Assessment, Diagnosis and Management (ADAM) tool - non-specific spinal pain

Exclude red flags:

• Emergency conditions including cauda equina syndrome.
• Signs of sinister pathology.
• Signs of myelopathy.
• Signs of specific pathologies – inflammatory disease, osteoporotic fracture.

Mechanism of onset.
Severity and longevity of symptoms.
Limitation to function.

Check for facial asymmetry, spinal deformity including scoliosis, muscle wasting, lumps, obvious leg length discrepancy, bony tenderness.

Spinal range of movement, check shoulder for neck pain, hip for lumbar pain.

Reflexes, sensation, power, pulses.

Lhermitte’s sign.

Upper motor neurone tests if indicated.

Imaging not indicated as first line assessment in absence of red flags.
Plain X-ray does not assist diagnosis of non-specific spinal pain.

• Neurological disorders.
• Vascular disorders.
• Parsonage-Turner Syndrome (brachial neuritis)
• Peripheral nerve entrapment.
• OA hip.
• Shoulder OA, capsulitis or soft tissue disorders.

In absence of red flags:

• Provide reassurance and advice regarding positive prognosis.
• Links to self-management.
• Analgesia/pain management.
• Reassure safe to move and beneficial to remain active.
• Safety net for deteriorating signs.

Refer to MSK Physiotherapy if persisting symptoms after first line management.