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DOI: 10.1055/s-2007-963695
© Georg Thieme Verlag KG Stuttgart · New York
Erkennen von Red flags bei Patienten mit Low Back Pain[1]
Recognizing Red flags in Patients with Low Back PainPublication History
Manuskript eingetroffen: 2.8.2006
Manuskript akzeptiert: 18.9.2006
Publication Date:
07 December 2007 (online)

Zusammenfassung
Physiotherapeuten behandeln häufig Patienten mit Rückenschmerzen, denen neben muskuloskelettalen Ursachen auch schwerwiegende Erkrankungen zugrunde liegen können. Die Arbeit stellt mögliche gravierende Pathologien bei Patienten mit Low Back Pain sowie das Modell der diagnostischen Trias vor, das das Erkennen von Gefahrensituationen erleichtert. Zudem wird ein Überblick über mögliche Red flags in der Patientenpräsentation gegeben und ihre Relevanz für weiterführende Diagnostik und Management erörtert.
Durch das bewusste Erheben von Red flags in der Routineuntersuchung und ihre Integration in den klinischen Denkprozess sind Physiotherapeuten in der Lage, Vorsichtssituationen bei Patienten mit Low Back Pain zu erkennen.
Abstract
Physiotherapists often treat patients with back pain due to musculoskeletal disorders or which may be due to serious medical conditions. This article describes possible serious pathologies in patients with low back pain as well as the model of diagnostic triade which helps in recognizing dangerous situations. In addition, an overview of possible red flags is given and their relevance for further diagnosis and management is discussed.
The conscious integration of questions concerning red flags during routine assessment and their integration into the clinical reasoning enables physiotherapists to detect precautionary situations in patients with back pain.
Schlüsselwörter
Red flags - Low back pain - Physiotherapie - Untersuchung - diagnostische Trias
Key words
red flags - low back pain - physiotherapy - examination - diagnostic triade
1 Die Arbeit entstand im Rahmen der OMT ÖVMPT-Ausbildung 2004 - 2006.
Literatur
- 1
Arce D, Sass P, Abdul-Khoudoud H.
Recognizing spinal cord emergencies.
Am Fam Physician.
2001;
64
631-638
MissingFormLabel
- 2
Bartleson J D.
Low back pain.
Curr Treat Options Neurol.
2001;
3
159-168
MissingFormLabel
- 3
Bratton R L.
Assessment and management of acute low back pain.
Am Fam Physician.
1999;
60
2299-2308
MissingFormLabel
- 4
Carragee E J, Hannibal M.
Diagnostic evaluation of low back pain.
Orthop Clin North Am.
2004;
35
7-16
MissingFormLabel
- 5
Della-Giustina D A.
Emergency department evaluation and treatment of back pain.
Emerg Med Clin North Am.
1999;
17
877-893, vi-vii
MissingFormLabel
- 6
Della-Giustina D, Kilcline B A.
Acute low back pain: a comprehensive review.
Compr Ther.
2000;
26
153-159
MissingFormLabel
- 7
Di Lorio D, Henley E, Doughty A.
A survey of primary care physician practice patterns and adherence to acute low back
problem guidelines.
Arch Fam Med.
2000;
9
1015-1021
MissingFormLabel
- 8
Dudler J, Balague F.
What is the rational diagnostic approach to spinal disorders?.
Best Pract Res Clin Rheumatol.
2002;
16
43-57
MissingFormLabel
- 9
Fritz J M, Delitto A, Erhard R E.
Comparison of Classification-Based Physical Therapy with Therapy Based on Clinical
Practice Guidelines for Patients with Acute Low Back Pain: A Randomized Clinical Trial.
Spine.
2003;
28
1363-1371
MissingFormLabel
- 10
Goel V, Young J B, Patterson C J.
Infective discitis as an uncommon but important cause of back pain in older people.
Age ageing.
2000;
29
454-456
MissingFormLabel
- 11
Greene G.
„Red flags”: essential factors in recognizing serious spinal pathology.
Man Ther.
2001;
6
253-255
MissingFormLabel
- 12 Grieve G P. Mobilisation of the Spine: A Primary Handbook of Clinical Methods. Edinburgh; Churchill Livingstone 1991 5th ed
MissingFormLabel
- 13
Harding I J, Davies E, Buchanan E. et al .
The symptom of night pain in a back triage clinic.
Spine.
2005;
30
1985-1988
MissingFormLabel
- 14
Hicks G S, Duddleston D N, Russell L D. et al .
Low back pain.
Am J Med Sci.
2002;
324
207-211
MissingFormLabel
- 15
Jarvik J G, Deyo R A.
Diagnostic evaluation of low back pain with emphasis on imaging.
Ann Intern Med.
2002;
137
586-597
MissingFormLabel
- 16
Jensen S.
Back pain-clinical assessment.
Aust Fam Physician.
2004;
33
393-395, 397 - 401
MissingFormLabel
- 17
Kendall N A.
Psychosocial approaches to the prevention of chronic pain: the low back paradigm.
Baillieres Best Pract Res Clin Rheumatol.
1999;
13
545-554
MissingFormLabel
- 18
Kendrick D, Fielding K, Bentley E. et al .
The role of radiography in primary care patients with low back pain of at least 6
weeks duration: a randomised (unblinded) controlled trial.
Health Technol Assess.
2001;
5
1-69
MissingFormLabel
- 19
Koes B W, Tulder M W, Ostelo van R. et al .
Clinical Guidelines for the Management of Low Back Pain in Primary Care: An International
Comparison.
Spine.
2001;
26
2504-2514
MissingFormLabel
- 20
Lurie J D.
What diagnostic tests are useful for low back pain?.
Best Pract Res Clin Rheumatol.
2005;
19
557-575
MissingFormLabel
- 21
Lyle M A, Manes S, McGuinness M. et al .
Relationship of physical examination findings and self-reported symptom severity and
physical function in patients with degenerative lumbar conditions.
Phys Ther.
2005;
85
120-133
MissingFormLabel
- 22 Maitland G D. Manipulation der Wirbelsäule. Berlin; Springer 1994 2., korr. Aufl
MissingFormLabel
- 23
Negrini S, Politano E, Carabalona R. et al .
General Practitioners’ Management of Low Back Pain: Impact of Clinical Guidelines
in a Non-English-Speaking Country.
Spine.
2001;
26
2727-2733
MissingFormLabel
- 24
Old J L, Calvert M.
Vertebral Compression Fractures in the Elderly.
Am Fam Physician.
2004;
69
111-116
MissingFormLabel
- 25
Pengel L HM, Herbert R D, Maher C G. et al .
Acute low back pain: systematic review of its prognosis.
BMJ.
2003;
327
323-325
MissingFormLabel
- 26
Rauschmann M A, Warzecha J, Arabmotlagh M. et al .
Diagnostics and minimally invasive therapy for chronic low back pain.
Schmerz.
2004;
18
463-474
MissingFormLabel
- 27
Rich J A, Donahue T C, Mick T J.
Symptomatic expansile vertebral hemangioma causing conus medullaris compression.
J Manipulative Physiol Ther.
2005;
8
194-198
MissingFormLabel
- 28
Rives P A, Douglass A B.
Evaluation and treatment of low back pain in family practice.
J Am Board Fam Pract.
2004;
17 (Suppl)
S23-S31
MissingFormLabel
- 29
Ross M D, Bayer E.
Cancer as a Cause of Low Back Pain in a Patient Seen in a Direct Access Physical Therapy
Setting.
J Orthop Sports Phys Ther.
2005;
35
651-658
MissingFormLabel
- 30
Saal J S.
General principles of diagnostic testing as related to painful lumbar spine disorders:
A critical appraisal of current diagnostic techniques.
Spine.
2002;
27
2538-2545
MissingFormLabel
- 31
Shelerud R A, Paynter K S.
Rarer causes of radiculopathy: spinal tumors, infections, and other unusual causes.
Phys Med Rehabil Clin N Am.
2002;
13
645-696
MissingFormLabel
- 32
Staal J B, Hlobil H, Tulder M W. et al .
Occupational health guidelines for management of low back pain: an international comparison.
Occup Environ Med.
2003;
60
618-626
MissingFormLabel
- 33
Staiger T O, Paauw D S, Deyo R A. et al .
Imaging studies for acute low back pain. When and when not to order them.
Postgrad Med.
1999;
105
161-162,165 - 166,171 - 172
MissingFormLabel
- 34
Sullivan M S, Shoaf L D, Riddle D L.
The relationship of lumbar flexion to disability in patients with low back pain.
Phys Ther.
2000;
80
240-250
MissingFormLabel
- 35
Swenson van R.
Differential diagnosis: a reasonable clinical approach.
Neurol Clin.
1999;
17
43-63
MissingFormLabel
- 36 Waddell G. The Back Pain Revolution. Edinburgh; Churchill Livingstone 1998
MissingFormLabel
- 37
Wand B M, Bird C, McAuley J H. et al .
Early Intervention for the Management of Acute Low Back Pain: A Single-Blind Randomized
Controlled Trial of Biopsychosocial Education, Manual Therapy, and Exercise.
Spine.
2004;
29
2350-2356
MissingFormLabel
- 38
Westhovens R, Dequeker J.
Musculoskeletal manifestations of benign and malignant tumors of bone.
Curr Opin Rheumatol.
2003;
15
70-75
MissingFormLabel
1 Die Arbeit entstand im Rahmen der OMT ÖVMPT-Ausbildung 2004 - 2006.
Marion Buchberger
PT, OMT ÖVMPT
Machlandstr. 17/2
A-4320 Perg
Email: marion.buchberger@hotmail.com