Importance of history and physical examination in low back pain in emergency care
Carlos Umberto Pereira, Samuel Pedro Pereira Silveira, Ana Beatriz Pereira Beiriz Pinto
Abstract
Introduction: Low back pain (LBP) is one of the most common health problems, affecting approximately 40% of people at some point in their lives. In about 85% of cases, no specific cause can be identified, termed nonspecific LBP. Diagnosing the underlying cause can be challenging, requiring comprehensive assessment of medical history, physical examination, and potentially imaging studies. Objective: To review the importance of clinical history and physical examination in diagnosing patients with low back pain in the emergency setting. Methods: Narrative literature review using PubMed, Scopus, SciELO, and Google Scholar databases. Articles published in Portuguese, English, and Spanish were included without date restriction, using the descriptors: low back pain, physical examination, clinical diagnosis, red flags, and imaging studies. Results: Most patients with acute LBP improve with conservative treatment and do not require immediate imaging. History and physical examination are generally sufficient to rule out serious causes and guide treatment. In the presence of warning signs (red flags), complementary tests are necessary to exclude serious underlying pathologies. Emergency imaging studies often show abnormalities in asymptomatic individuals and should be interpreted with careful clinical correlation. Conclusion: A thorough medical history combined with detailed physical examination allows identification of specific cases of low back pain and exclusion of serious pathologies. In the absence of clinical signs of serious pathology, imaging studies are often unnecessary. The most prudent recommendation is to reevaluate patients who do not respond promptly to conservative treatment.
Keywords
References
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Submitted date:
07/06/2026
Accepted date:
09/15/2026
Publication date:
10/22/2026
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