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Diagnosing Back and Neck Pains

One of the most popular questions we get is, “How do we treat back pain?” Understandably, if you are suffering any sort of pain, anyone would want to know how to get rid of it. But it is not the best first question. A better first question is, “How do we figure what’s causing the pain?

What is the difference?

Back pain like other sorts of pain is only a symptom. It is a sign that something is wrong. It is not a problem in itself. Unfortunately, it is one of a handful of symptoms that we have that is shared by thousands of conditions. We can trace from a specific condition to how it causes pain. But it is not as simple to trace back from pain to the specific condition. It is like watching someone climb up a mountain to the top. We know where they will end up. But just by observing someone standing at the top of the mountain, we cannot determine from which side of the mountain that person came up from. Take for example, some forms of internal organ problems (eg: kidney) cause back pain. If you were just treating the pain at the back without realizing that it is your kidney that’s the cause of it, you can imagine the result if the kidney was left untreated. While at the same time, there are some chest pains that are caused by issues with the muscles at the chest and not the heart.

Solution meets problem

It is only when we have a complete diagnosis, we can then treat. Otherwise, it is pretty much hit-and-miss. This is the reason why you often hear two persons having very different results with the same back pain treatment. That is because they actually have two different problems but share a common symptom – back pain.

xHow does back pain get diagnosed?

In most cases, back (or neck) pain has its roots in the body’s musculoskeletal system. This system comprises of your bones, joints, ligaments, tendons, muscles, nerves and the nervous system. A competent medical professional will be able to rule out other causes quite quickly and refer to you to the appropriate specialists. If a musculoskeletal specialist determines that the pain might be a result of bone cancer instead of a problem with the musculoskeletal system, the patient will be referred to a cancer specialist. When diagnosing a patient, a musculoskeletal specialist will rely on 4 things:

  1. The patient’s history of the pain.
  2. A visual observation of the patient movements.
  3. Feel of the affected and surrounding areas.
  4. Specific movement diagnostic test to confirm or eliminate probable causes.

An example of a movement diagnostic test is the Thomas Test. In a simple example of Snapping Hip, a condition where a popping sound is heard and pain felt when the leg is moved forward or backward at the hip. To determine if it is an Internal Snapping Hip caused by tight iliopsoas, a muscle deep inside the thigh and pelvis or an External Snapping Hip caused by ITB tightness, a taut band running along the outer side of your thigh. The Thomas Test is a movement that helps us isolated a specific muscle; in this case, the iliopsoas to determine if the Snapping Hip condition is arising from the either two possible causes.

What about machine testing?

Diagnostic tests using machines of late have become controversial in some areas of medicine. In some areas like cancer treatments, detecting specific genetic markers have helped medical practitioners to quickly and accurately, pin-point the exact type of cancer; thereby enabling them to prescribe the most appropriate and effective drug. In the past, cancer treatment employed a cocktail of drugs with the hope that one of them works. Even when successful, the patient suffers a range of undesirable side-effects. Today, success rates are much higher with fewer side effects. Unfortunately in the area of musculoskeletal conditions today, the strength of machine testing is also its weakness. Machines such as Magnetic Resonance Imaging (MRIs) are capable to producing a significant amount of information with a great level of precision. If not properly directed, scanning the entire body will produce a tremendous amount of information. Even when scanning a specific part of the body, the direction and angle of the scan matters. That is only possible if we have some idea of what we are looking for; a probable diagnosis. Another thing that confounds the machine’s precision is our body’s amazing ability to adapt and compensate. There are certain types of conditions within our spine that we know cause pain such as bulging or herniated discs. But not all instances of bulging discs cause pain. It may eventually cause pain in the future but for the moment, something else is causing it.

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