Lower Back Pain Diagnosis

How do you know what type of back pain you have got?

How does your doctor make a lower back pain diagnosis. How do you know which type of back problem you have? How do you know it is not something more serious?

First - Your doctor will ask you some questions

Your doctor will begin diagnosis by a process of elimination - firstly by ruling out other less common causes

• Your doctor will take a history and ask you lots of questions about how it started, what it feels like and how it behaves
• They will ask you questions about your health including some special questions - called red flag questions - which will help them rule out something serious or specific like cancer or fractures.
• They will check to make sure that you haven't got something which can mimic back pain - like kidney problems
• They will ask questions which will help them decide if you have an irritated nerve or not

Sciatica or Simple Back Ache?

The behaviour and symptoms of sciatica are very different from non-specific/simple lower back pain - see the symptoms of sciatica page for more on sciatica

So before the doctor has even started a physical examination they will already have a good idea of your lower back pain diagnosis.

Next - Your doctor will examine you

The physical examination will help them confirm that diagnosis. This is what they would expect to find with mechanical non specific back ache:

• normally the reflexes, sensation and power are normal. (A full neurological examination will confirm this.)
• tests which are designed to move the nerves in the legs are negative
• the symptoms do not usually go down the leg further then below the back of the thighs.
• certain movements may be reduced by stiffness or soreness e.g. bending forward
• movements usually change the symptoms for better or worse
  

So, having decided that your problem is not

• a nerve irritation (sciatica)
• something serious (cancer, infection)
• something inflammatory (inflammatory joint disease like ankylosing spondylitis)

the diagnosis that remains is non-specific mechanical back pain.

The good news and the bad news about this diagnosis

The good news is clear - there is nothing serious the matter - this is great. The bad news? It may well be impossible to pin point the exact cause of the problem.

For lots of people that doesn't matter at all, they are satisfied that the problem isn't serious, that it is not life threatening and that it will probably settle down in time.

Other people are far less happy with this - especially if the problem has been going on for a while. It can be very upsetting to be given a 'bucket' diagnosis when you want to know exactly what is causing the soreness.

Some doctors and clinicians will have a stab at it - they may say you have strained a joint, got wear and tear, pulled a muscle, got a misaligned pelvis or leg length difference. But at the end of the day nobody can say for sure.

No two people will have the exact same problem.

Once you have ruled out serious and specific causes it is far more important to have a plan to reduce your symptoms and get you feeling better than trying to find the one tissue that may or may not be the cause of the problem.

Are there any tests that will help me find a diagnosis

Yes and no. X-rays and MRI scans are great at ruling out serious problems and at identifying disc bulges and prolapses.

They are poor at ruling in the precise diagnosis that we would like. This is because so many of us have changes that show up on these tests but we have no symptoms.

Let's take changes of age for example. Most of us have some age changes in our spines. If you scanned everybody you would see similar changes in many of us. But not all of us with these ageing signs will have back ache. So, if you do have back symptoms and you have a scan which shows these age changes how do you know they have got anything to do with it at all?

There is a strong body of research highlighting this problem - so much so that the latest clinical guideline advice is:

 

References

National Institute for Clinical Excellence, 2009. NICE Low Back Pain:Patient Information. Available at: http://www.nice.org.uk/nicemedia/live/11887/44543/44543.pdf [Accessed November 12, 2012].

NICE, 2009. Early Management of Persistant Non-specific Low Back Pain. Available at: http://guidance.nice.org.uk/CG88.

29-Jul-2017