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Back Pain.Diagnostic Tools And Pain Assessments

In many cases, the low back pain is self-limited as it is caused by a simple muscle strain or sprain. However, if the pain persists for weeks, gets worse, or is associated with other symptoms it is time to see a doctor.  How is the doctor going to manage your problem? Is there any self-test you can do at home to evaluate your back pain? This article answers both questions. 

Tests at the doctor’s office 

A doctor will ask several questions to understand the history of the present illness.  For example, when did the pain start, how does it feel (the quality), the duration, the location and whether the pain radiates in the legs, and how intense is the pain on a scale from 0 to 10 (0 is no pain, 10 is very intense).  Is there any potential trigger like trauma or a sports injury that could be the cause? Which activities make the pain worse, and which alleviate the pain (ie rest, activity, changing position)? Does the pain get worse at night? Are there any associated symptoms like stiffness, numbness, incontinence, or constipation? 

Next, the doctor performs a physical examination, starting with general appearance, temperature, and observing the movements, balance, and coordination when getting undressed, climbing on the table. During the spinal examination, the back and neck are evaluated for deformities or skin rashes. The spine and surrounding tissue are palpated for tenderness or changes in the muscle tone. 

Physical examination is followed by a neurological examination, during which the doctor may test muscle strength, sensation, and reflexes. The straight leg test is done to assess sciatica, along with a few other tests. 

Additional investigations may be ordered to better understand the underlying cause of the back pain for example blood tests, X-rays, CT scans,  MRIs, or other tests. For example, bone scans with radioactive substances detect problems with the spine like arthritis, fractures, infections, or infections. Discograms use a special dye to evaluate the intervertebral discs. Myelograms also use a dye to evaluate the spinal canal or a condition affecting the spinal cord. Discograms and myelograms involve a special dye injection followed by an X-ray to visualize any abnormalities. 

Despite having these tests and other tools available, the exact cause of the back pain is not always identified. Still, conservative measures such as rest, heat and cold applications, and anti-inflammatory drugs can help manage the pain. 

Self test your back pain at home 

Physiotherapists or other healthcare professionals specialized in musculoskeletal diseases may use these three tests. You can use them at home to self-test your back pain to get an idea if there is nerve irritation involved in your back pain. 

1.The Forward Bend test 

Start this test by standing up straight. Keep your hand at your side. Bend forward to reach your toes. Try to go as close as you can to reach the toes. 

If the pain gets worse when bending over the test is considered positive. If the pain goes down to the leg (the back of your leg), it suggests that there may be a disc or nerve irritation. 

The test is considered negative if the pain in the lower back did not get worse when bending forward. 

2.The Slump Test 

Use a table or a chair for this test. You need to sit at the edge of the chair (or table). Slouch over, and bring your chin down to the chest. Bring one leg up, and your toes towards your face. Straighten the knee until you feel a pull in the low back. Once you feel that pull, look up to the ceiling. The test is considered positive if the pain improves by at least 50% when you lift your head up. If the test is positive it suggests there is nerve involvement in the low back pain- not necessarily nerve damage, but nerve irritation. 

According to research studies, the slump test is pretty accurate to diagnose neuropathic pain associated with mild to moderate chronic low back pain. 

3.The Quadrant Test                           

Stand up straight. Place your hands on your waist. Bend your spine backward, so your spine is extended. Side bend and rotate to the painful side of your spine. Follow the same movements on the opposite side (where you don’t feel pain). The test is considered positive if it reproduces pain in the lower back. When positive, this test suggests that the underlying problem may be irritation of the facet joint found on both sides of the spine. If the pain is felt in the hip or the leg, there may be pressure on the nerve roots.

There are many treatment options from over-the-counter and prescription drugs, to home remedies, exercise, alternative modalities like chiropractic, massage, and acupuncture,  and other therapies like soft lasers and virtual reality technology. Is important to seek medical advice and further evaluations if the pain doesn’t improve within a couple of weeks as the underlying cause may be more serious.