Workplace Health

Understanding the Symptoms of Back Pain

Back pain can be considered an evolutionary side effect of standing upright. Walking on two feet shifts your upper body weight to the lower spine, where most back pain occurs. As a rheumatologist who has had to sort out thousands of cases of back pain, I have come up with practical ways of dividing patients' problems into different categories.

Initially this involves asking a series of quick questions. Although everyone likes to think of him- or herself as unique, recurring themes usually separate back pain into specific groups. For example, if bending down to pick a heavy suitcase causes immediate back pain that lasts for a week, it is likely that you strained a muscle. However, if this pain shoots down the leg, it might be a ruptured disc pressing on a nerve.

Diagnostic Accuracy and Therapy

Pinpointing the cause of your back pain allows for the best treatment plan. Therapies are customized to help with a particular problem, and getting the incorrect one may make the situation worse. Here is an example to illustrate this point: A young patient with unexplained back pain has an inflammation in the back called a spondyloarthropathy (disease in the joints of the back). By having an accurate diagnosis and correct treatment this patient will know to avoid vigorous exercises that will make the pain worse. Likewise, an elderly woman with a vertebral compression fracture should avoid exercise.

Ten Questions

I try to get an answer to the following questions when interviewing new patients with back pain. Although these questions alone may not pin down the culprit behind your back pain, they will uncover valuable clues. :

1. Is the pain mechanical?
Mechanical pain is caused by abnormal or excessive stretching of back muscles, tendons or ligaments. It can also be caused by a vertebra in the back pressing on a nerve or the spinal cord itself.

Pain caused by an injury or unusual movement is typically easy to recall. I like to know if were you playing a sport when it happened, swinging a golf club, bowling or exercising, particularly with weights. Any new type of exercise is always a good clue, even if you think it was mild and don't believe it had anything to do with the current problem.

I also like to know whether you lifted something heavier than usual. Did you reached to get a package while in an awkward position, like pulling a shopping bag from the trunk of a car. Did you lift with your back (the wrong way) or by bending your knees first and then using the strength of your legs to help you? Were you moving furniture while cleaning, or moving boxes during a move at work or at home?

I always like to know what type of work you do, what your leisure activities are, and how you spend your day in general in order to uncover potential instants of extra or unusual physical exertion.

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