Diagnosis Of Back Pain
Regardless of what type of doctor you see, there are some things you can expect your doctor to do during your visit. Your doctor first will ask you a number of questions, the most common of which are listed as follows:
- What are your symptoms–that is, what aches or pains do you have?
- Exactly where is the pain?
- Where is the pain the most severe?
- When did the pain begin?
- How long have you had it?
- Did something specific cause your back pain, such as an accident or injury?
- What home treatments have you used?
- Were you under any additional stress when the pain began?
- Do you have any other health problems?
- What kind of work do you do?
- In what types of recreational activities do you participate?
Think about these ahead of time so you can answer them easily. You also may have questions you’d like to ask the doctor. As you think of questions at home, jot them down and take them to the appointment.
Next, your doctor will give you a physical exam. During the exam, the doctor may perform any of the following: observe your muscles and joints ask you to sit and lie down ask you to move your back in different positions observe and feel the area of most pain and/or check to see if other areas of your body are tender or painful If the doctor can identify the likely cause of your back pain at this point, no further tests will be needed.
What Does It Mean If Lower Back Pain Is Shooting Into Legs
Lower back pain can radiate to other parts of the body: up or down from its place of origin. Sometimes lower back pain can be on one side of the back, which is also normal.
If the pain is shooting from the lower back into one or both legs, it could be sciatica , but its not always the case. There are many parts in the lower back that may cause the pain to radiate into the legs, such as facet joints, sacroiliac joints, muscles or inflammation of the bursa.
Complementary Alternative Emerging Treatments
In some cases, doctors suggest therapies that are not considered current standard of care. They probably wont be covered by insurance, but they may be worth considering. Examples include:
. PRP treatments use a small sample of your own blood that has concentrated amounts of blood building blocks known as platelets. Your doctor then injects the PRP directly into a damaged disc. The theory is that PRP injections use your own healing system to accelerate improvement of injured tendons, ligaments, muscles, and joints.
PRP treatment has a longer track record in knee osteoarthritis, but a recent review article in the Journal of Spine Surgery suggests it may have a useful role for back pain, too. PRP needs a lot more research before it can be considered a proven technique.
In this emerging treatment, your doctor injects stem cells harvested from your hip into the intervertebral disc or discs causing your pain. Doing so may lessen pain and the degenerative effects of aging, though, like PRP, more research is needed before stem cells for lower back pain could eventually become the standard of care.
. Your doctor probably doesnt perform acupuncture , but may support you trying it as a complementary therapy. Acupuncture involves careful insertion of fine, sterile needles into specific points on your body. This may stimulate the release of your natural pain-killing chemicals.
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What Are The Symptoms Of Lower Back Pain
Symptoms of lower back pain can come on suddenly or appear gradually. Sometimes, pain occurs after a specific event, such as bending to pick something up. Other times, you may not know what caused the pain.
Pain may be sharp or dull and achy, and it may radiate to your bottom or down the back of your legs . If you strain your back during an activity, you may hear a pop when it happened. Pain is often worse in certain positions and gets better when you lie down.
Other symptoms of lower back pain include:
- Stiffness: It may be tough to move or straighten your back. Getting up from a seated position may take a while, and you might feel like you need to walk or stretch to loosen up. You may notice decreased range of motion.
- Posture problems: Many people with back pain find it hard to stand up straight. You may stand crooked or bent, with your torso off to the side rather than aligned with your spine. Your lower back may look flat instead of curved.
- Muscle spasms: After a strain, muscles in the lower back can spasm or contract uncontrollably. Muscle spasms can cause extreme pain and make it difficult or impossible to stand, walk or move.
Who Gets Back Pain
Anyone can have back pain however, several factors increase your risk. Risk factors increase your chance of developing back pain and can include:
- Fitness level: Back pain is more common among people who are not physically fit. For example, weak back and stomach muscles may not properly support the spine. Back pain is also more likely if you exercise too strenuously after being inactive for a while.
- Weight gain: A diet high in calories and fat, combined with an inactive lifestyle, can lead to obesity. This can put stress on the back.
- Job-related risk factors: Jobs that require heavy lifting, pushing, pulling, or twisting can injure the back. A desk job may also play a role, especially if you have poor posture or sit all day in an uncomfortable chair.
- Age: Back pain becomes more common with age, particularly after the age of 45.
- Heredity: Genetics play a role in some disorders that cause back pain.
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Can Further Bouts Of Back Pain Be Prevented
Evidence suggests that the best way to prevent bouts of low back pain is simply to keep active and to exercise regularly. This means general fitness exercise such as walking, running, swimming, etc. There is no firm evidence to say that any particular back strengthening exercises are more useful to prevent back pain than simply keeping fit and active. It is also sensible to be back-aware. For example, do not lift objects when you are in an awkward twisting posture.
Other Types Of Diagnosis
- A chiropractor will diagnose through touch, or palpation, and a visual examination. Chiropractic is known as a direct approach, with a strong focus on adjusting the spinal joints. A chiropractor may also want to see the results of imaging scans and any blood and urine tests.
- An osteopath also diagnoses through palpation and visual inspection. Osteopathy involves slow and rhythmic stretching, known as mobilization, pressure or indirect techniques, and manipulation of joints and muscles.
- A physical therapist focuses on diagnosing problems in the joints and soft tissues of the body.
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Lower Back Pain: What Could It Be
Do you have lower back pain? You are not alone. Anyone can experience lower back pain at any time, even if you dont have a prior injury or any of the risk factors. It is not always serious and can often get better on its own. But in some cases pain is your bodys way of telling you that something isnt right.
Learn more about lower back pain and what causes it from rehabilitation physician Akhil Chhatre, M.D., who specializes in back pain in the Johns Hopkins Department of Physical Medicine and Rehabilitation.
What Research Is Being Done
The mission of the National Institute of Neurological Disorders and Stroke is to seek fundamental knowledge of the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. NINDS is a component of the National Institutes of Health , the leading supporter of biomedical research in the world.
As a primary supporter of research on pain and pain mechanisms, NINDS is a member of the NIH Pain Consortium, which was established to promote collaboration among the many NIH Institutes and Centers with research programs and activities addressing pain. On an even broader scale, NIH participates in the Interagency Pain Research Coordinating Committee, a federal advisory committee that coordinates research across other U.S. Department of Health and Human Services agencies as well as the Departments of Defense and Veterans Affairs.
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How Is Back Pain Treated
You can do several things to manage back pain. A conversation with your doctor or physiotherapist can help address any concerns you may have and help you to better understand your treatment. Remember that not all information is trustworthy, so let your healthcare team know about treatments you are considering before you begin them.
Ways to manage back pain include the following:
Strong pain medication is not recommended for back pain. Research shows strong pain medication provides little benefit and can cause side effects such as drowsiness, sedation and/or dependence.
If you have severe back pain and your current medication is not adequately managing it, talk to your doctor about a suitable treatment plan. In some cases, your doctor may suggest an injection that can numb the pain such as an epidural injection, or a surgical procedure, such as a laminectomy to help manage your pain.
There are many other treatments to manage back pain, but they have not been well proven. These include:
- herbal medicines
- heat and cold therapy
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Your Pain Extends To Other Body Parts
If youre experiencing severe back pain that is coupled with pain in other areas such as shooting pain down your leg then you should see a doctor. This could be a sign that you have sciatica, a form of pain that affects the sciatic nerve, which runs from the lower back and through the buttocks before branching down each leg. This condition usually results from a herniated disk. A doctor will be able to offer a variety of ways that you can relieve this pain.
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When Back Pain May Mean Arthritis
Many forms of arthritis and related conditions can cause back pain, stiffness and swelling.
About 80% of back pain is acute and usually lasts one to seven days. Otherwise, its considered chronic and may be caused by arthritis. The lower back is the most common site of arthritis back pain. Several types of arthritis are part of a group of conditions called spondylarthropathies . Spondylarthropathies can affect adults and children.
If you are experiencing pain, swelling and stiffness in the back, you may have one of the following types of arthritis or related conditions.
Axial spondyloarthritis is a chronic inflammatory disease that primarily affects hip joints and the joint that connects the bone at the bottom of the spine to the pelvis .
There are two types of axSpA: Radiographic axSpA includes damage to the sacroiliac joints and spine that can be seen on X-rays, and nonradiographic axSpA does not include damage you can see on X-rays but it may show up on magnetic resonance images .
Psoriatic arthritis is a form of arthritis that affects joints and usually the skin . For about 20% of people with PsA, the disease involves the spine . In some cases, bony overgrowth can cause two or more vertebrae to grow together , causing stiffness.
Getting a Proper Diagnosis
How To Tell The Difference
If you have leg pain without significant back pain, it can be hard to tell if the problem is your back or your hip. Vinita Mathew, MD, FAAPMR, is a physical medicine and rehabilitation specialist at Northwestern Medicine Integrated Spine Center. Here, Dr. Mathew explains what to look for and what to expect if you see your physician for leg pain.
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The Most Common Causes Of Lower Back Pain Are A Strain Or Sprain
Whether you notice it or not, your lumbar spine gets put to work throughout the entire day.
Amid all of this work and motion, a lower back sprain or strain can result from an acute injury, such as one experienced while falling, lifting something too heavy or playing sports. A sprain or strain can also develop over time due to repetitive movements or poor posture.
“Straining a muscle or spraining a ligament are the most common causes of lower back pain,” says Dr. Palmer. “While they can be serious, these common causes of lower back pain aren’t long-lasting taking anywhere from a few days to heal or, at most, a few months.”
Your doctor can help you determine the particular course of self-care that can help heal your lower back pain.
“The treatment for a pulled back muscle or strained back ligament is fairly simple and can include pain and anti-inflammatory medications, muscle relaxers, ice to help reduce inflammation, heat to promote healing, and avoiding strenuous activity until the pain recedes,” explains Dr. Palmer. “The best course of care will depend on the severity of your injury as well as your overall core and lower body strength.”
If your lower back pain persists despite treatment, it may be time to consider other causes of lower back pain.
What Is The Treatment For Chronic Nonspecific Low Back Pain
Initial treatment is similar to sudden-onset attacks. That is, aim to keep as active as possible. Also, painkillers can help. In addition to the painkillers listed above, your doctor may advise a course of an antidepressant medicine in the tricyclic group – for example, amitriptyline. Tricyclic antidepressants have other actions separate to their action on depression. They are used in a variety of painful conditions, including back pain.
Also, a national guideline , referenced below) recommends one or more of the following treatments should be considered. Each of these treatments has some evidence from research trials to suggest that they will help to ease symptoms in some people :
- Structured exercise programme. This means a programme of exercise supervised by a professional such as a physiotherapist. This is likely to be in a group setting. Exercises may include aerobic activity, movement instruction, muscle strengthening, posture control and stretching. It typically consists of up to eight supervised sessions over 8-12 weeks with encouragement to keep on doing the exercises at home between sessions.
- Manual therapy. Typically this includes several sessions of massage, spinal mobilisation and/or spinal manipulation. With spinal mobilisation the therapist moves the joints of the spine around in their normal movement range. In spinal manipulation, the therapist moves joints beyond the usual range of movement.
- A course of acupuncture. It is not clear how this may work.
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Muscle Deconditioning And Poor Posture
People can condition their muscles over time to be stronger or more enduring through exercises and weight training.
The reverse is also true. Humans may decondition their muscles over time by not using them correctly.
In some muscles, including back muscles, deconditioning is as easy as sitting at a desk with incorrect posture for too long. A person may do this while at work.
Slouching in a chair over a desk may cause a loss of strength in the muscles. Over time, the weakening of muscles may lead to pain in the area as they experience strains or irritation.
When a person slouches, pressure from gravity and the body itself pushes on the spine, neck, discs, and ligaments. Over time, this pressure can lead to pain and other complications.
It is possible to condition the muscles to be stronger and more durable in most cases. This process starts with correcting the posture while sitting, and taking regular breaks from the desk to move around and stretch.
Exercises may also improve strength in the back, and using a standing desk can help, too.
Conditioning the muscle requires patience, however, and anyone with chronic upper back pain from weak muscles might benefit from seeing a physical therapist to find an exercise routine for their specific needs.
How To Relieve Lower Back Pain
If youre looking to relieve back pain , here are some tips to help reduce its severity so that you can get back to your everyday activities faster and with as little inconvenience as possible:
- Change your workout: There is such a thing as going too far when it comes to your workout and you need to make sure that you are careful in which workouts that youre doing, the severity of them, and how often youre doing them. As you get used to the workout, your back will get stronger and you can step it up a notch once you gain more muscle. Or, you can consider changing your workout all together, to one that is more back-friendly.
- Rest your back more often: If you are experiencing pain form work or other activities that involve lifting and strain on your back, try to rest more often. Lie on the floor or on a bed on your back and allow the muscles to relax and everything to return to its native position. If you have a desk job, take more breaks and stretch your back out to make sure that youre not over-doing it.
- Heat/Cold Therapy: Youll be able to do a lot with heat and cold therapy for your back. Using hot packs for 20 minutes intervals or cold therapy for the same amount of time can help with pain and to reduce inflammation . This is the preferred treatment for that reason.
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