Thoracolumbar Algorithm

An interactive decision flowchart for thoracolumbar and low back presentations. It screens for red flags, then works through postural relief on flexion and absence of pain when sitting, the two-stage treadmill and Romberg tests, Slump and Lasegue, an absent tendon reflex or specific dermatomal weakness, lumbar flexion over 53 degrees with passive intervertebral motion testing, the inflammatory pattern of morning stiffness over 30 minutes with onset before 40 and chest expansion under 2.5 cm, and the Flynn clinical prediction rule for who is likely to respond to manipulation. It separates canal stenosis, radicular compression, segmental instability, axial spondyloarthritis, manipulation candidacy, and specialist referral.

Written for qualified clinicians. The tool supports clinical reasoning; it does not replace examination, imaging or diagnosis.