Lower Back Pain – Dissecting A Diagnosis

Transcript

So now that you’ve gone to see your doctor, you’re probably asking yourself, well, how’s he going to sort this all out? How are we going to get to the bottom of things? How are we going to really get a diagnosis? And there’s probably a good place to say that sometimes we don’t always have exactly the diagnosis. Sometimes people do have pain and we don’t come to it numerical diagnosis as it were, and that can be frustrating. But the patient shouldn’t necessarily always come to the diagnosis. The doctor is going to often come to the diagnosis and how’s he going to do that? Number one is the history is hugely important. Second part is being a good examiner. The things that we do, people come in and always wonder about my reflex hammers. Am I going to get a stick that somewhere? And the reality is is I’m very interested in their reflexes. I’m very interested in their strength and very interested in their sensation and I’m very interested in their backs. I think stepping up on a, maybe not a soapbox, but something like that, that there was a interesting article that looked at people who went to practitioners for their backs and only 45% of the time did somebody put their hands actually physically on the back. And there are things to be gained there feeling muscle spasms, feeling if people can actually reverse their curvature when they lean over, march in place does do things relax, seeing where it really hurts. Sometimes patients will be very far off. They’ll say, oh, well I know this. It hurts it L1-2, and it really doesn’t, it’s not really L1-2 at all. It’s it’s either way above that are way below. So history physical, that’s going to get you about 90% of your diagnoses. The last 10% you’re going to get probably 6% of those, the MRI’s going to help you with the next 2% the EMG is going to help you with in the last 2% maybe that’s why we lose our hair. Maybe that’s way we scratch our heads, but we may never have exactly a diagnosis. It may be worthwhile to have a second look months later, maybe worthwhile to have someone else take a look. Clearly, experience and facility, ability examination really helps to get to the right diagnosis straightaway.