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Episode 3 - The Most Common Musculoskeletal Lower Back Pain Diagnoses
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In this episode I will be going over some common musculoskeletal lower back pain diagnoses.
If you have not listened to my episode on how I diagnose then please listen to it first before listening to this one. You can find it here.
By the end of this episode, you will learn about the 5 most common lower back pain complaints and some simple, quick and easy things to try to alleviate any discomfort (although this is not the main focus of this podcast).
Specifics on how to diagnose each one will feature in another episode. It is also important to note that there is not usually one single cause of back pain. I have laid out 5 separate diagnoses for the sake of simplicity, in reality, there are two or more of these at play with mechanical bak pain. Think of these as the main culprits in their presentations.
As always, the first step is to rule out any red flags. This process starts with the first contact you have with the patient (usually by phone when they book an appointment). For example, it typically takes less than 30 seconds to ask the basic cauda equine questions over the phone (not difficult!). Just for perspective, 99% of back pain will be musculoskeletal in origin with 1% being pathological. Don’t get caught out in that 1% bracket!
Lower back pain is a very common occurrence and can happen at any age. It tends to manifest in relation to one or more key factors:
- Birth defects - spina bifida, narrow spinal canal etc
- Injury - lifting with poor form, traffic accidents, falling over etc
- Psychosocial reasons - depression, stress, divorce etc
- Built up gradually over time (i.e. degenerative/wear and tear) - osteoarthritis, degenerative disk disease etc
- Recurrent cycles of lower back pain - poor conditioning/tone use of the body, poor physical health etc
- Systemic issues - aortic aneurism, kidney stones etc
- Disease process - autoimmune conditions such as AS, cancer, endometriosis, infection etc
- Environmental factors - pollution, humidity etc
- Lifestyle - diet, smoking, alcohol, IV drugs etc
- ‘Idiopathic’ (i.e. no known cause)
- Iatrogenic - due to medical error
- Referred pain from another structure
As a bonus point, see if you can spot the red flags in these categories (remember, we are talking in the context of mechanical lower back pain).
So, the 6 most common diagnoses for lower back pain are as follows:
- Disk herniation/discogenic pain - There are two common scenarios here. The first one is where the disk bulges to one side, pressing on nearby nerves and thereby provoking pain down the leg (in worst-case scenarios, you can have a central herniation whereby the disk can bulge toward your spinal column). The second is disk irritation without bulging, which would lead to back pain only if there is no substantial inflammation (some structures can refer pain to the buttock area). With this presentation, you would have morning stiffness/pain, find it difficult to put socks and shoes on, and find it hard to sit for prolonged periods of time. If you have irritated the nerves, you might also feel pins and needles, sharp shooting pains, numbness or a feeling that your leg might give way. The good news is that most disk-related issues heal on their own within 4-8 weeks depending on the severity, your metabolic and psychosocial health.
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