LOW BACK PAIN: HOW TO GET A DIAGNOSIS

Is there anything worse than being in pain and having to run around, trying to find someone who can help you figure out why you're in pain?!

The fact that so many people are struggling at navigating the same healthcare maze for back pain drives me bonkers. It's like we are all re-inventing the wheel.

Instead, let's pool our resources and retrain this broken system.

Truth be told, it's a feat of endurance to find the right doctor, get the right test(s) and then maybe get a diagnosis.

Is it even a comprehensive diagnosis? Is it the right diagnosis? Sometimes we chase the wrong diagnosis for years (like I did) and the pain persists.

Once you get a diagnosis, then you've got to run around again to find a physical therapist or other qualified clinician who can help you.

Somewhere in there, you fall victim to the inconvenience, expense and humiliation of it all and at some point start blame-hating on your body for failing you, second-guessing what you could've/should've done differently not to end up this way.

Okay, not everyone feels that way, but I did and I hear similar self-blame stories from my clients every single day.

Part of the problem in getting a diagnosis and good, pain-relieving treatment is knowing who to see when.

Another part of the problem is thinking that with a diagnosis will come treatment and relief. Unfortunately, this is not always how it goes.

Hopefully, this email will help you understand what options, tests and courses of action are immediately available to you if you’re figuring these things out for yourself.

WHERE TO START

Schedule with an orthopedist or a neurologist, who will administer a complete medical history and physical exam.

Orthopedic doctors focus on muscles and bones while a neurologist specializes in nerve issues.

A chiropractor may or may not be a good resource, depending on what you’ve got going on and what type of chiropractic medicine they practice. I do not recommend chiropractic back-cracking if you don’t know what’s going on back there because there are certain spinal conditions which can be worsened by chiropractic adjustments, like spondylolisthesis, which just happens to be my area of specialization.

These days, many doctors in the US will order routine imaging before your appointment to rule out specific causes of pain, including spinal stenosis and tumors.

Imaging is not always necessary if your doctor is a super-ace at manual spinal assessments, but they're rare to find and sometimes it is nice to have pictures.

Either way, medical imaging will most certainly reveal something...although what’s revealed in images or the radiology report may not necessarily be what’s causing your discomfort (as was my case).

Following is a list of different types of imaging plus some other types of tests you might encounter when sleuthing the cause of your back pain:

X-ray is often the first imaging technique used to look for broken bones or an injured vertebra. X-rays only show bony structures. Soft tissues like muscles, ligaments and discs are not visible on x-rays.

Magnetic resonance imaging (MRI) uses a magnetic force to create a computer image of soft tissues such as muscles, ligaments, tendons, and blood vessels. An MRI can be used to detect a disc herniation, nerve impingement, an infection or a tumor.

Ultrasound imaging, also called ultrasound scanning or sonography, uses high-frequency sound waves to obtain images inside the body. Ultrasounds will show tears in ligaments, muscles, tendons, and other soft tissues.

Computerized tomography (CT) is a radiographic scan of spinal structures that cannot be seen on conventional x-rays, such as disc rupture, spinal stenosis, or tumors. The CT scan is a three-dimensional image created from a series of two dimensional pictures.

Discography involves the injection of a contrast dye into a spinal disc creating fluid pressure which reproduces symptoms. A discography may be used when other diagnostic procedures fail to identify the cause of pain. The fluid’s pressure in the disc will reproduce the person’s symptoms if the disc is the cause. Discography are somewhat routine ahead of lumbar surgery treatment.

Myelograms involve injecting a contrast dye into the spinal canal to see nerve and/or spinal cord compression which may be caused by herniated discs or fractures. Myelograms enhance the diagnostic imaging of x-rays and CT scans.

Electrodiagnostics can confirm lumbar radiculopathy (radiating nerve pain). The procedures include electromyography (EMG), nerve conduction studies (NCS), and evoked potential (EP) studies.

• EMG uses fine needles to assesses the electrical activity in your muscles

• NCSs are often performed along with EMG to exclude conditions that can mimic radiculopathy. In NCSs, two sets of electrodes are placed on the skin over the muscles. The first set provides a mild shock to stimulate the nerve that runs to a particular muscle. The second set records the nerve’s electrical signals, and from this information nerve damage that slows conduction of the nerve signal can be detected.

• EP tests also involve two sets of electrodes—one set to stimulate a sensory nerve, and the other placed on the scalp to record the speed of nerve signal transmissions to the brain.

Bone scans are used to detect infections, fractures, or other bone disorders. A small amount of radioactive material is injected into the bloodstream which then collects in the bones and shows levels of joint disease.

Blood tests will show indications of inflammation, infection, and/or arthritis. They may also detect HLA-B27, a genetic marker of ankylosing spondylitis.

Let me know if you find this information helpful!

REFERRAL REQUEST

If you've discovered really great medical professionals, especially my NYC peeps, I'd love it if you would email me back with your excellent referrals. Just remember to say which body part your referral helped you with and something about why they're so special.