Getting to the root cause of your pain takes an in-depth assessment and a dose of patience.
by Featured Provider Emily Burns on Wednesday, September 22, 2021
There are 33 vertebrae in your spine and 46 muscles in your back and neck. Anything that’s inflamed, out of place or out of whack can send pain anywhere from your head to your toes to your fingertips.
So there’s a lot that can go wrong. And it takes a thorough examination of every part of your neck and back to pinpoint the problem at the root of it all.
“Early intervention is key. The faster you’re seen for neck or back pain, the faster you can relieve it and avoid a chronic issue,” says Emily Burns, ARNP, a back pain specialist at The Iowa Clinic’s West Des Moines campus. “The goal of a back pain assessment is to get you the right treatment at the right time.”
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The assessment starts with how you hurt your back.
The beginning of your back pain consultation might feel more like an interview than a typical exam. Because to get to the root of your pain, you have to start at the beginning.
“The initial assessment really comes from you,” Burns says. “I’m really looking for a good, solid history. I want to know exactly when your back pain started and what has been going on since then.”
A lot of things can cause back pain: poor posture or core strength, lack of exercise, excessive or improper lifting, trauma or a spine condition. Sometimes, there’s no clear cause at all. So the history of your back pain points the specialist in the right direction. They will want to know:
- When did the pain start?
- Was there a triggering event?
- Where do you have pain?
- What does it feel like?
- Has this ever happened to you before?
- Does your pain change with different positions or movements?
- Is it constant or did it go away and come back?
- Does your pain come on or go away at different times of day?
- Have you tried medication, stretching, exercise or other things at home?
- What worked and what didn’t?
“Your answers help me get a better idea of your diagnosis and where we should start our treatment,” Burns says. “But the number one question we ask is ‘Does this pain interfere with your life?’ If pain’s keeping you from performing daily activities, we want to at least bring it down to where you can function.”
Next, your back specialist examines you from head to tail.
The Q&A portion of your consultation provides an indication of what’s happening with your spine. But that might not be the whole story. The true source of your pain may be somewhere else, or there may be multiple things going on.
A physical examination, starting at the top of the spine and working down to the tailbone, can find the answer.
“I go down your whole spine, pushing on various areas. Does something move? Does it hurt when I push?” Burns says. “I also see if positioning your spine in different ways changes your pain. Or if I move your arm or leg, will that cause pain?”
The physical exam doesn’t stop at the spine. Other routine tests can show that you’re experiencing pain, even if you don’t feel it at a high level. The physical assessment also checks your:
- Vital signs – High blood pressure or a rapid heart rate signal that your body is responding to pain. This is an especially important indicator for people with high thresholds for pain.
- Reflexes – Pain can dull your senses and your reflexes — or make you more sensitive to stimuli. Reflexes that are too fast, too slow or not there at all can signal where the problem is coming from in your spine, Burns says.
- Strength – Weakness is another hidden indicator. Pushing and pulling against different objects tests your strength. The back pain specialist may also push or pull against you for a bigger test.
With all this information, your back pain specialist puts the pieces together and makes the diagnosis.
“With what your history and my assessment tell me, we have the entire picture to make the best diagnosis possible,” Burns says. “It might not be the same diagnosis as the pain you’ve had in the past. And we may try something different if it didn’t work previously or helped but then stopped working.”
Imaging is usually only needed if your back pain persists.
You might associate getting an X-ray or other medical imaging with diagnosing pain. If you fall, have an accident or think you have a fracture or broken bone, imaging often helps make a quick diagnosis.
Neck and back pain are different. You can still have pain despite nothing showing up on a diagnostic test.
“The best way to look at the spine is with an MRI. It shows us the soft tissue. But generally, you don’t need an MRI, X-ray or anything else until we’ve tried other things first,” Burns says.
The medical evidence backs this up. Experts recommend an MRI only if it’s absolutely necessary. If you’re not better in four to six weeks, then you may have an MRI to further explore your spine. But there are some serious symptoms that move that timeline closer.
“Certain symptoms are red flags. They need urgent evaluation,” Burns says. “If you experience sudden weakness in a limb (generally on one side of the body), foot drop and bowel or bladder incontinence, you need an MRI right away to see what’s going on.”
Your treatment plan adjusts to your pain.
Even with an accurate diagnosis, there’s no one-size-fits-all approach to resolving neck and back pain. And it’s unlikely that you’ll get immediate relief — especially if you have chronic pain.
“As much as we’d like to give you a pill to make the pain go away, that’s not going to be the case,” Burns says. “Pain relievers only offer short-term relief. We’re treating the cause of your pain to make sure it goes away and stays away.”
Your treatment plan will vary depending on your diagnosis, medical history, pain tolerance and interventions that have or have not worked in the past. You may receive:
“People often think that their pain will always be there or that the only way to fix it is through surgery,” Burns says. “But back pain, even chronic pain, can be improved over time by trying out different treatments to see what works best for you.”
That means finding the right treatment to resolve your pain may take a little time. You have to give each treatment enough time to assess its effectiveness, which can take two to six weeks.
“Following up is absolutely vital. I like to follow up every couple of weeks because that’s enough to see a trend,” Burns says. “Maybe your pain has improved but isn’t gone. Or maybe the treatment just isn’t working. Regular follow-ups help us finetune the treatment until your pain is gone for good.”