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Pain

Clues to Your Back Pain Diagnosis


Author:

Bruce Freundlich, MD

Graduate Hospital, Philadelphia

Medically Reviewed On: June 04, 2001

Each year more than twelve million Americans go to their doctors with back pain complaints. Not all back pain is treated equally, however, and making a specific diagnosis allows us to create a more customized and effective treatment. Below are a series of ten questions I ask my patients. The answers help us get closer to the right diagnosis, and treatment.

1) Is the pain mechanical (due to abnormal stretching of muscles, tendons, and ligaments) or a disc problem?
I like to know if you lifted something heavier than usual or reached to get a package while in an awkward position, like pulling a shopping bag from the trunk of a car. Did you lift by bending straight over (the wrong way) or by bending your knees first and using your legs (the correct way)? Were you playing a sport when it happened? Any new type of exercise is always a good clue, even if you think it was mild and don't believe it had anything to do with the current problem. I always like to know what type of work you do, what your leisure activities are, and how you spend your day in general in order to uncover potential moments of extra physical exertion.

2) Is there the possibility of a bulging or ruptured disc?
As these injuries are extremely common, I want to know if this is a muscle and tendon problem or if there is the possibility of a bulging or ruptured vertebral disc. Although both these types of injuries can cause immediate pain that ranges from mild to severe, disc pain has some telltale characteristics. One common symptom, known as sciatica, is lower back pain associated with pain shooting down the back of one or both legs. Other signs that a nerve may be pinched are tingling or a burning sensation anywhere in the buttocks or legs, a sensation of numbness, or a feeling that part of the leg or foot is "asleep."

More serious signs that demand immediate medical attention include weakness in the lower extremities or loss of bladder or bowel control. If any of these are present, the odds are greater that pieces of a ruptured disc may be pushing on either individual nerves or the spinal cord itself.

3) What position makes the pain worse?
For each different cause of back pain, there are particular positions that will be most uncomfortable. This is an important clue in diagnosing the problem.

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