Getting the doctor to understand your chronic back pain symptoms can make the difference between making a speedy recovery with a suitable back pain remedy or long term pain. The overwhelming majority of back pain sufferers who participated in a recent survey felt that the quality of their dialogue with practitioners was more important in diagnosing a problem than any clinical or technical procedure.
Why? Pain can’t be seen, and its intensity cannot be measured. It has to be described, and you’re the only one who can do it. Whether its a severe upper back pain, or you’re experiencing pain in lower back kidney area, it’s down to you to clearly explain where and how it hurts.
With this point in mind, here are suggestions from participants for making your examination more productive:
If you’ve already seen several practitioners, or if your lower back pain symptoms have lasted a long time, mention this in advance to the practitioner’s receptionist, and request an appointment time that is either longer man usual or held during non-rush hours.
Write a short chronology of your condition. This one-page report – at the most – isn’t meant to take the place of your verbal explanation, but it will help you organize your thinking. And good practitioners appreciate a concisely written history.
If a written report seems presumptuous to you, or if it’s just not your style, consider making some notes for your own use.
When you’re in pain and in need of help, it’s difficult to feel that you should examine the practitioner as carefully as you hope he will examine you, but try. The success or failure of your back pain treatment often hinges on your rapport with the practitioner. Trust your instincts. If you don’t have a good feeling about the practitioner, no matter how esteemed his or her reputation, don’t proceed with any back pain treatment at home, or even with an examination. (Naturally, if you’re in acute pain, you will want to get whatever immediate relief you can.)
In Oh, My Aching Back, a bestselling book by Dr Leon Root, the author states:
The inability of most patients to clearly explain their lower or upper back pain symptoms and what bothers them is a long-standing source of grievance to modern doctors.
Ironically, participants in the recent survey had just the opposite complaint. In effect, ‘Modern doctors don’t listen well, don’t believe that you can contribute anything intelligent, and seem put off if you can.’
This situation may now be improving, as more doctors are being trained to listen to their patients and try to understand their specific back pain symptoms. However, many practitioners are under pressure to deal with each patient within a limited time, and this may sometimes lead them to appear rather brusque and impatient. So for example if you are experiencing lower back pain kidneys, a muscle relaxant probably isn’t going to help. Don’t be put off by this.
Just give them the relevant information about your back pain, and quietly and firmly ask the questions you need to ask.
The Diagnosing Examination To Determine Your Chronic Back Pain Symptoms
Observation is the first part of examination. That is, the competent practitioner will look at your posture, gait and other movements from the moment you walk into view, as well as while taking your history and examining you. Then you will probably be asked to walk a bit, bend over gently from the waist, and bend to each side. Pain and lack of mobility, if any, will be noted. So will alterations in the movement patterns, tremors, lurching or inability to perform normal movements.
While you’re lying face down on the examination table, the practitioner will perform a hands-on examination. They will palpate (lightly tap) your back to determine the extent of spasming. He or she will also probe your back, hips and buttocks to check for tightness, ‘knotted’ muscles, trigger points (small, extremely sensitive areas that are painful to the touch), and areas of referred pain. If lying on your stomach causes you pain, ask if you can lie on your side, or tuck a small pillow under your abdomen.
While you’re on your back, the practitioner will raise each of your legs. Sharp pain felt during this procedure, as opposed to the slight pulling sensation of a tight hamstring, may indicate a ruptured disc (It also tests the dynamics of your nervous system, known as neurodynamics or neuromechanosensitivity.)
You will also be asked to bring both knees towards your chest simultaneously. If you have a plain old backache, you’ll feel pulling and tightness in your lower back. If you have a ruptured disc, you may find this to be a relatively pain-free position. Your reflexes and neurological reactions will be checked with a small rubber hammer. Lack of appropriate knee-jerk response may indicate involvement of the nerve root. The same holds true if you show an abnormal reflex when tested in your Achilles tendon area.
The chances are about nine out of ten that the findings in your examination will be negative. From your viewpoint, however, the medical word ‘negative’ means ‘positive’ – no serious disease, neurological impairment or structural abnormality.
X-rays: Their Value and Shortcomings in Investigating Chronic Lower Back Pain Symptoms
If you see an orthopaedic surgeon or chiropractor to help investigate the cause of your chronic back pain symptoms, you’ll probably be advised to have one or more pictures taken of your back.
Actually, ‘advised’ isn’t the right word. Told’ is more accurate.
You usually don’t have a choice unless you forego the examination altogether or see a back doctor who uses X-rays sparingly, or see a practitioner who isn’t allowed to take X-rays, such as a Shiatsu therapist or a non-medically qualified acupuncturist.
X-rays usually don’t reveal much about chronic back pain symptoms. What can you expect X-rays to tell you about your back pain? Chances are . . . nothing at all. But some important conditions can be seen this way. Osteoarthritis, for example, shows up on X-rays. X-rays are also crucial for ruling out possible fractures.
Then there are the congenital ‘spondy’ conditions, as confusing as they are hard to pronounce. Spondylolysis involves incompletely formed vertebrae. If you have spondylolysis, it can evolve into spondylolisthesis, a forward shift of one of the vertebrae, causing low back pain.
Spina bifida, an opening in the spine that can be serious enough at birth to cause paralysis below the lesion, is fairly common in a very mild form that seldom accounts for back pain.
X-rays will show that a portion of the spinal column failed to develop – a condition called spina bifida occulta – in perhaps 20 per cent of the population. But it is just an X-ray finding, and no one knows how this painless anomaly is related to the full-blown spina bifida, if at all.
The risks versus the benefits of X-rays
Keep these points in mind when deciding whether to have your back X-rayed:
- Fewer than 5 per cent of survey participants who were X-rayed by medical doctors learned the cause of their back pain from these X-rays.
- X-rays neither spot nor rule out many serious conditions because they do not clearly show soft tissues, such as muscles,