Lower Back Pain Assessment: Can we find out the cause of my lower back pain?

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Lower Back Pain Assessment:
A Step by Step Precursor to Effective Back Pain Treatment

Lower Back Pain Assessment - Take the next logical step to discovery of what the problem is, or what the problem is not!

The Lower Back Pain Assessment is a much needed logical procedure to provide us with information as to help us find out what the problem might be. The Pain Assessment consists of numerous diagnostic tests but is not in itself a diagnosis. The Pain Assessment will help us to gather information to create an appropriate and effective Treatment Plan. Treatment without assessment would be incorrectly based upon assumptions without facts or information, and would adversely impact the effectiveness of any legitimate Treatment Plan. The Pain Assessment is normally conducted by someone whom is aware about the knowledge that needs to be ascertained as a precursor to treatment. This would be someone whom is experienced in applying ROM Range of Motion and other similar tests, such as a Physician or Clinical Massage Therapist or Chiropractor.

Spine Examination

What should the medical history tell me?

The medical history portion of the Lower Back Pain Assessment should reveal a history of Lower Back Pain symptoms. Numerous questions about prior experiences with all possible causes as well as symptoms need to be asked that will help us to consider the elimination of unrelated causes. If these questions about past medical history are not asked, they will not likely be answered at all and we might miss crucial information that is pertinent to symptoms and causes of lower back pain.

Utilize a Pain Scale Map to get a Visual Representation of Pain Scale Levels and Representation.

The Pain Scale Map is a visual map of a illustration representing the human body. There should be a Legend of symbols that represent different forms of soft tissue dysfunction and joint position such as Spasm, Trigger Point, or Rotation and Elevation, as well as pain scale levels. A 0-4 pain scale indicates a pain experience at a functional level. A pain scale of 5-7 indicates pain at an uncomfortable level. When the pain scale hits 8-9, that is a level of pain that causes a person to become bed-ridden. Unbearable pain is when the pain scale hits 10. The diagram should then be mapped with the appropriate symbol, pain scale and location.

What makes the pain better or worse?

Ask about what movements exacerbate or decrease pain, and how the movements increase the pain, if the pain is continuous or intermittent, and what time of day the pain is at its worst and what has or has not been done to decrease pain.

Physician involvement may be needed.

With such a large number of possible causes, and some being very serious, Physician involvement and interaction is recommended for prescription medication, Imaging Diagnostics, application of Nerve Block Diagnostics, and other such tests.

What is an MRI: Magnetic Resonance Imaging?

Not only where, but how long and were there any Imaging Diagnostics taken?

We need to find out how long the Lower Back pain has been experienced, if there was rapid or gradual onset, if there is a history of spinal injuries or other injuries or problems such as degenerative disc disease, and if x-rays, or CT Scans, or MRI’s or other imaging diagnostics were taken and what the prognosis or results were. The Imaging Diagnostics will help us to define the following causes of Lower Back Pain:

Herniated Disc in the Lumbar spine
Degenerative Disc Disease in the Lumbar spine
Lumbar Spinal Stenosis-Narrowing of the spinal canal that results in Spinal Cord and/or Nerve Compression
Lumbar Spondylosis - Vertebrae Degenerative Arthritis
Lumbar Vertebrae Stress Fracture—Spondylolysis
Lumbar Vertebrae Anterior Displacement –Spondylolisthesis
Facet Syndrome or Facet Arthritis or Facet Joint Pain in the Lumbar Spine
Scoliosis
Cauda Equina Syndrome
Spinal Tumors
Spinal Cord diseases
Bone Disease

Are there any Visual Symptoms I can expect to see, and what can I do to reveal them?

Observation of the affected area might possibly reveal Lordosis, either Hyperlordosis or Hypolordosis if that is a cause of Lower Back Pain, but you might not see anything remarkable either. Make sure to have the Client or Patient take a few deep breaths to gauge the visual effect that has on the pain symptoms. A Gait Analysis might reveal the severity of the problem if one leg’s movement affects the Lower back, or if any walking movement is unnatural, or weight bearing characteristics. A Postural Analysis is also important, because it will also reveal weight bearing characteristics, and lower back curvature. Pay attention to foot position while standing upright and relaxed, because external rotation is a hint of leg length inequality, and leg length inequality is a hint of pelvic positioning differences. Hand positioning can be indicative of shoulder rotation or pelvic differences.

What should the affected areas feel like when palpated?

The Palpation part of the Lower Back Pain Assessment-evaluation of tissue by feel of the affected area might reveal hypertonicity, pain and/or tenderness in the lower back, glutes, in the Lamina Groove, or legs. Check to see if Trigger Points are present in the soft tissue structures. Check for individual temperature, tone, pain and tenderness of each specific location. Increased temperature indicates possible inflammation; decreased temperature could indicate poor circulation. Muscle tissues should be supple, because hypertonicity or flaccid tissues indicate possible circulatory or nerve related problems.

Hip Examination

Don’t forget to check for Joint Mobility

Make sure to perform a joint mobility test of the entire spine and especially the Lumbar Spine and Sacroiliac Joint of each hip to check for Facet Joint Pain and Sacroiliac Joint Dysfunction or SI Joint Pain and fixations or restrictions that could be a source of pain symptoms.

What Lower Back Pain Assessment Range of Motion Tests should I be doing?

Active(AROM), Passive(PROM), as well as Resisted Range of Motion(RROM) Testing for the Pelvis and Lower Back should be conducted to specifically determine the movements that exacerbate pain, how the pain scale for each movement is affected, the ROM for each movement, and the quality of the movements as to whether the movement is smooth, segmented, spastic, or rigid

What other Components contribute to the root of the problem?

We must absolutely check for proper Hip positioning, Hip Flexor movement and ROM, and Femur Internal and External ROM because that will show us:

If there are any movement restrictions
What the possible causes of those restrictions might be
If any restricted movements might be the cause of Lower Back pain

Nerve Block?

The concept of a Nerve Block is based upon the elimination of nerve pain as a diagnostic tool. The doctor will inject a numbing agent into the location of the suspected source of the problem. If there is significant pain relief, then that location is the cause or one of the causes of the problem. The elimination of pain by eliminating the pain signals that the nerve generates tells us that the nerve that is causing pain is impinged in some kind of way. More than one block may be performed to locate the source of the impingement. A doctor whom is skilled in performing nerve blocks is requisite to the proper application of the nerve block. This could be an Anesthesiologist, or a Physiatrist, or a Neurologist or Neurosurgeon. Lidocaine is usually the anesthetic numbing agent utilized. Depending upon the practitioner, the doctor might also combine the Lidocaine with a Corticosteroid and perform an epidural steroid injection.

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Lower Back Pain Assessment: A Step by Step Precursor to Effective Back Pain Treatment

Lower Back Pain Assessment:
A Step by Step Precursor to Effective Back Pain Treatment