Back pain
Assess back pain and identify features that need urgent investigation or specialist advice.
Clinical learning outcomes: Awaiting named clinical review.
What you should learn
- Take a history that considers neurological and non-spinal causes.
- Recognise concern for cauda equina syndrome or other serious disease and escalate.
Recognise and explain
- Consider infection, malignancy, fracture and vascular or urinary causes as well as musculoskeletal pain.
On your placement
Agree the activity and supervision with the clinical team. For patient-facing learning, seek permission and respect the patient’s comfort and care needs.
- Ask specifically about new bladder, bowel, saddle and leg symptoms.
- Examine relevant neurology with supervision.
- Discuss the local urgent referral pathway and a clear safety-netting plan.
Start here
MLA: musculoskeletal history
Take a focused musculoskeletal history.
Current guidance
NICE NG59: low back pain and sciatica
Start with assessment and serious alternative diagnoses; suspected cauda equina syndrome needs the local urgent pathway.
NICE: urgent referral for suspected cauda equina syndrome
Read recommendation 1.7.3 on severe back pain with new bladder, bowel, sexual or perineal symptoms; locate the local urgent pathway.
Discuss
Assessing acute back pain
Distinguish an urgent neurological or vascular concern from uncomplicated back pain and give a useful recovery plan.
Practise
One learner performs. One checks the important steps and gives feedback. Then swap. These are St Emlyn’s practice tools, not official MLA scoring systems.
Lower limb neurology paired practice
Practise the lower-limb neurological examination. An isolated normal finding does not exclude cauda equina syndrome.
Back examination paired practice
Rehearse comfortable non-traumatic back assessment within the agreed task.
On your next shift
State which change in symptoms would make the patient need urgent reassessment.
How this relates to GMC graduate outcomes and the MLA
These are St Emlyn’s learning connections, not a claim that this page covers every national requirement.
Presentations and conditions: Back pain.
Clinical and professional capabilities: Assessment and clinical reasoning; Recognising limits and seeking help.
Practical skills: Focused neurological examination.
St Emlyn’s interpretation of relevant GMC graduate outcomes and MLA themes; these are summary labels, not official topic codes or a complete curriculum.
Explore the student placement programme
Student practice and graduate expectations
About this resource and its review
A St Emlyn’s guide to learning Emergency Medicine during undergraduate placements. It is not an official medical-school or GMC curriculum. Your medical school’s curriculum and assessment requirements take precedence.
National foundations: GMC Outcomes for Graduates, the practical-skills supplement and the MLA content map applying from September 2026.
Framework checked: 8 October 2026. This is a source check, not clinical sign-off.
Clinical learning outcomes: awaiting named clinical review.
The four learning routes are St Emlyn’s groupings. The six interconnected MLA domains remain part of the official content map.