Back Pain Tests – Physical, Neurological, and Imaging

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doctor reviewing an x-ray of the person affected by the back pain
Because a lot of different things can cause back pain, your doctor will ask you about your medical history as part of the exam.

When and how do you choose to see a back pain specialist? What kinds of tests are doctors able to perform and what results do they reveal? These are just a few of the many questions this article will answer.

Primary Care Physician

Your primary care physician is well-versed in many conditions and illnesses that can lead to back pain. This person can help you narrow down the causes of your discomfort. Your primary care physician can also diagnose and treat non-spine-related issues like bladder, kidney, or gynecological issues.

First, it is best to approach everything from a broad perspective. If you don’t, how will you know if you need to see a back pain specialist in bone, nerve, or another specialty? Your primary care doctor can help you navigate the process.

A benefit to first seeing your primary physician is that they already have your health history and that you have built trust with them. Good rapport can get you better treatment. Talking openly and freely about your body and mind can help you get better treatment for back pain.

The same evaluation rules apply, regardless of whether your primary care doctor is new or has been with you for decades. Ask your primary care doctor lots of questions, including when, where, and how it hurt; how long it has been there; and what treatment you have used to treat it.

Reflexes, muscle strength, flexibility, and reflexes should all be tested during physical exams. They should also feel your spine and back muscles.

You may find that you have a common strain or sprain after these initial tests. These conditions can take some time to heal. While this is a relief, you still need to manage the pain.

You can get additional medication, self-help suggestions, home remedies for lower back pain, and/or physical therapy prescriptions from your doctor to help you heal.

However, if your doctor suspects that it is more than a simple strain or sprain, imaging diagnostic tests (Xray, MRI, etc.) might be recommended. To rule out infections, primary care doctors may order additional tests (mostly blood tests). We will discuss the diagnostic tests that your primary care doctor or another specialist may use to diagnose the root cause of your backache.

Common Tests

Back pain specialists and primary care physicians use many of these tests. Always inquire about the reason for the test, the information it will reveal, the time it will take to get the results, and how you will be notified. We’ll help explain the purpose of the tests.

Preparation is important for some tests. You should not, for example, eat or drink anything the morning of your test. To ensure accuracy, be clear about what you must do. You can also find out if there are any side effects to the test so that you can plan your day accordingly.

Physical Tests

A physical exam will be performed by your primary care physician. If you visit a specialist, they may repeat the same tests. Your posture, range of motion, reflexes, as well as strength, flexibility, balance, strength, and sensations will all be evaluated by them. Here are some common ways they do it.

Your posture will be assessed by the doctor, whether you are standing or sitting. These positions should feel natural and comfortable. Do not suddenly sit straight up when your natural posture is slouched. Realize your situation to get the care that you deserve.

A small rubber hammer can be used to gently tap your knees or other parts of your body by a doctor to test your reflexes. Tests of reflexes reveal what’s going on with nerve communication. The doctor might ask you to stand on one foot in order to test your balance.

This is another test that can reveal how your nervous system functions. There are many ways to determine your range of motion or flexibility. Do you feel your toes touching the ground? How far back can you bend, turn, and extend your back?

Your doctor will then use your feedback to determine if you are experiencing pain. Back pain can be caused by tight muscles. Your Rx may be to simply do lower back stretches or to take medication to reduce inflammation and pain.

The doctor will again ask for your input by touching your back or palpating it. Is it painful? What is the problem? Your doctor will also be looking at it to determine if there are any abnormalities in your spine.

These physical exams can be compared to detective work. It’s a process that eliminates the problem. Nerve problems can lead to pain and loss of sensation. A gentle poke with a newspaper clip can help you determine if there is a loss of sensation.

Sciatic nerve problems can be identified by a lift in the leg that causes pain. If your reflexes aren’t responding, it could indicate a problem with your nerve pathway. If you feel pain when you bend forward, it could be an indication of intervertebral disk problems.

If you feel pain when you bend backwards, this could be a sign that you have spinal stenosis, or arthritis in a facet. Your pain may decrease after you wake up, which could indicate osteoarthritis.

Physical tests can help you diagnose the problem and also indicate which tests are needed to find the main reason of your back pain.

Neurological Tests

Your balance, coordination, and reflexes are all evaluated by physical neurological tests. The following neurological tests can be used to determine if an unusuality has been identified: A specialist, such as a neurologist or physiatrist (see section “The Medical Specialists”), will usually order neurological tests.

Electromyography (EMG), which is also known as nerve conduction studies (NCS) or nerve condition studies, can often be combined with electromyography (EMG). These tests assess your peripheral nervous system (PNS).

An EMG measures the electrical activity of nerves and muscles. An NCS measures the speed at which electrical signals travel through nerves. These tests are not difficult to perform, but they can be uncomfortable for reasons that will soon become apparent.

A specialist will insert fine needles into the muscles of your body to conduct an EMG. An EMG machine uses the needles to record and detect electrical patterns produced by nerves. The EMG monitors your muscles and the nerves they supply.

An EMG test will ask you to move one part of your body, such as your arm. Your nerve responses are visible as wavelengths in a special scope. You can also hear them through speakers. The nerve produces signals that sound almost like radio static.

This test measures how your nerves and muscles respond to a stimulus, such as your brain’s telling your arm to raise. There are no side effects to the test. You might feel some tenderness or bruising around the site where the needles were placed.

Two sets of electrodes are used in nerve conduction studies. They look similar to electrocardiogram patch patches and are placed on the chest to check heart function. The electrodes are attached to the skin and are not used for needles in nerve conduction studies.

One electrode stimulates a nerve running to a specific muscle with a mild electric shock. The second electrode measures how fast impulses travel through the nerve. The test results will reveal how well the nerve functions.

It can sometimes reveal pinched nerves outside the back, or other neurological problems. Although the shocks may be uncomfortable, they are not usually painful. Once the shocks stop, there are no side effects.

Imaging Tests

There are many tests that can be used to determine the condition of your bones and soft tissue. These tests should not be your first step in the evaluation. These tests come later in the process because of common age-related changes in soft tissue and bone.

However, they may not be the cause. There are many treatment options for osteoarthritis that can be used without worrying about side effects. If the signs are clear that the patient has arthritis, why not treat them accordingly?

When there are questions or concerns about the patient’s condition, tests are recommended. Common X-rays can show problems with bones and their structure, such as a fracture, infection, or tumor.

The results can be seen on either physical film or on a computer monitor. It is the same painless procedure that you have probably had many times at the dentist’s office, but this time they are taking photos of your back.

Dynamic X-rays can be used to evaluate the motion of the spine. They are usually taken at the extremes of bending. You can bend forward or backward (flexion, extension), or side-to-side (lateral bending). These tests may reveal spinal instability while moving.

Computerized tomography, also called computed-axial tomography or CAT scan, is an improvement on the standard X-ray. It shows the bones in great detail. It provides basic information about soft tissues (muscles and tendons as well as discs).

This tool can help you determine whether your back pain is caused by spinal stenosis or an intervertebral disk rupture. It is painless and fast. It does not reveal nerves well. This type of scan is often used by orthopedic specialists (which we’ll talk about shortly) when patients have had an accident or fallen.

It shows more detail than an X-ray. Magnetic resonance imaging (MRI) is similar to an Xray, but it uses a strong magnetic field and radio waves instead of radiation. These are converted into three-dimensional computer images that show your spine and soft tissue.

These images show the position of the spine, discs, nerve roots, spinal cord, and discs. MRIs are often ordered for surgical purposes. This will allow surgeons to pinpoint the problem areas (where nerves have been pinched). These machines can be expensive, as can the tests they run. They typically cost between $1,000 and $2,000, so make sure you check with your insurance before you order.

MRI scans require that your entire body be placed in a large cylinder. The cylinder is narrow and noisy, and you must remain still for at least 30 minutes. Your doctor might prescribe mild anti-anxiety medication if you are claustrophobic. Because MRIs are magnets, MRIs cannot be performed on people who have metal in their bodies, such as pacemakers, shrapnel, or certain aneurysm clips.

The test of discography can be used to determine if a disc is responsible for your pain. A special contrast dye is injected into the spinal disc that’s causing your lower back pain. The injection may trigger your pain.

The disc may not be the cause of your pain if it doesn’t replicate the symptoms. A CT scan is often done following the injection of the dye. The dye is injected into the disc to highlight any disc problems.

Patients who have a disc problem may be ordered by their doctors to have discographies done. It can be painful because the needle passes through muscle and tissue to reach the disc. Other risks include infection, bleeding, or worsening symptoms.

Myelography uses a contrast dye, which is similar to discography. The dye is injected into your spinal canal. Images are then taken using a fluoroscope. This is a special X-ray machine that displays real-time moving images. Another option is to have a CT scan.

This scan shows if there is nerve compression in your spinal canal. Painful injections can occur. In rare cases, spinal fluid may leak from the needle at the dye injection site. This can cause headaches that last several days. Patients who are unable to have an MRI due to a metal implant or screw in their back often have myelograms.

Bone scans are used to diagnose bone diseases such as fractures or tumors. Radioactive material is injected into your bloodstream and absorbed into your bones. The material takes several hours to reach the bones. After that, a special machine scans the image.

Radioactive material can collect in areas that are problematic and show up in an image as a hot spot. Although injecting radioactivity may sound scary, the amount used is very small. It’s about the same as what you would get from a few X-rays.

The Medical Specialists

Four years of pre-medical school and four years of medical school are required to become a doctor. Two years in the classroom and two in a clinic setting. Graduates can apply for residency after they have completed their medical or osteopath degree. This is the final step.

They are medical doctors who have completed their degree and can now treat real patients, but they are still students in training. The residency is similar to a paid internship. Residency training is required in most states. Doctors are then licensed to practice medicine in the state. The internship is the first year of residency.

To become a medical specialist, you will need to complete many years of training. An example of this is an internist, who is an internal medicine specialist who studies for three more years. The typical training period for a neurosurgeon is seven years.

This is in addition to the eight years spent in medical school and pre-med. Although specialists are not required to hold board certification, it is worth seeking out a specialist who has completed board-specific training.

Some physicians also receive additional training after completing their residency. This is known as a fellowship. This is a more specialized form of apprenticeship. These are typically done by orthopedic surgeons to further their training in spine surgery. Without undergoing a fellowship, neurosurgeons can operate on the spine.

For any physician, the education process does not end. Physicians must keep abreast of new treatments, medicines, and procedures. Fortunately, they can do so by continuing their medical education. Each state has its own licensing renewal process. Most states require physicians to keep and submit continuing medical education credits (CME) every year.

Pain-Management Physicians

According to the American Board of Medical Specialties, a pain-management specialist must be an M.D. in anesthesiology or physical rehabilitation. The pain-management specialist helps people reduce their pain and improve their quality of life.

A pain-management specialist might be referred to you if you have had back surgery or if your pain is persistent or recurring. It takes a village to manage back pain. Patients suffering from severe or chronic pain must be managed from all angles. Patients will be assigned a pain management team that includes several disciplines.

Orthopedists And Neurologists

Neurologists do nonsurgical treatment of the central and peripheral nervous systems (brain, spinal cord). They identify pain causes such as pinched nerves, and also treats patients suffering from fibromyalgia and strokes.

Orthopedists are concerned with issues related to bones and muscles. They are also known as the musculoskeletal systems in medical lingo. They treat the bones of the spine and surrounding tissues, such as muscles, tendons, and ligaments.

Some are more concerned with scoliosis, or back pain that is caused by problems at the hip joint. This specialty is also known as orthopedics.

Physiatrists

Physical medicine is the specialty of physiatrists. They help those who are severely disabled. The field grew after World War II, when soldiers returned from combat with physical injuries. To help patients with back problems, physiatrists are recommended.

Physiatrists can prescribe medication, therapy with a physical therapist, and assistive devices (such as a cane), as well as prescriptions for medications. Sometimes, physiatrists are also called rehabilitation specialists or physical medicine specialists.

Although the training required to become a physician is shorter than in other specialties, it can take a decade or more if the candidate intends to specialize in neuromuscular medicine and traumatic brain injury.

Rheumatologists

A rheumatologist is a doctor who treats arthritis patients. Their scope of practice is much broader than that of other doctors, though they can treat pain conditions of the joints, soft tissues, muscles, tendons, connective tissues, and autoimmune diseases.

Ankylosing Spondylitis, a form of progressive and chronic arthritis of the spine that can cause a bent-forward posture in severe cases, is called ankylosing spondylitis. It can also be an autoimmune disease.

A rheumatologist may also treat osteoporosis or fibromyalgia. Rheumatologists, like the other specialists we have mentioned, train for many years after completing their medical doctor’s degree.

The Surgeons

A decade of education is not enough. To become a surgeon, you will need to complete several more years of training. You will be referred either to an orthopedic or neurosurgeon for spine surgery. Many of the same procedures are performed for spine conditions.

Neurosurgeons

Neurosurgeons are specialists in the surgical treatment of the nervous system. They can treat sciatica, ruptured discs, and other causes of lower back pain. Neurosurgeons can also diagnose and treat back and neck problems.

They may also see patients with brain injuries or other conditions of the nervous system, such as tumors and aneurysms. However, neurosurgeons can also treat brain conditions. Orthopedists are skilled at treating spine conditions.

Orthopedic surgeons

Specialized in spine surgery, orthopedic surgeons treat herniated discs and degenerated discs. They also deal with stenosis and fractures. Peripheral nerve surgery is also performed by some orthopedic surgeons.

Orthopedic surgeons are more concerned with hip joints, sacroiliac diseases, and arthritic causes of back pain. Most scoliosis surgeries are still performed by orthopedic surgeons.

Summary

  • Your primary care doctor should be the first doctor you see to treat your back.
  • In-office physical tests are common and include ones that test your balance and flexibility as well as muscle strength and reflexes.
  • After physical examinations, diagnostic tests like MRIs or CT scans should be performed.
  • Back pain can be treated by a variety of specialists. The right specialist will be referred by your primary care doctor.

Source:

  • Facebook Title. (2021, December 15). SAA. https://spondylitis.org/about-spondylitis/types-of-spondylitis/ankylosing-spondylitis/.
  • H. Sonntag, MD, V. K. (2018, March 13). Neurological Exams for Neck And Back Pain: Nerve Deficits. SpineUniverse. https://www.spineuniverse.com/exams-tests/neurological-exams-neck-back-pain-nerve-deficits.
  • Low Back Exam, Approach To. (n.d.). Stanford Medicine 25. https://stanfordmedicine25.stanford.edu/the25/BackExam.html.
  • DC, FACO, S. Y. (n.d.). Types Of Sciatic Nerve Pain. Spine-health. https://www.spine-health.com/conditions/sciatica/types-sciatic-nerve-pain.
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