Tag Archives: Sciatica

Diagnosing Lower Back Pain

Lower back pain is a common complaint of so many people at some points in their lives.  Although frequently, the pain is associated with the sacroiliac joints, one should not take it for granted because there are cases that such affliction may just be a representation of a more serious problem. The body usually locates the discomfort near the surface but can hardly point its source when the pain is in the interior. Affliction due to severe injuries, illness, or infections of organs, like the heart, lungs, stomach, and back may appear to be coming from a certain point and radiates into varied areas of the body.

Therefore, it is important that the sufferer must see a doctor for proper diagnosis of his pain, especially if it is accompanied by other symptoms and/or caused by certain factors, namely:

  • If the pain follows a trauma, like car accident or fall
  • If it persists and getting worse and does not improve despite application of typical solutions such as rest, cold pack, and medications
  • If it lingers for more than four to six weeks
  • If the pain is particularly severe at night, to the point that it  wakes the sufferer up from his deep sleep
  • If the back pain is accompanied by abdominal pain
  • There is a feeling of numbness or altered sensation in the upper inner thighs, groin area, buttocks, or genital areas
  • Neurological conditions like weakness, numbness, or tingling in the legs or arms

It should further be noted that many types of lower back pain have no identifiable anatomical cause.  But this should not be an excuse for not seeing a doctor, or for ignoring the pain.

Nevertheless, during an examination, the doctor may classify the patient’s ailment according to the three types of pain, such as: axial low back pain, lumbar radiculopathy (sciatica), and lower back pain with referred pain.

diagnosing back pain


Axial low back pain.  This is the typical type of back pain, which affliction is limited only to the lower back and does not extend into the buttocks or legs.  The pain is usually characterized by a sharp or dull aching sensation that can be severe enough to keep the person from doing his usual activities with ease, such as standing and walking, and may aggravate when the person takes on sports, or certain physical positions like sitting for long periods.  But this kind of lower back pain can easily be eased with ample rest.  Most lower back pain is acute, or short-term, usually lasting from few days to 12 weeks.  But then, again, if left untreated, an acute lower back pain can develop into chronic or serious, which pain can persist for more than 3 months.

Lumbar radiculopathy, or sciatica. Next to axial low back pain, the lumbar radiculopathy is the second most common type of lower back pain. It is characterized by a more severe pain in the leg than in the back, and caused by a prolapsed disk in the spine that presses on the sciatic nerve

Low back pain with referred pain. It is characterized by a dull and tender sensation in the lower back that radiates to the groin, buttock and upper thigh with varying intensities.  It is treated the same way as treating axial pain since the two are similar.

Diagnosing lower back pain starts with a review on the complete history of the person’s back pain, and conducting physical tests that include evaluations of abdomen and the extremity, pelvic, and rectal examination. Further examinations may also be performed, like urine and blood tests, plain X-ray, CAT or MRI scanning, electromyograms (EMGs), bone scanning, and also nerve conduction velocities (NCVs).

Then, based on the results of these examinations, appropriate medication and treatment will be applied.

Epidural Steroid Injection


Epidural steroid injection, or ESI, is a minimally invasive dose of anti-inflammatory steroid medication into the epidural space to relieve pain in the neck, arm, back, and leg due to an infection in the spinal nerves. This quick and simple procedure, which has been used since 1952, is usually performed by soaking the inflamed nerve root in steroids to relieve patients suffering from these ailments, namely:

Spinal stenosis, an irregular narrowing of the spinal canal that commonly attacks people who are more than 50 years old, and/or younger men and women who either hurt their spines, or who have congenitally narrow spinal canal;

Spondylolysis, is a specific injury between the upper and lower facets of a vertebra most often caused by rigid movements of the body, and whose usual patients are the teenagers;

Herniated disc, also known as bulging disc, ruptured disc, or slipped disc, a common spine problem characterized by a protuberance of an inter vertebral disc through a delicate area in the annulus;

Degenerative disc, another common cause of low back pain characterized by numbing due to a decline of the inter vertebral disc as a sign of aging, and;

Sciatica, an irritation of the sciatic nerve characterized by pain in the leg, which is oftentimes excruciating, making it extremely difficult for patients to stand up or sit down.

ESI, however, is not applicable to patients who are pregnant, diabetic, have bacterial infections, or those who have problems with bleeding because the process might cause their blood sugar level to soar, stimulate high blood pressure, stomach pain, arthritis of the hips, and other related ailments.

Epidural steroid injection is recognized in the medical field as a basic component of non-surgical management of radicular pain due to lumbar spine disorders. It should be clarified, however, that ESI is not a cure for any disease it is usually applied to. Rather, it is only used to ease the pain and control the symptoms for a pro-longed period so that the patient may be able move about freely, become active, and participate in physical therapy program. Be-cause of this nature, the injection is, therefore, temporary and may last up to two months only. The medications used here are usually anaesthetic and cortisone. The anaesthetic, which is usually in the form of novacaine, lidocain, or bupivicaine, may cause a momentary numbness just like what it does when doing a suture on laceration or doing dental work; while cortisone is a very effective treatment to reduce swelling and inflammation in the nerves and connective tissues.

The modern ESI procedure is performed with the aid of a fluoroscope, a sort of x-ray machine that allows the doctor to actually watch where the needle goes as it is inserted; and once the needle reaches the spot to be treated, a little amount of radio-graphic dye is then injected to confirm the right position and further ensure that the medication would go right into where treatment should be go.

ESI is a safe procedure, although just like any other medical course of action, it is not 100 percent free of complications. However, its complications are only minor ones and not life-threatening, such as: allergic reaction; wet tap, which occurs when the epidural needle goes a bit off the target site and a hole is created in the dura that may result to a spinal fluid leak; headache, and; nausea. Other complications, which very rarely occur, include epidural hematoma, epidural abscess, and nerve damage, which may then require surgery.

After the ESI procedure to help reduce the SI joint pain, the patient is normally allowed to go home, and may not necessarily be bound to perform any activity at all, or restricted on diet.