Doc, What's Wrong With Me?

Doc, what’s wrong with my back and how come it hurts so bad?

Most back or neck pain conditions can be divided into 2 main groups: Acute pain and chronic pain. We then look at subgroups to find the most likely fit (Actual Clinical Back Pain Classifications are listed below).

Although the origin or root cause of your back pain can be very difficult for your physician to accurately diagnose or even be considered non specificback pain, as is frequently the case, it is important for the layperson (patient) to have an idea of some key information and terms related to the physical component of true health and wellness.

The physical component is composed of the body and the mind; it is both structure and function.  The spine is anintricate and complex neuro-musculo-skeletal system; it is composed of bones, nerves, ligaments, muscles and cartilage, all of which we will soon discuss ingreater detail.

So with all of the individual components and the intricate complexity of the region the exact condition causing the pain can often be difficult to pinpoint.  A single injury or condition can create numerous symptoms and have the potential for numerous possible diagnoses. Because of this it can be difficult for a patient to get a definitive diagnosis from their own doctor about the source or exact cause of their back pain.  In addition there are varying terms that are used in an interrelated manner by different medical doctors, chiropractors, osteopaths and orthopedic specialists.

Some doctors may say there is a pinched nerve, or a nerve root irritation, some doctors say a vertebrae is out of alignment, or that you have a subluxation, other physicians may say a slipped disc, a bulging disc, a herniated disc or even a ruptured disc, all these words can be used in describing a problem.

It depends on the individual doctor’s precision with language as they can be discussing different problems or the exact same problems – it is no wonder that a patient may be confused about their diagnosis and therefore extremely uncertain of the best course of treatment to resolve their problem or problems with such confusion in terminology.

We look at your case history-rays, MRI’s, physical exam findings and frequently work with your MD, and radiologist to get a clear diagnosis of why you hurt. We do our best to not just chase the symptoms but actually find the root cause of your problem. Our goal is to help you get well and stay well

CLINICAL BACK PAIN CLASSIFICATIONS

•    ACUTE: 6 weeks or less of symptoms: Sprain/Strain, Herniated Disc, Sciatica

•    SUB-ACUTE:  7 – 12 weeks of symptoms

•    CHRONIC RECURRENT:  episodes of pain lasting less than 12 weeks with significant pain-free intervals

•    CHRONIC PERSISTENT:  pain lasting longer than 12 weeks without any significant pain-free intervals, Spinal Stenosis, Degenerative Disc, Spinal Osteoarthritis

Conditions               Symptoms                           Diagnosis

ACUTE

Acute        Rapid onset                   clinical history/findings

Sprain/        of pain                        Decreased ROM

Strain        Often related to injury        x-ray

Back pain dominant

No numbness/weakness

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Conditions               Symptoms                           Diagnosis
Disc

Herniation/    Rapid onset of            clinical history/findings

Bulge        Back pain &            MRI

Radiating                                           EMG tests                                             Leg

Pain

Often related to injury

Predominate leg pain

Possible numbness/

Or weakness legs

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Conditions               Symptoms                           Diagnosis
Sciatica     Rapid onset of            clinical history/findings

Back pain &            MRI

Radiating                                           EMG tests

Leg Pain

Often related to injury

Predominate leg pain

Possible numbness/

Or weakness legs
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Conditions                  Symptoms            Diagnosis

Chronic

Chronic

Recurrent       back pain with                           clinical history/

Pain                 some pain                                   findings

Free periods                                 X-rays

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Conditions               Symptoms                           Diagnosis
Chronic     Prolonged recovery        clinical history/

Persistent      from acute attack        findings

Pain        Frequent reoccurrence        x-rays/MRI

Limited or no pain free        bone/ CT scan

Periods

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Conditions               Symptoms                           Diagnosis
Disc        Middle Age             x-rays

Degeneration    Heavy lifting,            CT scan/MRI

Vibration            discography

Typically back-dominant pain

Overweight

Smoking

Pain worse with flexion
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Conditions                  Symptoms            Diagnosis

Chronic

Spinal        Common over age 50        x-rays

Osteoarthritis    Rarely symptomatic        CT scan

Most arthritis on X-rays        bone scan

is not related to pain        blood tests

Aching back pain

Often worse with extension

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Conditions               Symptoms                           Diagnosis
Spinal                 Back pain increasing        clinical history/

Stenosis             with walking              symptoms

Leg pain/numbness        CT scan/MRI

associated with walking                    (+) Valsalva’s

Weakness/clumsiness in legs

Symptoms eased by flexing forward

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Conditions               Symptoms                           Diagnosis

Tension              Back pain after activity                   Clinical history/

Myositis         spasm & tightness                            symptoms

Syndrome