Complex low back pain assessment checklist

Subjective examination

  • Detailed history (from first onset of symptoms, occupational factors, compensation claims, treatment response, exercise/activity pre/post injury)
  • Body chart (constancy, location, nature, relationship, severity out of 10)
  • Aggravating/easing factors including key activity tolerances - walking, sitting, standing, bending, lifting, housework, gardening, social/recreational.  Pathology specific aggravating factors (eg cough/sneeze and sit to stand for discogenic pain).  Relationship between aggravating/easing factors and different symptoms
  • Detailed 24-hour behaviour particularly sleep (bedding, sleeping posture, time to get to sleep, hours of sleep, waking frequency, getting out of bed frequency), morning pain and/or stiffness duration, naps (frequency/duration), symptoms at end of the day
  • Special questions including red flags, imaging results, medication (name, dose, effectiveness, duration of use), general health/comorbidities/previous injuries


Physical examination

  • Observation* (sitting/transfer tolerance, standing/sitting posture, gait, functional tests such as sit to stand, BMI)
  • Active movement testing* (range, limitation, observation of quality/segmental motion, overpressure if indicated)
  • Palpation* (soft tissue, swelling, tenderness, stiffness, end feel, movement diagram features such as P1/P2)
  • Local muscle activation* (transversus abdominis, lumbar multifidus, pelvic floor) as well as global muscle pattern during non-weight bearing and functional activity
  • Waddell’s signs (distracted SLR, non anatomical tenderness, exaggerated response to AMT/transfers, non-anatomical neurological examination or symptom distribution, simulated rotation and compression)


Other testing as required

  • Pathology specific such as sacro-iliac joint or reducible discogenic pain
  • Lower motor neurone neurological testing
  • Provocative neurodynamic testing* (straight leg raise, slump, relevant bias’)
  • Response to mechanical loading strategies such as extension in lying*
  • Red flags (eg upper motor neurone neurological testing)
  • Musculoskeletal screen
    • Global muscle overactivity, shortening or weakness (eg erector spinae, iliopsoas, hamstrings)
    • Reduced joint mobility (eg hip, thoracic spine)


* Consider reassessment of these tests after performing test and/or correction of potentially maladaptive movement patterns


Questionnaire data supported by follow up questioning

  • Activity limitation (Oswestry Low Back Pain Disability Scale)
  • Orebro Musculoskeletal Pain Screening Questionnaire
  • Optional testing as required

Post Traumatic Stress Disorder Checklist – Civilian

  • Depression, Anxiety and Stress Scale – DASS21
  • Pain Catastrophising Scale
  • Pain Self Efficacy Questionnaire


For copies of these questionnaires and scoring methodology see