Differential Diagnosis of Common Back Conditions
By Byron Reynoso, D.P.T.

Many of us at one point have complained of back pain, whether it is something simple as a sore back, or as debilitating as suffering from chronic neurological symptoms down one or both legs. The likelihood of a person having ever complained of back pain is fairly high in the United States. A recent survey from the American College of Sports Medicine (ACSM) concluded that 80% of Americans at some point in their life will suffer from back pain. The purpose of this article is to give the reader a better understanding of different diagnoses made in relation to common complaints that people who suffer from back pain may have.

Ankylosing Spondylitis is a rheumatic disease which can cause chronic inflammation of the spine and sacroiliac joints. Thought to be an inherited disease, Ankylosing Spondylitis can affect people of all ages. Ankylosing Spondylitis is two to three times more common in men than women. Some common complaints include pain, which may vary from a dull ache to sharp pain, morning stiffness, fatigue, and a decrease in spinal mobility. Plain films such as x-rays may be used in order to diagnose this condition, as well as blood tests.

Spinal Stenosis is a condition which involves the narrowing of the spinal canal or the intervertebral foramen. This narrowing can put pressure on the spinal cord or on the nerves that branch out from the compressed areas. Depending on the nerves affected, Spinal Stenosis can cause cramping, pain, or numbness in the legs, as well as pain located at both sides of the back. Diagnostic tests utilized include x-rays, MRI, and/or CAT scan.

Lumbar Strain/Sprain is perhaps the most common cause of low back pain. A muscle strain occurs when the muscle fibers are abnormally stretched or torn. And a sprain occurs when the ligaments of the spine are torn. Lumbar Strains/Sprains may be caused by sudden trauma such as an automobile accident, improper lifting techniques such as bending forward to lift heavy objects, or poor body mechanics such as repetitive twisting of the spine to move items from one location to another. The most common symptoms of this condition include pain which may refer to the buttocks, low back muscle spasms, and a decrease in lumbar spine mobility. Neurological signs and symptoms are typically nonexistent with this diagnosis. Diagnosis is made by clinical examination comparing results of flexibility, resistive tests, and palpation.

Physical Therapy can help with each of these back conditions in order to decrease pain and increase functional mobility. The treatment strategy will be dependent on a patient’s diagnosis. Treatment plans will vary and may include options such as soft tissue mobilization to decrease back spasms, electrical therapy to decrease pain, manual techniques to increase joint mobility, therapeutic/aquatic exercises to increase both strength and flexibility, and patient education on proper posture and lifting techniques. As always, consult your physician before beginning any type of treatment. Your physician will be able to determine what treatment approach will be best suited for you.