Back pain symptoms
Pain in the lumbosacral portion of the spine (lower back) is the main symptom of back pain.
The symptoms can radiate downwards, to the front, to the side or back of the leg, or can be isolated to the back.
The pain may increase with activity.
Worsening of the pain is possible at night or when sitting for a long time (e.g. on long car journeys).
Numbness or weakness may be felt in the limb innervated by an irritated nerve ( lumboischialgia or lumbocruralgia ).
This can result in the patient being unable to extend the foot down to the sole of the foot, ie unable to tiptoe. This situation arises when the root of S1 is pinched or damaged.
On the other hand, if the L5 nerve root is irritated, it is impossible for the patient to lift the big toe upwards.
When is a doctor’s visit advisable?
The “Agency for Healthcare Research and Quality” has identified 11 so-called “red flags” (red flaggs), i.e. alarm signs, which doctors evaluate when examining a patient with back pain.
Using this list of alarm signs, fractures (broken bones), infections or tumors in the spine can be detected. Any of the following red flags associated with back pain should be taken as an alarm signal that requires a visit to the doctor as soon as possible for a thorough evaluation.
- Recent trauma of some magnitude, such as a fall from a height, a car accident, or a severe contusion.
- Milder trauma from the age of 50: falling down a few stairs or slipping and landing on your buttocks can be enough to cause minor trauma.
- A medical history that has required prolonged use of steroids; asthma patients and people suffering from COPD (smoker’s lung) or rheumatic complaints may also have taken this type of medicine.
- Incidents suggestive of osteoporosis: for example, an elderly lady who has previously fractured a hip is at high risk.
- Anyone over 70 years of age: Increased incidence of cancer and pelvic infections which can cause the pain.
- An alarm bell is a medical history of cancer.
- Anyone who has recently had an infection .
- A fever above 38°C must always be taken into account.
- Drugs: Taking drugs significantly increases the risk of infection.
- Low back pain at rest: it can be linked to an infectious or malignant cause of pain, but it can also be due to ankylosing spondylitis.
- Unexplained weight loss can indicate serious medical conditions.
Any one of these signs requires immediate medical attention and warrants a visit to the hospital emergency department, especially if the family doctor is unable to perform an examination within 24 hours.
If a nervous dysfunction occurs, a doctor must be consulted immediately. In connection with nerve pathologies, the following symptoms can be felt: the patient is unable to walk, raise the big toe up, walk on heels or tiptoe. These symptoms could indicate damage or compression of a nerve.
In certain circumstances, these could be complaints that fall within the competence of a neurosurgeon.
Lack of bowel and bladder control, including difficulty in starting and stopping the process of urinating and defecation, can be a sign of an acute emergency and needs urgent evaluation in a hospital emergency room.
If the pain is not controlled despite taking the prescribed medication, the situation should be reassessed by the general practitioner or, if this is not available, a visit to the emergency room.
However, it is advisable to have the doctor treating you, as he is familiar with the course of the disease.
Medical history (anamnesis) for back pain
Because many different medical conditions can cause low back pain (lumbago), the doctor will ask about the patient’s entire medical history. His questions may sometimes seem inappropriate, but they are important for the doctor to find out the cause of the pain.
The doctor asks many questions about the onset of pain (did you feel direct pain when you lifted a heavy object? Did the pain come on gradually?). He (or she) will want to know what makes the symptoms worse or better. The doctor bases his questions on the symptoms and “red flags”. It is important for him to know if the pain has occurred before; he will ask for information about recent illnesses and side effects, such as a cough , fever, difficulty urinating or stomach problems. For women, the doctor needs to know if there is vaginal bleeding, cramping , or dischargepresent. Pain that originates in the pelvis is often felt in the back.
Physical examination for back pain
For a thorough examination, the doctor will ask the patient to uncover the top. In search of nervous problems, he lets him walk on his heels and tiptoes. The reflexes are usually checked with the help of a small mallet; the test involves a hammer blow to the knee and back of the ankle.
Then the patient lies supine on the couch; he lifts one leg at a time, the knee is stretched and the toes point towards the ceiling. This movement is performed actively and passively to check for tension in the sciatic nerve and to assess muscle strength.
Sensitivity is usually checked by running a nail, paper clip, broken tongue depressor, or other sharp object across the leg to assess any form of sensory disturbance (dysesthesia) in the legs.
Doctors may also do abdominal, pelvic, and rectal exams based on suspicions and symptoms to rule out conditions that can cause back pain. The nerves in the lower part of the spinal cord innervate the sensory area and muscles of the rectum; if these nerves are damaged, the ability to control urination and bowel movements can be lost. In this case, a rectal examination is essential to ensure that there is no nerve dysfunction in that area of the body.
Imaging procedures for back pain
Various examination methods are available to doctors, which provide a “look” into the body and give an idea of what could be causing the back pain. None of these diagnostic methods is perfect, as the presence or absence of a disease cannot be determined 100% of the time.
If there are no warning signs (red flags), an X-ray is of little use in the case of acute back pain. In about 90% of those affected, the back pain disappears within 30 days of onset; for this reason, most physicians do not prescribe technical examinations while performing the routine assessment of acute low back pain when it occurs without complications.
Usually, plain x-rays are considered of little use in evaluating acute low back pain, especially within the first 30 days. If there are no warning signs, it is even discouraged because they emit radiation. An X-ray, on the other hand, is recommended for major trauma, minor trauma in people over 50 years of age, osteoporosis patients and prolonged use of steroids.
In a myelogram or myelography, a contrast medium is injected directly into the spinal canal and an X-ray image is then taken. Since the invention of magnetic resonance, the use of this examination method has drastically decreased. Myelography is usually done in conjunction with a CT scan and only if surgery is planned.
Magnetic resonance (MRI) is a very precise but also very expensive examination method; Here, no X-rays are used for imaging, but strong magnets. Routine magnetic resonance imaging for acute low back pain is not recommended unless the situation requires rapid surgery, such as for cauda equina syndrome.
Magnetic resonance is appropriate when there are warning signs of spinal canal infection, bone fracture , tumor, or infection.
MRI may also be considered to rule out serious causes if symptoms have lasted longer than a month.
Magnetic resonance is not a perfect diagnostic method. Disc bulging (bulging of the core of the disc) has been found in 80% of MRIs performed on people without back pain. Other studies have found that MRI could not even diagnose 20% of disc damage found during surgery.
Computed tomography, or CT for short, uses X-rays to create cross-sectional images of the body. CT is used just as often as MRI.
Examination of nerve conduction
Electromyography, or EMG, is a test in which tiny needles are inserted into muscles to measure electrical muscle activity. It is commonly performed for chronic pain and to assess nerve root damage. Electromyography helps doctors distinguish nerve root disorders from muscle disorders.
The following blood tests can provide information about whether there is inflammation in the body: blood sedimentation rate (ESR) and C-reactive protein concentration.
A blood count is made to detect an increased proportion of white blood cells or anemia .