pain worse when supine or at night.

In the absence of red flags, diagnostic imaging such as x-rays and laboratory tests are typically not recommended in the initial phase following low back injury.

Non-spinal causes of pain can include vascular, abdominal, urinary, or pelvic problems. Particular care should be taken with people less than 20 or greater than 50 years of age who have red flags.

Yellow flags

Yellow flags help to identify people who are at potentially greater risk for chronicity and to ensure appropriate monitoring and intervention during treatment.

Yellow flags include the following:

  • Believes hurt equals harm
  • Fears or avoids activity
  • Low mood or social withdrawal
  • Prefers passive treatments
  • Home environment concerns
  • Work environment concerns


Treatment focuses on evidence-based treatment interventions, including

  • Patient education about condition.
  • Pain and self-management strategies.
  • Treatment (exercises, spinal manipulation, and mobilization).
  • Progressive pain management steps.
  • Transition to work and activities of daily living.

Non-prescription analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) can be used as a temporary palliative measure in conjunction with other pain relief interventions.

Image citation staff. “Blausen gallery 2014“. Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762. – Own work. Licensed under CC BY 3.0 via Wikimedia Commons.