CLINICAL EVALUATION

          A careful history is by far the most important aspect in assessing back problems. A careful medical history can guide the physician in choosing the appropriate physical and laboratory examinations.

History:

1. Age: although back pain low back pain from traumatic or mechanical causes occur in all age groups, it is more common in the third decade and peaks at age 40.
2. Occupation: most low back pain are occupationally related; occupation may provide clues to risk factors that are not often known by the patient; for example, constant vibration, as experienced by truck drivers who drive for long hours, can contribute to the occurrence of back pain.
3. Pain:

• Onset of pain: Many patients associate back pain with heavy lifting or heavy work loads and do not realize that even simple maneuvers, such as twisting while mopping the floor or twisting while pulling something out of a drawer, can trigger pain.
• Aggravating and relieving factors.
• Characteristics and distribution: Precise localization of pain and of any associated neurologic symptoms (e.g. paresthesia, numbness, weakness) can identify the specific nerve root involved.

Physical Examination:

          A thorough physical examination is mandatory for all patients with back pain.

1. Inspection - body built, posture, deformities, pelvic obliquity, spine alignment
2. Palpation - Palpate for tender or trigger points, muscle spasm, tightness of paraspinal muscles.
3. Range of Motion assessment
4. Neurologic Examination

Diagnostic Testing:

          Routine radiographs of the spine is still useful, quick and costs less. Used to establsih a baseline and to rule out metabolic, inflammatory and malignant conditions.

• Computed Tomography (CT) Scans accurately show most bony and neural problems in around the spine and spinal canal. Detects disc disease.
• Magnetic Resonance Imaging (MRI) delineates soft tissue extremely well and does not require the use of intravenous contrast agents or radiation.
• Electromyography (EMG) may be appropriate if there is a nerve root dysfunction.

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The information in PROFCENTRAL  is not intended as a substitute for medical professional help or advice but is to be used only as an aid in understanding medical conditions. A physician should always be consulted for back pain or any other health problem. PROFCENTRAL  provides links to other organizations as a service to our readers and is not responsible for the information, services, or products provided by these web sites, health professionals, or companies.