People who have come to see me with bad back pain sometimes ask “Why do I have to do so many tests?!” That’s a fair question.
I wish I was like Bones McKinney on Star Trek, and could wave a simple gadget over your body to know “Aha!. There’s your problem. You have a displaced Thingamagigorother. If we just adjust your Ionphontophoretic stabilizer, we’ll fix you right up!”
But of course, it’s not that easy. Diagnosing your back pain involves taking a look at your nervous system, the most complicated system in the body. Your nervous system consists of the brain and spinal cord (central nervous system) and nerves (peripheral nervous system). It’s in charge of coordinating actions by transmitting signals to and from different parts of your body. Whereas your other systems can all be replaced or transplanted, your nervous system cannot.
To understand what’s going on and why you are experiencing back pain, we conduct tests, each one serving as a piece of a puzzle that allows us to make the right diagnosis and select the best treatment plan. We do different type tests because none of these single tests are perfect and none of them tells us everything we need to know about what is causing a problem like back pain nor how we can help you with it.
For instance: Someone who comes in with severe back pain that radiates into the leg or hip may have numbness in the foot or leg. They may also have weakness in the leg involving specific muscles. When we examine them, we find they have decreased reflexes. Based on all this, we think they might have a pinched nerve in the back. The nerves that go into the leg and hip come from the back. But what if you have a pinched nerve in the hip or the leg too? Without multiple tests, we won’t know and may potentially end up with the wrong diagnosis.
To prevent that, we use the four-step testing process.
Four Step Testing Process to Diagnose Lower Back Pain
Step 1: Electromyography (EMG)
We start by conducting an Electromyography (EMG) which measures muscle response to a nerve’s stimulation of the muscle. The EMG results allow us to assess the health of the muscles and see how badly the nerve is pinched in the back. The EMG will also let us rule out a pinch somewhere else in the arm. With these results, we have one piece of the puzzle.
Step 2: MRI
The EMG helps us identify the pinched nerve, but it won’t tell us what’s causing it. So, we do an MRI of the back and in rare cases, the hip or pelvis. The MRI allows us to see if a disc herniation, or tumor, or cyst, or something in the lower part of the spinal cord is pinching the nerves as they travel through the spinal canal to leave and go through the muscles and into the leg or hip.
Step 3: X-Ray of Your Back
While the MRI is the best at showing soft tissues like nerves and the spinal cord, it doesn’t look at abnormal low back movement when you stand and bend over. As a matter of fact, your back looks the best it ever will in an MRI machine, because you’re lying down, with your legs supported so you’ll be comfortable. It’s in the perfect position to display the nervous structures in the back.
To find out if there’s abnormal movement of your back, we have to do an X-Ray of your back with weight bearing and flexion and extension. These results will shed light into what may have led to a disc herniation or arthritis in the first place. But of course, it doesn’t tell us everything. That’s where Step 4 comes in.
Step 4: Test for Sleep Disordered Breathing
You may be thinking, what does sleep have to do with my back pain? Your back pain could actually be related to a sleeping disorder, something that an EMG, MRI or X-ray will not tell us.
Patients with Sleep Disordered Breathing often snore and wake up tired, no matter how much sleep they get. To try and improve their sleep, they sleep on their side or tummy, never giving their neck or low back a break. This could be causing the lower back pain, but to fix it, we have to fix your sleep.
We have found that testing for sleep-disordered breathing can improve the quality of your life like almost nothing we can do.
What the Tests Tell Us
With the results of these four tests — EMG, MRI, X-Ray, and tests for Sleep Disordered Breathing — we will have the pieces we need to solve the puzzle of your low back pain. Having this complete picture, we can understand what’s really wrong, create a treatment plan for the actual cause, and avoid unnecessary surgery and/or daily pills.
So that’s why we do tests. They’re essential to finding the root cause and the best treatment.
Until somebody comes up with tricorders1.
1A Tricorder is a scanning device used by Starfleet personnel in the Star Trek universe. There are two variations; a regular (engineering) tricorder and a medical tricorder. Medical tricorders are used to wirelessly scan a patient, either in a ‘sick bay’ on a starship or during an away mission. The advanced scanning tool can determine a patient’s medical status and readings and allows doctors to quickly and easily diagnose their condition without an intensive or invasion examination.