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The process of diagnosing the precise cause of back pain,
which occurs in about 80% of the population, can be a difficult.
Back pain can result from muscular strain, degenerative
spine disease (e.g. degenerative disc disease), wear and
tear (e.g. osteoarthritis), anatomical defects, nerve compression,
trauma, and a broad range of other disorders.
In some instances, the spine specialist could be compared
to a detective who compiles clues and physical evidence
to prove a case. The spine specialist gathers clues from
patient history, physical examination, imaging studies and/or
other tests, and a neurological assessment to confirm a
diagnosis.
Many people associate a neurological exam with patients who
are paralyzed, have suffered a stroke, or who have problems
sleeping. Although this is true, assessing a patient’s neurological
function is important to diagnosing and treating spinal
problems too. A general neurological examination provides
the physician with valuable insight into the patient’s brain,
spinal cord, nerves, and muscles.
Evaluating Symptoms
The spine specialist asks several questions about the patient
in general and their symptoms. The list below is not all-inclusive.
Depending on the patient and their symptoms, additional
questions may be posed.
- Have you noticed weakness
in your arms or legs?
- Does the weakness come
and go or is it consistent?
- Do you experience muscle
twitching?
- Do you have problems walking?
What kind of problems?
- When do you have problems
walking? Climbing stairs? Walking downhill?
- Do you experience cramps
in your legs?
- Do you have any numbness,
tingling, or pain in your back or extremities?
- Does changing position
relieve your symptoms?
- What makes your symptoms
worse?
- Do you have bowel or bladder
problems?
Gait and
Balance
Walking, or gait, simply means the way a person walks: rhythmical
pattern and speed. Walking is a complex process involving
different reflexes stimulated by the nervous system and
the person’s awareness of where they are in space (termed
‘proprioception’), which is important for balance. The physician
may ask the patient to walk across the room, turn and come
back, walk heel to toe, on their toes and heels, hop in
place on each foot, and/or rise from a sitting position.
The physician observes any listing, erratic movement, or
loss of rhythm. These movements may also indicate weakness
and difficulty with balance.
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