The Key to Proper Diagnosis and Treatment of Neck and Back Pain

The Key to Proper Diagnosis and Treatment of Neck and Back Pain

Published by Wichita Chiropractor Dr. Tracy A Norris, DC, CCEP, Cert. MDT on Sep 19th 2019

Certain movements cause neck & back pain and certain motions relieve pain.  Understanding this relationship and using it during self-treatment can help you reduce your pain.

Most back and neck pain is caused by damage to the moving parts of the body, such as joints, discs and ligaments, therefore it is logical that by paying careful attention to how pain behaves in response to different movements and positions during your daily routine is helpful in identifying at is causing the pain and determining the type of treatment required to correct the issue.

Once an understanding of how different movements and positions affect your pain during the history portion of your assessment, a repetitive movement exam is done to verify the history findings. During this exam, you are asked to move in different directions as far as you can possibly go. The doctor notates your response to the movement as you are doing it and after the movement is finished. 

Certain motions may cause pain and others may improve pain. The goal is to find a direction of movement that when repetitively performed reduces or eliminates the pain. This movement is not an exercise, it is a specific therapeutic movement that creates a certain amount and direction of force to the damaged joint, disc or ligament to improve your pain and range of motion. The direction of movement that improves pain and restricted range of motion is called a “directional preference”. A directional preference repetitive movement is used to remodel and rehabilitate damaged tissue. Finding a directional preference indicates that there is a good likelihood of a good prognosis.

posterior-derangement-in-flexion1.jpgExample 1: Pain comes on with sitting or bending forward

Sitting causes the spine to bend forward, pushing the disc tissue backwards further deranging the already damaged disc.  It is likely that the derangement in your disc is toward the back aspect and as you force more disc tissue towards the back the worse the pain can become. Getting out of the position of sitting removes the force on the derangement, the pain gets better or goes away after a period of time. Getting up from sitting to a standing position can be difficult. However, once you are up and moving, the pain usually improves or goes away.

Disc pain with standing and walking - © 2019 Wichita Pain Center

Example 2:
Pain comes on when standing or walking

Standing & walking cause the spine to bend backward, pushing the disc tissue forwards further deranging the already damaged disc. It is likely that the derangement in your disc is toward the front aspect and as you force more disc tissue towards the front the pain worsens. Relief may come while sitting or bending forward.

During the examination there are 4 types of responses we evaluate, which become the baselines that are used to compare future improvement.

  • 1.Mechanical Response- restricted range of motion, gait difficulties, limp.
  • 2.Symptomatic Pain Response- intensity, frequency, location and quality of pain
    • Intensity of pain on a scale of 1-10
    • Frequency of pain: constant to intermittent / intermittent to constant, occurs less frequently / occurs more frequently
    • Location of pain: radiating limb pain that moves out of the limb towards the spine (Centralization)
    • Quality of pain: sharp, dull, stabbing, burning, crushing, throbbing, shooting, stretching, tightness
  • 3.Neurological Response- Muscle strength testing, reflexes, and sensation
  • 4.Functional Response- Work or recreational activities that cause you pain or have been stopped due to pain (can’t vacuum, stopped sports, can’t sit for long periods…)

If a directional preference is found during your exam, there is a good probability that you will be able to self-treat your own pain with good results. If no direction of movement improves your pain or your condition is worsened by all directions of movement, then further investigation is necessary to determine whether surgery may be an option.

Book appointment for back and neck pain with Wichita Pain Center in Wichita Kansas

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