Chiropractic Diagnosis of Low Back Pain

In the assessment of lower back pain, differential diagnosis utilizing a "triage" concept of classifying low back injuries into one of three categories helps to guide the doctor of chiropractic. These categories of chiropractic diagnosis include:

• Potentially serious: tumor, infection, fracture, major neurological problem (cauda equina), local open wound or burn, prolonged bleeding (hemophilia), artificial joint implant problems, pacemaker problems, joint infection

• Sciatica: when the nerve root in the low back is pinched or compressed

• Non-specific: mechanical back pain in the lumbar spine (most common type of presentation).

With chiropractic diagnosis of potentially serious injuries, chiropractic manipulation is typically avoided over the relevant anatomy, although it may not be ruled out on other areas.

Chiropractic Diagnosis and Classification of Low Back Pain

With instances of a potentially serious diagnosis, the chiropractor will typically refer the patient to a relevant medical specialist and possibly a surgeon, and as appropriate the chiropractor may co-manage the patient’s care with other back pain specialists.¹⁶

With chiropractic diagnosis of a nerve root problem causing sciatica and or non-specific causes of back pain, chiropractors typically describe the symptoms experienced on another classification system.

Lower back pain symptoms are typically described by chiropractors on the following scale:

• Acute (symptoms lasting less than 6 weeks)
• Subacute (symptoms lasting between 6 and 12 weeks)
• Chronic (symptoms lasting for 12 weeks or more)
• Recurrent/flare up (symptoms are similar to original symptoms and return sporadically or as result of exacerbating circumstances).¹⁷

These lower back pain symptoms may be further broken down as mild, moderate or severe in pain.

Chiropractic Treatment Plan for Lower Back Pain

Goal setting for the chiropractic treatment plan is driven by the patient’s pain and disability issues and activity intolerance. Patient education with the guidance of the chiropractor is important to reduce anxiety levels that often accompany intense low back pain. The guidelines recommend chiropractic care 3-5 visits/week over 1-2 weeks.

If no demonstrable improvement is noted, the compliance and sincerity of the patient should be evaluated and the risk factors that may prolong recovery identified followed by discharge, referral to another chiropractor, or the initiation of a different treatment approach at 3-5 visits/week for 2 weeks.¹⁸

Consistent among all guidelines of low back pain treatment is the prevention of chronicity. The use of active care (care that is patient-driven such as exercise, activity modification, ergonomic modifications, etc.) are emphasized to accomplish this goal.

References

Complete Listing of References

• Article written By:
• Steven G. Yeomans, DC

October 7, 2009

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