Secondary Assessment of Low Back Problems
The purpose of the secondary assessment in current algorithms is to determine the reason for delayed recovery in a patient who has not symptomatically or functionally improved after one month of initial treatment (i.e., the patient has progressed to a subacute low back problem).

The first step in secondary assessment is a re-evaluation with assignment of the patient into one of the five same clinical categories (as in the initial phase):

	Conditions involving the bony spinovertebral axis such as cancer, infection or fracture;
	Intraspinal pathology involving the neuraxis such as cauda equina syndrome or radiculopathy;
	Arthritic or inflammatory conditions;
	Mechanical conditions; or
	Referred low back pain due to viscerogenic and/or other causes.

Secondary Assessment Methods are as follows:
(Medical Services Department; Work. Compensation Board)

	Education
	Activity Modification
	Exercise
	Drug therapy
	Physical Treatments
	TENS
	Acupuncture
	Epidural Injections
	Myofacial Trigger point Injections
	Discectomy / Laminectomy
	Spinal Fusion

The aim of ‘secondary (intermediate) treatment’ is to provide appropriate symptomatic relief of pain for the patient and prevent progressive deconditioning and permanent disability, while promoting return to function and work for those who are either off work or on modified duty. Treatment is based on the findings of the diagnostic re-evaluation at four weeks. This phase of treatment may be extended up to two months beyond the initial phase of treatment.

The list of suggested treatments in the Sub-acute phase of treatment is identical to the list of treatments suggested in the initial phase, with the addition of biofeedback and surgical procedures.