Back Pain Self Help

Back pain diagnosis help decide the best treatment

If you have severe or chronic lower back pain, don’t take any chances. Have your back condition thoroughly evaluated, so that serious medical conditions can be ruled out. Most of the time, nothing serious will be found, but in a small number of cases, back pain is caused by a problem independent of the spine that will require a particular treatment.

Physical examination

First you must describe your back pain as clearly as you can. If possible write a short (1 page) account of your back problem: when it first happened, what seemed to cause it, what seems to aggravate it, when it recurs, what helps, and so on.

The doctor will probably ask you to walk, sit, bend over, bend sideways (to check your mobility) then will ask you to lie face down on an examination table. Here he/she will check your reflexes and do a hands-on examination by probing and tapping your back to find areas of muscle spasming and referred pain.

You will then be asked to lie on your back and the practitioner will raise each of your legs in turn and ask you to bring your knees up to your chest. Any sharp pain will be noted, and if your doctor suspects a fracture, tumour or some disease, he/she may recommend that you undergo one or more of the following procedures.

X-rays for back pain diagnosis

Fractures of the vertebrae, osteoporosis and arthritis, as well as congenital deformities can be diagnosed using x-rays. However ruptured or herniated discs and spinal tumours are more difficult to detect, and muscle strain is impossible.

CAT (or CT) scan: A CAT scan can detect almost any condition – fracture, herniated disc, tumours, bone disease, congenital problems and many others. The CAT scan image is highly detailed, showing soft tissue as well as bone. The procedure is painless. The patient lies in the machine and x-rays are transmitted from many angles, resulting in a composite image. The downside is that appreciable levels of x-rays can be involved.

Myelogram: A myelogram is an x-ray examination to detect abnormalities of the spine, spinal cord, or surrounding structures. A dye that can be seen on an x-ray, is injected into the fluid-filled space around the spinal cord to assist in making a diagnosis.

MRI scan

The Magnetic resonance imaging (MRI) scanner utilises a magnetic field and radio signals to produce highly detailed cross-sectional images of bone and soft tissue. This procedure is also painless and is a particularly safe diagnostic tool because x-rays are not involved.

Bone scan

If your doctor suspects bone cancer, a stress fracture, infection (osteomyelitis), or if the cause of your back pain isn’t clear, he/she may ask you to undergo a bone scan. Tiny amounts of radioactive materials will be injected into your vein and once the material has collected in the bones, the radiation it emits will be recorded by a special gamma camera. A nuclear medicine specialist or radiographer interprets these images.

Electomyography (EMG)

This procedure tests muscle and nerve activity, by inserting fine needles into different muscle groups and measuring the electrical impulses produced by the nerves when the muscles are and rest and contracted.  An abnormal EMG pattern can confirm a diagnosis of a rupture or herniated disc. This procedure may be uncomfortable and can take from one to two hours.