Back Pain Diagnosis
Chartered Physiotherapists are expertly placed to collect a detailed medical history and provide a thorough spinal assessment to be able to safely diagnose back pain.
Medical history forms the foundation of the assessment which will include your current presenting symptoms, when and how symptoms began, levels/types/frequency of any pain, medication, previous trauma/surgery/spine problems. More in depth questioning regarding bladder and bowel function, bedroom performance difficulties, sleep pattern and weight will provide plenty of clues to the underlying cause of the problem and eventual diagnosis.
A physical examination will be required to assess the ranges of spinal motion available. A loss of expected range will help identify the underlying cause. To enable a thorough examination you should prepare to undress to your underwear or have a pair of shorts and loose T-shirt available.
A neurological examination to include muscle power, sensation and reflexes will highlight any variation from normal values. The sciatic and femoral nerves will be assessed for any signs of tension. Hips and pelvic joints will be assessed as will the muscles in the thigh for any increase in tension. The spine will be palpated/mobilised systematically assessing the mobility of each spinal segment and any underlying muscle spasm or guarding. The abdomen and vascular systems will be assessed to provide a full picture of physical health.
At this point a diagnosis will be established and fully discussed with you so you are reassured and knowledgeable regarding your back pain.
The majority of assessments will conclude symptoms are safe to treat however on occasion and possibly following a short course of treatment further tests and investigations may become appropriate. Your GP or specialist spinal service may choose one of the following:-
An X-ray of the lumbar spine may be appropriate if a fracture is suspected
Blood tests to evaluate raised inflammatory or bone markers
MRI/CT scans are not routinely required however provide an excellent picture of any structural cause (disc, degeneration, infection, fracture..).
The decision to refer for further investigations is often taken if a change of management is required, i.e. will imaging change the treatment/outcome? If spinal surgery or corticosteroid injections are to be considered then imaging is definitely required.