How Doctors Test To Determine Back Pain Causes

In order to accurately diagnose your back pain, doctors and other medical care workers are going to need to run tests if they cause can not be accurately determined by questioning the patient. Here are some of the most common tests that doctors will request when you visit about your back pain troubles.

Physical Exam

During a physical exam, the doctor is going to probe your back and your neck to see if they can feel any abnormalities in the surface and the structures beneath.

Often, a tense muscle will be easy to palpate upon examination, but deeper back pain causes may not be able to be felt. The doctor will also examine the back from a distance to see if the sides are similar in structure or if there is any asymmetry when you stand up and when you bend over.

They will also note the height of your shoulders and whether they are the same height.

This is also the time when you will be asked questions about your lifestyle and your activity levels. You will also be asked if you’ve had any recent illnesses or infections.

You want to be as honest as you can about things that you’ve noticed prior to and leading up to the back pain. Any theories that you have should be discussed as you are the one that’s been feeling the problems, so you’re the best person to diagnose yourself.

Your reflexes may also be tested to see how your nerve function is and if any of the physical tests warrant further examinations of other parts of your body, the doctor may perform those at the same time.

Unfortunately, if the doctor doesn’t immediately find someone in a physical exam, they may not be interested in pursuing more diagnostic testing.

Often, people with common back pain will see their pain subside within a month; so many doctors will simply prescribe muscle relaxants or pain medications to see if the patient improves.

If there is no improvement, further tests will be needed.

X-Rays

The most common diagnostic testing for back pain is a standard x-ray. Though it’s rare that people have troubles with back fractures and breaks, these x-rays can also point out other abnormalities in the bones surrounding the back and the spine area.

An x-ray can be easily performed within minutes and the results will come back within a few days of the test being read. It’s non-invasive and it doesn’t require that you do any preparations for the test itself.

If nothing shows up on the x-ray, and you still have back pain, further testing will need to be done.

In most cases x-rays aren’t going to turn up anything if you have general back pain. They are effective for significant traumas – accidents, falls, etc. – but in your everyday strained back situations, they’re not necessarily called for.

The current thinking in medicine is that x-rays are actually only useful if the patient has a history of osteoporosis or problems with spinal stenosis. Because the x-ray isn’t going to reveal anything as being wrong, more doctors are considering other testing options to help diagnose back pain.

However, if you enter the emergency room or you have been injured in a specific manner, x-rays are still the standard of care.

And while x-rays aren’t considered to be entirely effective, you will want to consider the reasoning of your doctor if they decide to order them anyway.

MRI

Magnetic resonance imaging, or MRIs, are the most expensive way to test for troubles in the back, but are often recommended when other testing fails to show any specific causes.

This test is performed with strong magnets that help to produce images of the internal structures of the body and create a clear ‘map’ of what may be going on in the back of the patient.

MRIs can be done without any preparation, though they can take time to process. You will need to lie still in the MRI to make sure that the images are clear for the radiologist or the orthopedist to read; otherwise the test will need to be redone.

You will lie in a tube-like structure while the magnets work to create images in the equipment. Some people find that this is slightly too claustrophobic for them, but there are many more open MRIs these days that make the process less scary.

The good news is that an MRI is very effective at finding things that are wrong in the body, often things that aren’t related to the back, but may be causing the pain.

For example, if you have kidney stones, this might show up on an MRI, though it will not show up on a traditional x-ray.

The main concern with the MRI is not the effectiveness, but often the price. Insurance may not cover an MRI until a certain battery of tests is done first to rule out other diagnoses.

CT Scan

Like the x-ray, a CT or computed tomography, uses 3D technology to get a bigger picture of what’s going on inside of your body.

The x-ray can only tell what your body is doing in two dimensions, so the CT is a favored test for checking out back pain issues.

Just like the MRI, you will be set up into a tube-like structure, though this is open and tends to be less frightening for the person inside of the machine. You will be injected with some sort of contrast, usually iodine, so that the contrasting images will show up on the images in the end.

This test only takes a few minutes to complete and it is generally non-invasive, though some people are sensitive to the contrast when it is injected into your body.

You may also need to have the test performed without contrast as well to show the differences in the images.

The CT is a relatively effective test as it can show internal issues, but generally only in cases when surgery is going to be the eventual treatment – this is a test that will point out severe back and neck injuries and disorders.

Myelogram

While slightly out of date since the invention of the MRI, myelograms are still done when back pain is being diagnosed.

Just like an x-ray, myelograms are radiographic studies that show a two dimensional image and are usually performed in conjunction with a CT if the patient is going to be having surgery in the near future.

Radioactive contrast is injected right into the spinal column to provide a clear picture of anything that might be taking place in the spinal space.

This helps detect any shifts in the patient’s condition as well as where the surgeon will operate.

EMG

When structural injuries and disorders are ruled out, some doctors will order an EMG nerve test for the patient. Electromyogram nerve testing is done in the cases of chronic back pain to help pinpoint the source.

Small needles are placed into the muscles of the body in the back and then electrical activity is measured to see where the activity may be disrupted. This can help to assess nerve damage and serious nerve conditions in the back and spine.

If you are having this test, it’s likely that all other tests have ruled out other injuries, so the doctor is trying to figure out whether the pain is coming from nerve problems or from the muscles themselves.

Other Tests

If your doctor is concerned that you might have other issues in your body outside of the physical area of the back, you might be advised to have a blood test, urinalysis, and possibility heart testing.

These tests will simply help to further narrow down the potential cause of your back and neck pain.

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