There are a number of methods that can be used to diagnose the cause of your back pain. Most often, your doctor will begin with a personal history and physical examination. Click on the topics below for information about specific types of diagnostic procedures which may be used to help determine what is causing your back pain.
- History of Back Pain
- Physical Examination
- X-ray Examination
- MRI (Magnetic Resonance Imaging)
- CT Scan
- Electromyogram (EMG)
- Bone Scan
Be prepared to help your doctor understand how your back problem developed, how long you’ve had it, how severe it is and anything that helps lessen the problem or makes it worse. For example:
- When did your back symptoms start? What activities make the pain worse? What measures relieve the pain?
- Which of your daily activities or normal movements are you not able to do because of your back symptoms?
- Have you noticed any problems with your legs?
- Around the time your symptoms began, did you have a fever or symptoms of pain or burning when urinating?
- Have you had a problem with your back in the past? If so, when?
- What other medical illnesses do you have?
- What medicines do you take regularly or daily? Include vitamins and any over-the-counter medications you take
How to describe pain:
- Is the pain stabbing, sharp, dull, aching?
- On a scale of 1 to 10, with 10 being the most severe, how severe is your pain?
- Does the pain come and go intermittently, or is it constant?
- Is the pain present at night?
- Do you have any accompanying symptoms such as numbness, tingling, radiation of the pain to other locations such as down one or both legs?
Your physician will evaluate your overall neuromuscular status, as well as conduct specific tests
to evaluate any areas of concern.
Your physician will observe your posture while you are standing, sitting, walking, and bending. If
there are differences between the right and left sides, these will be taken into consideration.
General skin and muscle condition is also observed, looking for color, scars, bruising, and shape.
Palpation is another part of the examination. Your physician will palpate or “feel” the body, looking for tenderness, swelling, or warmth.
Movement is evaluated to test joint function and muscle strength.
X-ray films are used to identify structural changes in the spine, such as a fracture, infection, or change in alignment. The soft tissues, such as the discs, muscles, and ligaments do not show up on x-ray film, so the x-ray tests are used primarily when the bony structures are thought to be involved.
The MRI scan is the most common test used in diagnostic evaluations of the spine. The MRI scanning machine uses magnetic waves instead of radiation and provides 3-dimensional views of the structures in question. The MRI images show the vertebrae and soft tissues such as ligaments, cartilage, tumors and discs. You will be placed inside a scanning chamber, which can sometimes make you feel closed in or claustrophobic. The only discomfort involved in this procedure is if a dye is injected to help visualize the tissues. The dye is injected through a needle and may cause you to feel “flushed” or warm for a few moments.
The CT scan uses x-ray technology that, like the MRI, can show 3-dimensional images of the spine and soft tissues. The CT scan is usually considered better for examinations of the bony structures of the spine, while the MRI is usually better for viewing the soft tissues. The CT scan may be combined with a myelogram to achieve a clearer image of the nerve roots and to help determine if there is pressure from spinal stenosis or a herniated disc.
The myelogram is a test that involves placing dye into an area around the spinal cord and visualizing the location and placement of the dye. This exam identifies any pressure on the nerves of the spine. There may be slight discomfort when the dye is injected.
The discogram is a test in which dye is injected directly into a disc in the spine. The discs and spaces between them can then be visualized, revealing disc herniation or other abnormality. This procedure is utilized to confirm the painful disc (spinal level). Injecting the dye may cause some temporary discomfort.
An electromyogram is a test that helps to evaluate the electrical impulses causing a muscle to move or contract. The test is performed by inserting tiny needles into the muscles to be examined. The needles used are extremely tiny, but may cause some slight discomfort during the procedure. Abnormal electrical activity may indicate that a nerve is being irritated or pinched as it leaves the spine.
A bone scan is used to help locate infection, tumor, fracture, or arthritis in the affected area of the spine. In order to perform a bone scan, a radioactive chemical is injected into the bloodstream. The radioactive chemical attaches itself to areas of bone that are undergoing rapid changes and will appear as dark areas on the scan. Once the affected area is identified, additional tests such as an MRI scan may be localized for further evaluation of the affected structures. There may be slight, temporary discomfort during the injection.