All back pain is not equal. (Photo: UHS)
Low back pain is the leading cause of disability in the world, and one of the most common reason for visits to doctors’ offices, walk in clinics, and emergency rooms across the globe. Despite how common it is, effective treatment of back pain has remained challenging and widely variable. Different providers may endorse different approaches, but after 20+ years treating spine pain I can assure you that the key to getting your back problem under control is as individual as your thumbprint.
ALL BACK PAIN IS NOT EQUAL – WHY A DIAGNOSIS IS IMPORTANT
Although sometimes an exact cause is hard to pinpoint, the foundation to effectively treating low back pain is a proper diagnosis. Is your pain from a pinched nerve, unstable pelvis, bulging disc, scar tissue, poor posture, or a combination of factors? Without an understanding of what is causing your pain, you simply cannot treat it effectively. Failure to find an accurate diagnosis can lead to wasted resources, needless procedures, and unsuccessful surgeries.
Proper diagnosis of back and neck pain is based on three foundational principles: (1) your personal history, (2) your physical examination, and (3) tests and imaging results.
YOUR PERSONAL HISTORY
It goes without saying that every person has their own story. When it comes to back pain, this story plays an important background for your health care provider. When you see your provider for back pain, you should be asked important questions such as how long you have had pain, how it started, where it hurts, and if symptoms stay in one area of radiate into other parts of the body. You should also be able to explain what makes your symptoms better or worse.
Beyond those questions, your health care provider should also learn about your overall health, including any history of diseases, injuries, or other bouts of the same or similar problems. Your hobbies, work responsibilities, and daily activities are also important to know.
Your provider should take the time to assess your movement and work with you to determine what positions or movements make you feel better or worse. This can be tricky and requires a keen eye, because patients with spinal stenosis, for example, tend to feel better when they bend forward or sit. Those with disc disease, however, tend to be worse with sitting or bending forward, which is the exact opposite with often similar findings on a test such as an x-ray.
In addition to your ranges of motion, your provider should check the status of your nervous system by testing your reflexes, sensation, and strength in certain key muscle groups. Physical tests that assess nerve compression, joint movement, muscle tenderness, and body mechanics are also important.
CLINICAL PREDICTION RULES AS A TREATMENT GUIDE
Over the past few years, trained spine care clinicians have adopted a compass of sorts, which are referred to as clinical prediction rules (CPR’s). Much like certain infections are best treated with specific antibiotics, unique findings on your history, imaging, and examination can steer your doctor towards prescribing specific treatment protocols. This is where the CPR comes in play. For example, patients with a herniated disc will often require a different approach than those with sacroiliac syndrome. When your provider understands and applies these CPR’s, you will have a better chance of improving with treatment.
TESTS AND IMAGING
When you have a new episode of back pain, sometimes tests such as x-rays, CT scans, blood work, or MRI’s are necessary to help find the source of your pain and rule out other problems. If you have had your back pain for a while, you may have already had tests done and your provider may need to fit these results into your overall puzzle. This is why it is important that you see a provider who can order and interpret these tests to help arrive at a proper diagnosis.
Although back pain is common, every patient brings with them a unique set of personal history, test results, and physical examination findings. When these three aspects of care are put together, your clinical picture can help your provider tailor a treatment approach that gets you back on track sooner and with better potential for a pain-free lifestyle. One size simply does not fit all when it comes to treating spinal disorders.
For more information, visit nyuhs.org.
About The Author
Dr. Douglas Taber is an award-winning chiropractor with over 2-decades of experience in non-surgical treatment of spine related disorders. He is a clinical researcher and bestselling author having written several books including The Back Pain Solution: Unlocking the Spinal Code and Overcoming Failed Back Surgery. As part of UHS Spine Care and Pain Relief, Dr. Taber currently sees patients by appointment only at UHS Chiropractic in Vestal (607-754-4850) and UHS Primary Care in Walton; on the campus of UHS Delaware Valley Hospital. (607-865-2407)
Members of the editorial and news staff of the USA TODAY Network were not involved in the creation of this content.
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