The back and spine are designed to provide a great deal of strength, protecting the highly sensitive spinal cord and nerve roots, yet flexible, providing for mobility in all directions. However, there are many different parts of the spine that can produce back pain, such as irritation to the large nerve roots that run down the legs and arms, irritation to small nerves inside the spine, strains to the large back muscles, as well as any injury to the disc, bones, joints or ligaments in the spine.
Because the causes of back pain are often complex and multi-factorial, it is often more difficult to get an accurate diagnosis for back pain than for other medical conditions. While some spinal diagnoses are relatively straightforward (such as tumors, infections, or fractures), for many conditions there is little agreement among spine specialists about a diagnosis.
The challenge for healthcare providers is to diagnose the correct disease so they can recommend the appropriate treatment. While there are a number of diagnostic imaging tests physicians can use to determine the cause of a patient’s pain—CT scans, MRIs, nuclear imaging studies—choosing the most appropriate test is not always a straightforward decision, and experts often disagree on the best course of action.
The medical diagnosis, also called a clinical diagnosis, serves to identify the underlying cause of the patient’s back pain. Medical professionals determine the cause of the patient’s pain through a combination of the following two to three steps:
A Review of the Patient’s Medical history
The physician will spend time asking the patient a series of questions, such as a description of when the low back pain, sciatica, or other symptoms occur, a description of how the pain feels, what activities, positions, or treatments make the pain feel better and more.
A Physical Examination
The physicians will conduct a thorough physical exam of the patient, such as testing nerve function and muscle strength in certain parts of the leg or arm, testing for pain in certain positions, and more. Usually, this series of physical tests will give the spine professional a good idea of the type of back problem the patient has.
Diagnostic Testing (Maybe)
After the physician has a good idea of the source of the patient’s pain, a diagnostic test, such as a CT scan or an MRI scan, may be recommended in order to confirm the presence of the suspected cause of the patient’s pain. For example, if a disc problem is suspected, an imaging test can provided a detailed image showing the location and size of the herniated disc and affected nerve roots.