Why we don’t diagnose your back pain

Patients are able to track their improvement in their data with our Physiotherapists.

By Adam Cabble, getback Head of Exercise Physiology

Chronic back pain is so common that almost everyone knows someone who has chronic, long standing back pain. 

As if chronic back pain isn’t enough, another major challenge for sufferers is the number of treatment options available. 

And, with the ever-increasing services and professions offering treatment to chronic pain comes a growing number of diagnoses. 

The International Classification lists 36 different diagnosis options for ‘bulged disc’ or ‘slipped disc’, and that’s before you consider diagnoses for ‘back’. In all, there are 100 possible labels that could be applied to a patient presenting with back pain. 

You could see 10 different professionals, describe the exact same symptoms or activities that aggravate your pain, how long you have had pain for and where it moves to, and end up with 10 different diagnoses for your pain.

The result? Your understanding of your pain has not improved and you’re more confused about your back pain than you were at the start of the appointment. 

At getback we have stopped giving our patients a ‘diagnosis’ for their back pain. Instead, we focus on what you can and can’t do, and how your back impacts your day-to-day activities. 

Work by Canadian orthopaedic surgeon Hamilton Hall identified that 90 per cent of back pain is mechanical in nature. Put simply, that means some activities will aggravate your back pain and other activities won’t. For example – sitting and bending increases your pain, but walking is ok (Hall, 2014). 

Back pain that is mechanical in nature also fits into four clear patterns. In simple terms, the four patterns are:

  1. Back pain that is worse with flexion (sitting and bending forward) and relieved by extension (walking)
  2. Back pain that is worse with extension (standing and walking) and relieved with flexion (sitting or bending forward).
  3. Pain is worse in your legs than your back, ie numbness, tingling and pins and needles that is aggravated by all movement directions.
  4. Pain that is worse in your legs than your back, ie numbness, tingling and pins and needles that is relieved by flexion (sitting) or extension activities (walking).

(Hall, 2014)

During your 60-minute Initial Consultation at getback, your therapist will ask you a series of questions to gain a deep understanding of your pain and how it is impacting you. They will ask you questions about where your pain is worse, if you ever have less pain, and if so, which activities reduce your pain. 

Once a pattern has been identified, a series of relief strategies such as stretches or activity modifications will be provided to help manage your pain between getback appointments.  

Over a series of blog posts we will define each pattern of back pain, which symptoms are associated with each one, relief strategies and how getback treats each pattern. 

Hall, H (2014). Effective Spine Triage: Patterns of Pain. The Ochsner , 14: 88 – 95.

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