Back Pain

Dr. Weyrich's Naturopathic Functional Medicine Notebook

Diagnosis

Active Movements

Resisted Movement

Reflexes

Sensory Testing

Muscle Testing

Peripheral Joint Examination

Differential Diagnosis

The causes of back pain can be broken down as follows [Deyo2001]:
  1. Mechanical causes (97%):
    1. Herniated disc (4%).
    2. Osteoporotic compression fractures (4%).
    3. Spinal stenosis (3%).
  2. Visceral disease, such as pancreatitis, prostatitis, and aortic aneurysm (2%).
  3. Nonmechanical spinal conditions such as tumors, infections, and rheumatologic disorders (1%).

The differential diagnosis of low back pain includes the following:

Treatment

For most patients, "active recovery" is best - and "bed rest" is counter-productive, as it not only delays recovery, but also worsens symptoms. Although patients should remain active, they should avoid specific movements or activities that provoke pain, especially lifting weights, sitting or standing for extended periods, and impact activities. During the acute phase of back pain, walking is perhaps the best activity, and application of ice may be helpful in relieving pain [ACE-AHFS, pg 492].

After the acute phase has passed, application of heat to relieve muscle spasms may be better, instruction in proper body mechanics and targeted exercise forms the cornerstone of recovery and prevention of future exacerbations [ACE-AHFS, pg 494].

The most effective exercise programs are individually designed, at least partially supervised, and extend over 20 total hours. Stretching exercises have the greatest impact on pain, while strengthening exercises give the greatest functional improvements [Hayden2005].

It is important to note that attempting to “work through the pain” when exercising the back is usually counterproductive. As Stuart M. McGill points out, if an exercise causes pain, the patient is probably "doing the exercise incorrectly, or more likely, doing the wrong exercise" [ACE-AHFS, pg 499].

ICD-9 Codes

ICD9-CodeDescriptionComments
   

References

Unless specifically noted above, references used in the construction of this web page include the following:

[FDM] Lecture notes from Functional Medicine University.

[SCNM] Lecture notes from Southwest College of Naturopathic Medicine.

[UT] Lecture notes from the University of Tennessee graduate programs in Chemistry and Biochemistry.

[ACE-AHFS] American Council on Exercise. "Advanced Health & Fitness Specialist Manual" Chapter 20: Low-back Pain.

[Deyo2001] Deyo & Weinstein (2001). Cited in [ACE-AHFS, pg 491].

[Evans2001] Ronald C. Evans. Illustrated Orthopedic Assessment. St. Louis: Mosby (2001).

[Hayden2005] Hayden, van Tulder, & Tomlinson (2005). Cited in [ACE-AHFS, pg 494].

[PIHMA] PIHMA lecture notes.

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This web page is http://www.DrWeyrich.com/disorders/pain_back.html   -   Phone Dr. Weyrich at (480) 423-6952