Back pain is a common problem in our country. Sometimes, when you rest a little, when you don't bend over and do nothing, it goes away. But sometimes, the pain becomes unbearable, and then we have to see a doctor. So when you go to a doctor, you have a big question in your mind, 'Oh, will they tell me to take an X-ray now? Or will I have to do an MRI?' Many people are afraid of these tests. In this article, we will talk about what kind of tests a doctor does to find the cause of your back pain, and whether everyone needs these tests.
The first thing the doctor will ask you (your medical history)
When you go to see a doctor, the first thing he does is not prescribe you medicine or order tests. He first talks to you, asks you a few questions, and tries to find out as much information as possible. You may be wondering, "Why are you asking me about my cough, fever, and stomach ache when I have a headache?" But all of these questions are very important in finding the cause of your back pain.
Imagine, Doctor, you might be asked things like this:
- How did the pain start? Did it suddenly feel like your back "snapped" when you lifted something heavy? Or did the pain gradually get worse day by day?
- What makes the pain worse/worse? How is the pain when bending forward, sitting, standing, or sleeping at night? Does doing anything make the pain worse?
- Has this pain ever happened before?
- Have you had any other illnesses recently? For example, cough, fever, difficulty urinating, stomach aches , etc. Sometimes back pain can be caused by an infection elsewhere in the body.
- If you are a woman, you may also hear about unusual bleeding, pain, or discharge from the vagina. This is because some pelvic conditions can cause pain in the back.
Simply put, these answers will help the doctor get a better idea of your condition. Therefore , it is very important to tell the truth without hiding anything.
Next, the physical examination.
After asking you a question, the doctor will examine you. This is called a physical examination . The main thing here is to check for any damage or compression to the nerves that run from your back to your legs.
- Gait testing: You will be asked to walk on your heels for a short distance, then on your toes. This can give you an idea of your muscle strength and nerve function.
- Reflex testing: The doctor will tap the back of your knee and ankle with a rubber hammer. If the nerves are working properly, your leg will automatically jerk at this time.
- Leg raise test: You will be asked to lie down on a bed and raise one leg straight up. You may be asked to do this with or without the doctor's help. This mainly checks for pressure on the sciatic nerve, a large nerve that runs from the back down the leg.
- Sensation testing: A small object, such as a pin or paper clip, will be used to touch different areas of your legs and ask, "Do you feel anything?" This can help determine if there is damage to the nerves that carry sensation to your legs.
- Other tests: If your doctor suspects a serious condition, they may also examine your abdomen, pelvis, or rectum. Loss of bladder and bowel control, especially if the nerves in the lower spine are damaged, may be a cause. These tests may be needed to rule out a more serious condition.
Does everyone need an X-ray or MRI? - Imaging tests
This is what most people think about the most. Do you need to get an X-ray or MRI when you have a back injury?
The answer is, no . Not everyone needs this kind of special testing right away when they start having back pain. In fact, about 90% of people with back pain get better within a month. So, unless there are specific warning signs (red flags), there is little point in doing these kinds of tests within the first 4-6 weeks.
Okay, so let's see what these tests are and what situations they are used in.
| Name of the test | In what situations is it used? | Important things to know |
|---|---|---|
| Normal X-ray | This is not very useful in the early stages of a common backache. However, if you have had a trauma, are over 50 years old, have a bone-thinning condition such as osteoporosis, or have been taking steroids for a long time, an X-ray may be necessary. | X-rays only show bones. They do not show soft tissues, such as the discs between the vertebrae or the nerves. |
| MRI Scan | This is a very advanced and expensive test. It is not recommended for general back pain. However, it is done if there is a suspicion of a serious condition that may require surgery (for example, a spinal infection, cancer, fracture, or an emergency such as Cauda Equina Syndrome). It is often considered to find the cause if the pain has persisted for more than 12 weeks. | There are also problems with MRI scans. Even in healthy people who don't have back pain, MRI scans can show bulging discs between the vertebrae. Seeing something like this can lead to thinking that this is the cause of the pain and resorting to unnecessary treatment. Therefore, it is very important to show the MRI report to your doctor and seek advice rather than trying to interpret it yourself. |
| Myelogram and CT scan | This is a test that is only used in very specific cases, often when planning surgery. It involves injecting a special dye into the spine and performing a CT scan. | With the advent of MRI, the use of this test has now decreased significantly. |
What are "Red Flags"?
Doctors call "red flags" warning signs that could indicate a serious medical condition. If you have these symptoms, your doctor may immediately refer you for imaging tests.
- A fall or serious accident.
- Unexplained weight loss and fever.
- Inability to control urine or stool (This is a very serious emergency. You should immediately go to a hospital's Emergency Department (ETU).
- Gradually increasing loss of sensation or weakness in the legs.
- Having a previous history of cancer.
Nerve Tests
Sometimes, especially if the pain persists for a long time, another test is done to find out exactly how much damage has been done to a nerve.
It's called an Electromyogram (EMG) . In this test, tiny needle-like electrodes are inserted into the muscles and the electrical activity is monitored on a computer screen. This test can be a little painful. But it helps the doctor determine whether a nerve is damaged or if the problem is in the muscles, and it can also help measure the extent of nerve damage.
Take-Home Message
- Back pain is very common and in most cases, it resolves within a few weeks with proper rest and simple treatment.
- Not every time you have back pain, you need an X-ray or MRI. Unnecessarily resorting to these can be a waste of money and cause unnecessary stress.
- The first thing your doctor will do is listen to you and examine you. That is the most important step in the diagnosis.
- Trust your doctor's advice. If a test is needed, he will definitely refer you for it.
- If you have "red flag" symptoms, such as loss of urinary/fecal control, sudden loss of strength in your legs, go to a hospital's Emergency Department (ETU) immediately.
- Don't assume you have the same condition just by looking at a friend's or relative's MRI report. Each person's situation is different. Always discuss your test results with your doctor.
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