Diagnosis

The Three Important Steps in Back Pain Diagnosis 

First Step in Diagnosis:  Patient Interview

Back pain diagnosis from any health care professional – your medical doctor, osteopath or chiropractor – always starts out with an interview about your patient history.

Some of the questions asked during this interview include the following:

• your family history of major illnesses

• your own history of major and minor illnesses

• what you came to the doctor for today

• explanation of your present situation with back pain

• what makes the back pain worse or better

2nd Step in Back Pain Diagnosis: Physical Exam/Orthopedic Tests

The next step in the process is a physical examination where the doctor looks for visible signs of illness and causes of back pain.

You will also be asked to move in certain positions to see when you have back pain and when you don’t. Moving the body in certain positions is a way that all doctors perform what are called orthopedic tests.

Orthopedic Test for Lower Back Pain Diagnosis

For example, the straight leg raise test is where you will lie on the doctor’s table as if you were sleeping. The doctor will raise each leg up and will be looking for the angle that your leg is at when the pain occurs.

If the angle is between 30 and 60 degrees, and you feel pain in your back, it may mean that the nerve roots of the sciatic nerve in the spine are affected. If your leg is then bent, the pain should go away. If the pain continues, the problem is in your hip. If you feel pain behind your knees for both legs as they are raised, then the diagnosis is tight hamstrings.

Often between the patient history, the physical examination and the orthopedic tests, a doctor can arrive at a back pain diagnosis.

3rd Step of Back Pain Diagnosis: Order Further Tests

X-rays may be the next step in your back pain diagnosis if your doctor has not yet made a diagnosis about the cause of back pain. Otherwise, your treatment and prognosis is discussed next. Your treatment varies, depending on what type of physician you have chosen to visit.

If your pain continues despite treatment, then your doctor may order further tests such as an EMG, Bone scan, MRI or CT scan.

How an EMG Helps Doctors Diagnose Back Pain

EMG is short for electromyography. For example, if you have sciatica symptoms, this test will tell the doctor how fast the sciatic nerve is conducting nerve impulses and whether or not the impulses are getting to the appropriate muscles they should be getting to. If results find a weak or slow impulse, the muscles associated with the area where the slow down occurs and below that point are affected. This is then confirmed with the associated sciatica symptoms of weakness in the muscles of the leg.

The EMG test doesn’t stop there. A needle is inserted into a muscle to see if it has nerve damage or not. Muscles give off electricity and the needle can pick up the electrical signals from the nerve that innervates that muscle. If one nerve is not firing its electrical signal as it should, then that test result is different from more than one nerve not working (called neuropathy).

Your doctor may order an EMG, but usually this is reserved or chronic back pain with nerve symptoms often related to sciatica.

Other Advanced Tests Include MRI, CT Scans, and Bone Scans

MRI Test for Back Pain Diagnosis

The beauty of all the advanced imaging studies now is that they are incredible tools to really pinpoint what is wrong. An x-ray won’t show you what’s happening in the soft tissues of the body, such as the muscles, blood vessels, and nerves, but an MRI will. If you have disc herniation symptoms and that disc herniation is causing nerve compression, you can see this confirmed on an MRI as well. However, this test is so sensitive, that it often finds “problems” in areas that do not even hurt. This has been shown in studies of health patients with no back pain who underwent MRIs and 10% of them were found to have herniated discs. None of them required treatment as they were not in pain.

CT Scans for Back Pain Diagnosis

CT scans are x-rays but the x-rays are “slices” of the body in crosscuts with a camera showing blood vessels, clots, bone, discs, joints, tumors, and nerve/muscle problems. These scans also show the spinal canal and what’s happening in it, such as changes in the bone or narrowing which is found in spinal stenosis.

CT scans are also a great way to view osteoarthritis, spondylolisthesis Link to spondylolisthesis and fractures. Link to Fractures However, CT scans can only suggest a disc herniation; an MRI is always more precise for detecting disc herniation.  Link to disc herniation

Bone Scans 

Bone scans can tell the doctor whether or not you are healing from a fracture, arthritis, or tumors. This is another one of the wonderful imaging studies that can help determine what the real cause of your back pain is. You should be aware that xrays, CT scans, and bone scans all use radiation as part of the test, which has been linked to increased health problems later in life. MRIs do not use radition as part of the test.

After these three steps in diagnosis, a decision is made on what is wrong with you and what type of treatment you will need.

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