CLASSIFICATION OF

LOW BACK PAIN

LOW BACK PAIN

Algorithmic categorization
of low back pain
●  Associated pain
●  Onset pain
●  Aggravating and relieving factors
●  Medical history and system review
●  Psychological history
●  Physical examination
 Key to Algorithm

1: simple mechanical low back pain
2: low back pain with radiculopathy
3: serious pathological low back pain
4: low back pain with psychological overlay
● ASSOCIATED PAIN

TYPE KEY OF
ALGORITHM

1 Leg pain 1 , 2 , 3 or 4

2 Loin , abdomen / pelvic pain 3

3 Thoracic pain 3

4 Generalized or non anatomical 4
pain
 ● ONSET

1) Traumatic 3
● Severe
● Minor

2) Insidious
● Constant , progressive 3
● 1st time/ few recurrence 1 , 2

3) Long term history of with 4
recurrence
● AGGRAVATING AND
RELIEVING FACTOR

1) Constant pain , no change 3
with movement , rest or time

2) Increase with activity or 1 , 2
towards the end of the day ,
decrease with rest

3) Pain worse at start of day 2 , 3

4) Cramping pain 3
 ● Medical history and systems
review

1) Previous history of cancer
or or a systemic condition

2) Unexplained weight loss         3

3) Systematically unwell

4) Associated organic or
other joint symptoms
● Psychological history

1 Associated
compensation claim

2 Excessive pain
      4

3 Depression , anxiety ,
somatization
● Physical examination
1) Positive nerve tension signs
/valsalva

2) Widespread neurology
    3

3) Structural deformity

4) Persisting servere lumbar flexion

5) Positive abdominal exam

6) Conflicting examination signs    4

7) Sensory /  motor loss in in one    2
dermatome
 Treatment based
classification system
By delitto Et al.
Meckenzie classification
of low back pain
1.postural syndrome
• In early stage of life, poor posture and flexion
habit stretching and minor pain arises from
localised periarticular structure around spine .
• Pain disappear once structure is released from
tension
• Pain arises from midline of spine and doesn't
radiates to lower limbs.
• Pain from abnormal stresses.
2. Dysfunction syndrome
• With persisting poor postural habits,annulus. And
other periarticular get overstretch and begin to tear.

• Majority tear heals quickly and little

consequences are felt at that time.
• Recurring mircotrauma and repair lead to loss of
elasticity and decrease little ROM.
• Pain is at end of ROM
• Pain resulting from stretching of adaptive shorten
muscle
3. Derangement syndrome
• As long as annulus fibres remain intact , patient
will experience no more than postural back
pain .
• But with progressive overstretch, hysteresis
and creep , annulus get weak and it's ability to
hold nucleus is lost.
• Pain is even at midrange and decrease ROM
which is irreversible.
The classification system designed by the QTF was intended to
help in making a clinical decision, establishing a prognosis,
evaluating the quality of care and conducting scientific research.

QTFC procedure classify patients into 1 of 11 diagnostic

categories according to:
1.presence of pain
2.anatomical location of pain
3.presence of neurologic signs
4.findings from radiological imaging techniques
5. Surgical history
Categories further subdivided to
1. Pain duration (for categories 1-4)
2. working status(1-4,10 and 11)