Diagnosing Back Pain

Nearly everyone has back pain at one point or another. In fact, back pain is the second most common pain complaint in the United States—only headache is more widespread. People often feel back pain in the lower, or lumbar, region or in the middle, or thoracic, region of the back. Symptoms may include shooting or stabbing pain, tingling or numbness, and intense muscle ache or spasm, along with limited flexibility and difficulty walking or standing up straight.

Back pain can be caused by a variety of conditions, such as degenerative disc disease, arthritis, spinal stenosis, or osteoporosis. Trauma, muscle tension or spasms, spinal deformities, tumors, or infections can also contribute to back pain. 

The back and spine consist of many parts. The spinal canal is the hollow center of the spine that contains the spinal cord and nerve roots. Surrounding the spinal canal, ring-shaped bones called vertebrae stack on top of one another in an interconnected system of joints that allows spinal flexibility and movement. 

In between each vertebra, a soft disc of flexible connective tissue called cartilage acts as a shock absorber between the bones. A large network of muscles aids in supporting the spine and allows you to bend, twist, lift objects, and walk. Back pain may involve the bones, nerves, muscles, or connective tissues like ligaments, tendons, and cartilage; very often it involves all of these structures. 

Back pain that persists for more than six months is considered chronic and may require treatment. NYU Langone orthopedic surgeons, neurosurgeons, and physiatrists—doctors specializing in physical rehabilitation medicine—have specialized training in treating back pain and the conditions that cause it. They evaluate your symptoms and use detailed images of your spine to diagnose the cause of your back pain.

Medical History

Your doctor takes a medical history and asks about your symptoms, including when you first noticed the pain, where in the back it is, how long it has been there, what time of day it seems strongest, and whether it interferes with your everyday activities. The doctor also asks whether you feel tingling or numbness in the arms or legs, which may indicate a pinched nerve, what medications you take, and if you have any other medical conditions that might affect the health of your spine. For example, a previous back injury may involve nearby discs and joints and contribute to the development of degenerative disc disease, leading to back pain.

Physical Exam

The doctor examines your spine for signs of disc disease, which is when discs that cushion the vertebrae and support the back break down with age, or a herniated disc, which is when a disc slips out of place, leading to pain or tenderness in the back. He or she also evaluates the flexibility and range of motion of your spine. 

You may be asked to walk or bend so that your doctor can see which movements cause the most pain and whether the pain significantly restricts movement. 

Neurological Exam

The doctor also performs a neurological examination to determine how the spinal cord and nerves connected to it are working. Your doctor may also assess the function of the nerves connected to the brainstem—the cranial nerves—by testing for sensation in the face, checking your hearing and eye movements, asking you to swallow or say “ahh,” and observing your ability to move your head, neck, and shoulders. 

A neurological examination may also include an evaluation of your mental status, motor strength, vision, and reflexes. This along with imaging helps a doctor identify the cause of pain.

X-rays

X-rays of the spine can reveal structural problems in the back that may be causing back pain, such as cartilage loss. An X-ray image can show reduced space between vertebrae, the presence of bone spurs, which are bony projections that form along the edges of bone, or a vertebra that has slipped out of place.

MRI Scans

MRI scans use magnetic fields and radio waves to create detailed images of soft tissues inside the body, including cartilage and nerves. Doctors examine MRI scans for evidence of disc damage that may not appear on an X-ray and for signs of a tumor or nerves pinched between bones or soft tissue. 

CT Scans

A CT scan is a type of X-ray that creates very detailed images of your tissues and internal organs. CT scans may show structural changes in the spine in more detail than a regular X-ray and can help a doctor determine if surgery is needed to treat your pain. CT scans show a better image of bones, while MRI images show better pictures of soft tissue such as muscle, discs, and nerves. Sometimes, to get the most information possible, doctors will obtain both types of images.