If you have back pain that doesn’t go away within a few weeks, your doctor will likely recommend testing to determine the cause of the pain and suggest treatment to effectively deal with it.
What common tests will a spine specialist perform?
Your physician will start with physical exam tests to determine the cause of your back pain. Physical tests, such as moving your arms, will identify any loss of motion and will reproduce any movements that cause pain. Neurological tests will evaluate muscle strength, reflexes, nerves function, and sensation.
Frequently these tests alone will not be able to identify the exact cause of your pain and your physician may recommend other diagnostic tests.
Depending on what your doctor thinks is may be the source of the problem you may undergo several other types of tests.
Here is a discussion of common back pain tests.
And if you’d like to see a pictorial breakdown of the back pain tests, we got you covered:
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- 1 Types of Physical Tests
- 2 Blood Tests
- 3 X-Ray
- 4 CT or CAT (Computerized Axial Tomography) Scan
- 5 MRI (Magnetic Resonance Imaging)
- 6 Bone Scan
- 7 Discogram
- 8 Electromyogram (EMG) and Nerve Conduction Studies (NCS)
- 9 Diagnostic Injections
- 10 Spinal Tap
- 11 Are Imaging Tests Really Necessary?
- 12 Related Questions
- 13 Conclusion
Types of Physical Tests
To start off with, your physician will want to ask you questions about the history of your back symptoms and will examine your body in various ways to see what might be causing your back pain.
- Testing for weakness. Your muscles will be evaluated through various maneuvers and movements. Your doctor might ask you to lift your arm or leg and see how they respond when light resistance is placed on them.
- Testing for spine and neck motion. Your doctor will ask you if you feel pain in your back or neck when you do certain movements, such as bending or twisting around and will measure your range of motion compared to normal.
- Testing for sensory changes. The doctor will touch your feet and hands and see if you feel certain sensations including pain, light touch, and warmth.
- Testing your reflexes, such as at your patella and Achilles’ tendons.
- Testing for motor skills. You might be asked to walk on your heels or toes to measure your strength and coordination.
- Testing for other problems. Sometimes, the pain you feel in your back or neck may be referred pain from elsewhere in the body. Your doctor will ask you questions to find out if you’re experiencing other symptoms, such as a fever or weight loss, that can point to other conditions.
While blood tests are not a comprehensive means to determine the cause of your back pain, they can be useful if your doctor suspects that you have an infection either in your spine or elsewhere in your body.
A blood test can also offer valuable information if you have inflammatory arthritis, which is when your immune system is overactive or doesn’t work in the way it should.
X-rays are typically the first imaging tests your doctor will want you to do.
An x-ray is important because it gives your doctor a good picture of what the bones in your spine look like, and it can give a good overall assessment of your spine.
For example, are there narrowed canals in the spine that can point to spinal stenosis? Or, is there evidence of osteoarthritis?
There are different types of x-rays. Sometimes your doctor may want to get further information through a myelogram.
A myelogram is a spinal x-ray where contrast material is injected into the cerebrospinal fluid spaces and then an films are taken. The contrast dye helps display if there is pressure being placed on the spinal cord or nerves from conditions such as tumors, bone spurs, or herniated discs.
With this type of x-ray a radiologist can see how the contrast material travels in real-time through the use of fluoroscopy.
This can be beneficial after surgery to see if there is improvement and can also be useful for people who cannot have an MRI or CT scan.
X-rays have limitations and at times more sophisticated and detailed testing is needed to get a better look at both the bones of the spine and the surrounding soft tissues.
CT or CAT (Computerized Axial Tomography) Scan
If your doctor suspects a more significant spinal problem, they may recommend a lumbar spine CT scan.
CT scans give a more detailed look at the bones of the lumbar spine and can be useful for conditions such as a pinched nerves or weakness in the legs. CT scans are also typically used to evaluate spine fractures as they give a three-dimensional view of the bone and any fracture lines.
A CT scan is a combination of x-ray technology with sophisticated computers that create multi-dimensional slice images of your body.
These images can even be turned into 3D views of your back.
Since CT scans reveal soft tissues and muscle much clearer than regular x-rays, they’re a valuable test for diagnosing conditions that cause back pain.
MRI (Magnetic Resonance Imaging)
An MRI goes one step further than a CT scan in evaluating both the bone and the soft tissues that surround it.
MRIs provide much clearer and detailed views of the muscles, cartilage, discs, blood vessels, and tendons in the back.
It is common to get an MRI of both your low back, called a lumbar MRI, or your neck, called a cervical MRI.
A lumbar MRI scan will carefully study the lower back. This is where many back problems tend to originate.
The lumbosacral spine consists of five lumbar vertebral bones, the sacrum (located at the bottom of the spine), and the coccyx. The coccyx is also known as the tailbone.
MRIs also image nerves, ligaments, discs, cartilage, and blood vessels in this area of the body with great detail.
If you have the following symptoms, your doctor might order a lumbar MRI scan to evaluate the problem.
- Back pain with fever
- Birth defects that affect your spine
- Back pain as a result of injury
- Back pain that won’t go away
- Back pain that’s severe
- Back pain that’s accompanied by bladder problems
- Leg pain, weakness, or numbness
In addition, this scan might be performed before back surgery to help your surgeon plan appropriately.
A cervical MRI is similar but it focuses on the bones and tissues around your neck.
The cervical spine is the top of the spinal column that attaches to the base of the skull and is made up of seven bones or vertebrae that are separated by intervertebral discs.
Your doctor will order a cervical spine MRI if they want to check for the following problems in the neck area:
- Herniated discs
- Soft tissue disorders
- Joint disorders
- Vascular disorders, such as aneurysms
- Bone abnormalities
- Injuries or trauma
If your doctor suspects that you have a deeper problem with the bones of your spine, such as a fracture or infection, they may suggest a bone scan to get a clearer view.
During a bone scan procedure, radioactive dye is injected into a vein in the arm. The dye quickly circulates through the body and into the bones of the spine.
An x-ray scan is then done to display places where there’s more blood flow. This can indicate conditions such as tumor, infection, or fracture.
There are some back pain tests that are used for specific conditions your doctor may suspect.
A discogram is an example. Your doctor might want to do a discogram if he or she suspects that you have your pain is coming from one of the discs of your spine but is unsure which one it is.
Discograms are commonly done after some or all of the above tests have been tried first and your diagnosis is still not clear.
During a discogram, you’ll be injected with a radiopaque dye directly into the disc. This is usually then followed by a CT scan or x-ray to fully evaluate the disc.
If the dye remains inside the disc’s center, then the disc is working normally.
However, if the dye moves out of the center, then the disc has been damaged.
This is commonly done at more than one level of the spine. If your pain is reproduced at just one level this can be a clue that this is the source of your symptoms that needs to be addressed.
Electromyogram (EMG) and Nerve Conduction Studies (NCS)
These are tests that measure the electrical impulses along with the nerve roots and into muscle tissue.
They are useful because they can show if there is nerve damage or compression on the spinal nerves in the back or the nerves distally as they go into your arms or legs.
If you’ve been experiencing numbness or weak muscles, then these tests can help doctors to find the cause.
- An electromyogram measures how your muscles respond to nerve signals from the brain. If your muscles are not responding as they should it may indicate some form of a neuromuscular disorder.
- A nerve conduction study will measure the speed and strength of a nerve’s electrical activity. If there is a problem with the nerve conduction you might experience symptoms such as weakness in your muscles, tingling, or even pain. This test will reveal if your nerves have been damaged or if the nerve is being compressed at any time from when it leaves the spinal canal until it reaches the target muscle.
During an EMG test you’ll have a few electrodes or small needles inserted into your skin and muscle.
They will pick up the electrical activity which will be displayed on a monitor (oscilloscope) in the form of waves.
Activity will be measured when the muscle is resting and when it contracts, so during the test, you’ll likely be asked to contract your muscles.
An NCS test is performed in a similar way with the use of electrodes attached to the skin directly over a nerve that is monitored.
A stimulating electrode is placed proximally and the nerve is given a mild and quick shock.
This nerve stimulation will be displayed on an oscilloscope and can be monitored for normal transmission of electrical activity.
Both of these tests will help doctors to diagnose the following problems:
- Nerve problems in the spine, such as herniated discs compressing spinal nerve roots
- Compressed nerves distally in the arms or legs
- Neuromuscular diseases such as muscular dystrophy
- Guillain-Barré syndrome, which is when the immune system attacks nerves in the limbs
While back injections can be used as a treatment to relieve your symptoms, some injections can also be used for diagnostic purposes to determine what’s wrong with your back.
These types of injections include epidural steroid injections, selective nerve root blocks, facet joint injections, and others.
These injections typically combine a strong anti-inflammatory medication such as a corticosteroid, with a strong local anesthetic numbing medicine, such as Lidocaine or Marcaine.
The numbing medicine provides near immediate pain relief in the area of the injection and can help determine if that is the source of your symptoms. The steroid stays in the area of the problem much longer and helps decrease inflammation, which is often a cause of the pain you are feeling.
These injections have the benefit of giving you a bit of pain relief – usually up to 12 hours from a medicine like Marcaine– and they can show your doctor what’s wrong.
If you get pain relief after one type of back injection, that tells your doctor where the problem is. If you don’t, then the doctor will be able to assume that the pain has a different origin.
Sometimes, your doctor might want to get a sample of the spinal cord’s cerebrospinal fluid – this is fluid that surrounds the spine and brain.
By doing a spinal tap, sometimes called an epidural tap, your doctor will be able to check the content and pressure of that fluid. If there are problems with it, it may point to an infection, bleeding, inflammation, or tumor.
During a spinal tap, a needle is inserted into the spinal canal in the lumbar region, directly between two vertebrae.
A spinal tap can help diagnose conditions such as multiple sclerosis, cancer, meningitis, and central nervous system disorders.
If your spinal fluid is cloudy or pink in color, this could point to abnormal bleeding.
Infections can also be noted if there is too little glucose in the spinal fluid or too much protein and if bacteria are found in the spinal fluid, this also indicates an infection.
Are Imaging Tests Really Necessary?
Sometimes it might feel like rushing to your doctor for imaging tests to diagnose what’s causing your back pain is unnecessary.
This may be the case if you have only had your pain for a few days or it is not very severe.
Most people who experience back pain will feel better in about a month and that’s the case whether or not they get imaging tests.
So, the important thing to remember is that if your pain is not severe, you haven’t had it for longer than a few weeks, and you don’t have any other symptoms, then you may want to try to treat it at home before contacting your doctor.
Following this guideline can also save you unnecessary spending.
According to a report that was published in The National Institute for Health Care Management (NIHCM) Foundation, people in America spend over $100 billion on diagnostic imaging every single year, and a large amount of it is unnecessary.
That said, if you’re suffering from a lot of pain, or you’re experiencing other troubling symptoms, such as numbness, weakness, lack of bladder control, or fevers or your pain doesn’t go away within two weeks, then it’s time to see your doctor, who might want to send you for imaging or other tests.
In those cases you shouldn’t delay getting medical help.
The bottom line is that when they’re really necessary, back pain tests can be highly beneficial to help you and your physician understand the cause of your symptoms and to get you into the right treatment.
What can I do to heal my back pain?
There are many things you can try, bearing in mind that most cases of back pain will go away on their own.
Stay active to keep your muscles flexible, use over-the-counter anti-inflammatory medications, apply heat and ice to the area, and make sure you sleep with your spine aligned to prevent making your pain worse.
How can you prevent back pain?
It’s not always easy to prevent back pain, but you can prevent some conditions and injuries by maintaining good posture, doing regular exercise (at least 150 minutes a week), maintaining a healthy weight, and engaging in stress-relieving activities.
If you’re suffering from back or neck pain, your doctor might want to conduct some tests.
As outlined in this article, the various tests all have the purpose of determining what’s causing your pain and how to best treat it.
While these back pain tests may not be ordered right away, your doctor will suggest one or more of these tests if you haven’t gotten relief from your symptoms with other treatments and home remedies