The Importance of Assessment and Diagnosis

 

Perhaps more important than treatment or exercise recommendations is the ability to perform the most accurate assessment possible and therefore be able to diagnose (to the best of our ability) the source of pain and the factors that may be playing a factor in the development and persistence of pain.

 

Without a proper assessment and diagnosis, it is very easy to miss the true pain generator. If that occurs, your provider won't be able to recommend the most effective treatment for that particular subgroup of back or neck pain. Assessment by a Primary Spine Practitioner (PSP) involves finding the answers to the following 3 questions:

 

1) Do the presenting symptoms reflect a visceral disorder, or a serious or potentially life-threatening illness?

 

• Some more serious pathologies can present as back pain, neck pain or headaches. Identification of the history facts and exam findings can lead to a speedy diagnosis and immediate referral for appropriate care.

• On the bright side, only 3-7% of spine-related disorders require further investigation with specialist referrals, blood work or imaging.

 

2) Where is the pain coming from?

 

Lumbar Spine

 

• Disc Derangement (a range of disc disruption from mild to an actul disc herniation)

• Joint Dysfunction (facet joint or sacroiliac joint pain)

• Radiculopathy, Acute or Chronic (a pinched nerve - from disc or spinal stenosis)

• Myofascial Trigger Points / Myofascial Pain (muscular involvement resulting in pain spreading into the buttock or leg)

• Piriformis Syndrome (sciatic nerve entrapment in/around a muscle in the buttock that can mimic a pinched nerve)

• Greater Trochanteric Pain Syndrome (Trochanteric Bursitis - swelling of fluid filled sac(s) around the hip joint)

 

Cervical Spine

 

• Disc Derangement (a range of disc disruption from mild to an actual disc herniation)

• Joint Dysfunction (facet joints)

• Radiculopathy, Acute or Chronic (a pinched nerve - from disc or spinal stenosis)

• Myofascial Trigger Points / Myofascial Pain (muscular involvement resulting in pain spreading into the arm or shoulder)

 

3) What is happening with this person as a whole that would cause this pain experience to develop and persist?

 

Lumbar Spine

 

• Dynamic Instability (miscommunication between your brain and lumbar spinal stabilizing muscles)

• Nociceptive System Sensitization (an overly sensitive nervous system that mis-interprets normal stimuli out of the region of pain)

• Identifying "The Big 5":

1. Fear

2. Catastrophizing

3. Passive Coping

4. Poor Self Efficacy

5. Depression

 

Cervical Spine

 

• Dynamic Instability (miscommunication between your brain and lumbar spinal stabilizing muscles)

• Oculomotor Dysfunction (miscommunication between your neck and eyes AND/OR balance center and eyes following trauma to the upper neck - i.e. motor vehicle accidents and whiplash)

• Nociceptive System Sensitization (an overly sensitive nervous system that mis-interprets normal stimuli out of the region of pain)

• Identifying "The Big 5":

1. Fear

2. Catastrophizing

3. Passive Coping

4. Poor Self Efficacy

5. Depression