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How to diagnose low back pain

I refer to Professor Charles Greenough's article 'Can surgery end low back pain?' (February 16). In my experience between 25 and 50 per cent of cases of low back pain presenting in general practice can be attributed to sacroiliac problems.

They have rarely if ever been diagnosed before I see the patients and they have usually been seen several times by other doctors. I was not taught how to examine patients with back pain at medical school ­ indeed I was not taught how to examine very much at all.

Examination of anyone presenting with back pain should include an assessment of the sacroiliac joints as well as leg length. In any case, with persistent symptoms not responding as expected, a rectal examination should be carried out. Remember the old surgical adage 'if you don't put your finger in you will soon put your foot in it'.

It may also be worth remembering the importance of a clear history of what the patient actually experiences. 'Listen to the patient; they are telling you the diagnosis.'

Dr Michael Blackmore

Independent GP



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