The Relationship between Clinical Symptoms and Low Back Pain Syndromes

Chris Hoffman* MD, Chris Gregg* MSc, Greg McIntosh** MSc*and Hamilton Hall** MD
*TBI Health Group, Wellington, New Zealand
**The Canadian Back Institute Research Department, Toronto, Canada


Introduction: The purpose of this study was to compare clinical characteristics of low back pain (LBP) based on a syndrome approach to classification.

Methods: This retrospective study of prospectively collected low back pain (LBP) cases was a collaborative effort of rehabilitation clinics in New Zealand and Canada over a four year period.

All patients assessed were classified into one of four distinct syndromes (patterns 1-4).  Statistical analysis was conducted to determine associations between symptomatic variables recorded at assessment (dominant pain site, numeric pain score, aggravating and relieving activities, perceived function and neurological findings) and the eventual diagnostic pattern.

Results: The sample group consisted of 1912 patients: Pattern1 = 1653 (86.5%), Pattern 2 = 196 (10.3%), Pattern 3 = 62 (3.2%), Pattern 4 = 1 (0.1%).

Patients classified as Pattern 3 were more likely to report leg dominant pain (71%), compared to pattern 1 and 2.

Aggravating factors for each pattern differed (p<0.01) and patients with Pattern 1 were more likely to aggravate their back pain with flexion activities.  Relieving position of each pattern was significantly different (p<0.01) with Pattern1 best reduced in extension (91%), Pattern 2 best reduced in flexion (85%), and Pattern 3 most improved when lying down.   

The neurological profile of each pattern was significantly different (p<0.01). 27% of patients with Pattern 1 had at least one positive neurological finding compared to Pattern 2 (12%) and Pattern 3 (72%).

There was no statistically significant difference in baseline numeric pain rating between patterns.

Perceived level of functional ability was significantly different between all three patterns (p<0.01) and Pattern 1 had the highest level of perceived functional capacity.

Conclusions: This international study contradicts a categorization of LBP as one homogeneous ‘non-specific’ entity.  The findings of this study suggests that LBP is heterogeneous in nature with recognizable and unique clinical markers.