There is a lot more to back pain than pulled muscles. Back pain is the fastest growing disability in the western world, affecting 1.8 million Australians, and incidence are only expected to rise. Appreciating the complexities of diagnosis can help you help your doctor and set you on the road to recovery sooner.
In 2010-2011 there were 93,564 hospital admissions across Australia for back pain. Some of these would have been caused suddenly in dramatic accidents like falling from ladders. Sadly though, many of the conditions would have crept up slowly from sedentary lifestyle or repeatedly straining the back muscles over long periods of time.
For doctors the challenge is to untangle all of the symptoms, and figure out the source of the pain to provide an accurate diagnosis. As patients we can help the process by communicating the details of our experience as clearly as possible.
When you first present for a medical examination the doctor may wish to get an idea of how severe the pain is, asking you to rate it between 1 – 10. 1 is minor pain like a knocked knee and 10 is agony. If you can continue about your usual activities the pain will be below 5 but if you find it hard to move the score will be closer to 10.
To reveal the extent of the injury the doctor can observe you perform simple movements. Actions like lifting your arms, bending down, leaning to the side or just walking show which parts of the body have impaired flexibility.
Another thing a patient can do to help the doctor accurately diagnose the problem is to describe the pain. For example, a dull ache is quite different from a spasm. One points to muscle damage and the other to a spinal cord problem. Think back over the times leading to your appointment. Were there activities that eased the pain? For example, you may not have noticed pain very much if you were walking. Or was the morning worse because the muscles became seized and stiff overnight?
The longer the pain persists, or the more severe it is, the chances are the doctor will need to order tests. These may include:
X-ray: Most of us are familiar with X-rays from childhood. It shows breaks and cracks in the bones, and also the shape of your spine. A healthy spine has a gentle S-shape from neck to tailbone, but people will feel pain if there is too much curvature, like in scoliosis.
MRI: Magnetic Resonance Imaging is a painless scan that can show structures within bones and organs. It requires lying absolutely still in a narrow tunnel while the machine takes photos of the body with magnetic and radio frequency pulses. MRI scans show an incredible level of detail of what is happening within the spinal cord itself such as damaged vertebrae or ruptured vessels or herniated discs.
Blood tests: Sometimes back pain is due to inflammation and a simple blood test can determine if the body is fighting an infection. A prescription of antibiotics may be needed.
EMG: Electromyograms will find a problem in the communication signals between the brain and the body. An electrode is placed into the back muscle via a needle so the level of electrical activity can be measured when the muscle contracts. If the strength of the signal is disproportionate to the muscle activity it indicates there is an issue with the nervous system.
Psychological evaluation: Studies are increasingly showing the link between depression and chronic pain, mind and body. People with depression may be more susceptible to pain because the emotion and pain are processed by the same area of the brain.
Back pain is an umbrella term covering a range of conditions. The one thing they have in common is pain. All back pain sufferers want the same thing; a full diagnosis that will lead you on the path to the best possible treatment, or for some, a full recovery.