Low Back Pain Detailed Exam Critical For Good Outcome

By John F. Kibby, DC

Bay Area Wellness Group, PC

. https://www.kibbychiropractic.com/

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Low Back Pain Detailed Exam Critical For Good Outcome

The complaint by a patient of “low back pain” must be clarified. Patients may also use this term to describe a kidney or hip problem. The exact site of pain described by the patient must be identified. Patients may be asked to point to the precise site of pain. Patients often use verbal descriptions that don't match the anatomic site of their pain.

Pain characteristics, as described by the patient, can have a lot of value in determining the source of the pain. Nerve pain, sciatica for example, is usually sharp with well-defined limits, whereas pain from muscle, tendon, bone and ligaments is usually more of a deep, dull, achy nature, with poorly-defined borders. The degree of severity can help gauge the patient's reaction and response to significant pain.

Words such as “excruciating”, “unbearable”, and “intolerable” can indicate a significant emotional component and a higher level of difficulty in dealing with or tolerating the pain.

The “how and when” of pain is also revealing. The “how” usually relates to the movement, activity, or position that caused or causes the pain.

The “when” implies the motion, action, time of day, state of mind, and possible fatigue factors related to pain.

A thorough discussion with the patient, allowing the patient to express their pain symptoms fully, is valuable. Check off lists, by themselves, are limiting, as are yes/no questions. Patient's may be asked to fully describe their pain, how it changes, and the details of any accident or injury.

The purpose of the low back examination itself is to determine the “pain-generating tissue” as specifically as possible. Possible tissues include bone, disc, cartilage, ligament, muscle, tendon, fascia, and organs.

The basic rule of evaluating the cause of low back pain is

If the patient's pain is reproduced with a motion, posture, or position during the exam, and the relationship between that movement and/or position and the functional anatomy is understood, the cause of the pain has very likely been identified.

It's not good enough to say “you have back pain” as a diagnosis. It's non-specific and lacks focus.

So, the examination is really an analysis of the various tissues in the patient's low back area. This is accomplished by testing various movements and positions, in an orderly manner, and assessing their effect on the patient's pain.

The findings from this type of detailed pain assessment, along with imaging findings from X-ray or MRI, lead to a very precise diagnosis.

Establishing a precise diagnosis is critical in setting up a successful treatment protocol, which is customized for each patient.