Low Back Pain (LBP): Diagnostic Steps
Part 2 of 3
Pain felt in the low back (lumbar spine) is not always indicative of a spinal problem. A thorough physical and neurologic assessment may reveal the cause of the low back pain. The physical examination begins with the patient's current condition and medical history.
Range of Motion
The patient's range of spinal motion is evaluated while standing straight, bending
forward, and to the side. Asymmetry, posture, and leg length is noted. Methodical
palpation of the spine can reveal muscle spasm, possible bony displacement,
and tender points. Abdominal palpation is performed to determine if the cause
of low back pain is possibly organ related (e.g. pancreas).
Neurologic Assessment
The neurologic assessment evaluates weakness, absence of reflexes, tingling,
burning, pain, diminished function, and other signs that may indicate nerve
involvement. In some cases electrodiagnostic studies such as electromyography
(EMG) or nerve conduction velocity (NCV) are performed to confirm a diagnosis
or localize the site of nerve injury.
Lab Tests
If infection, malignancy, fracture, or other risk factors are suspected, routine
lab tests may be ordered. These tests may include complete blood count (CBC),
erythrocyte sedimentation (ESR), and urinalysis.
Imaging Studies
Plain radiographs (x-rays), CT Scan, and/or MRI studies are performed when fracture
or neurologic dysfunction is suspected. An MRI represents the gold standard
in imaging today. An MRI renders high-resolution images of spinal tissues such
as the spinal cord and intervertebral discs. X-rays are still the imaging methods
of choice to study the bony elements in the low back.
The results of the physical and neurologic examinations combined with test
results are carefully evaluated to confirm a diagnosis.
