Welcome to Emergency Medicine Cases.com. I'm your host, Dr. Anton Hellman, bringing you Canada's

brightest minds in emergency medicine from EMC Studios in Toronto.

On this month's episode number 26 on emergency causes of low back pain, we have with us Dr. Brian

Steinhart and Dr. Walter Himmel.

Dr. Steinhart is an emergency physician at St. Michael's Hospital in Toronto. He's

certified in emergency medicine by the Royal College of Physicians and Surgeons of Canada, as well as the American Board of Emergency Medicine.

He's been a delegate for the Heart and Stroke Foundation of Canada, as well as the American Heart Association.

Dr. Walter Himmel is an emergency physician at North York General Hospital, Scarborough General Hospital, and Toronto East General Hospitals.

He's a world-renowned speaker in emergency medicine and a recipient of multiple teaching awards.

So without further ado, let's get into talking

about low back pain. When we pick up a chart in the ED and see the chief complaint is low back pain,

most of us have a similar reaction. Not another lumbosacal sprain or not another drug seeker

or not another patient I can't do anything for.

Sometimes it seems like a big drag.

That's because most often the cause of the low back pain is benign,

and many of us feel that we aren't equipped with the tools we need to help these patients in any significant way.

And this is backed up by the literature.

Upwards of 90% of low back pain presentations in the ED turn out to be benign etiologies like lumbosacal sprain. And ED docs have been

shown to be poorer at providing good education and evidence-based treatments for lumbosacal sprain,

even though there's a huge, often long-term morbidity associated

with it. For whatever reason, there's a tendency for us to be nonchalant and complacent about low back

pain, which is odd. Because if you compare this 90% comprising benign causes of back pain to chest

...