What is a later sign in the context of back pain assessment?

• A. Gross limitations in side bending
• B. Unilateral leg weakness
• C. Increased lumbar lordosis
• D. Positional leg pain

Answer: (A)

In the context of back pain assessment, gross limitations in side bending are considered a later sign due to the implication of advanced pathology. This may indicate significant involvement of structures such as muscles, ligaments, or vertebral joints that require prolonged injury or degeneration to manifest visibly as restricted motion. Often, more acute signs, such as unilateral leg weakness or positional leg pain, may present at earlier stages of musculoskeletal or neurologic issues related to back pain.

Increased lumbar lordosis could also suggest adaptive changes but is commonly seen in a variety of conditions and does not necessarily indicate advanced pathology. Therefore, the presence of gross limitations in side bending serves as a more definitive indicator of a chronic or more serious underlying condition, reflecting the progression of dysfunction and compensatory mechanisms that have developed over time.