Acute Low Back Pain Diagnosis

If you’ve had lower back pain for less than 6 weeks, it’s considered to be "acute". While many cases of low back pain resolve without treatment, getting your spine checked in the case of persistent symptoms is a good idea.

A man sitting on his bed with low back pain

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When you go to the healthcare provider for your back pain, she will conduct a medical interview (called a history) and a physical exam. The information he or she gathers at this appointment will help her diagnose your pain by placing you into one of three general categories:

  • Non-specific low back pain
  • Pain directly involving nerves, for example, radiculopathy caused by a herniated disc.
  • Other more serious conditions that may have back pain as a symptom. An example might be a fracture, infection or tumor. Some types of symptoms are associated with these, and are called “red flags.” If you have a red flag, your healthcare provider will probably order diagnostic tests to try to get to the root of the problem.

Your treatment plan and the decision for any further testing will be determined based on your specific findings of symptoms and physical examination.  

Factors not related to your back such as depression, anxiety, and social conditions can actually influence how long the pain will last, and how severe it gets. So don’t be surprised if, during your medical interview, your healthcare provider asks you questions related to this. This information may help your healthcare provider identify and treat causes that may increase your risk of developing chronic back pain and disability.

Diagnostic Imaging Tests 

Your back problem may or may not require diagnostic testing, such as an X-ray or MRI. If you are sent for one of these tests, keep in mind that they are meant to help the healthcare provider pinpoint locations in your spine that show damage or changes that correspond to your symptoms.

But because most back problems have no specific cause, they often cannot be detected on a film. The exceptions are: You have nerve symptoms, spinal stenosis, or — based on your history and physical exam — the healthcare provider thinks a more serious problem is causing your pain. Another reason for diagnostic imaging tests may be if your healthcare provider asks you to consider surgery or a spinal injection.

The potential for overuse of imaging tests is real. A 2011 study found that getting such tests for low back pain did not help the patients feel better or do more, as compared to clinical care that did not involve these tests. As for finding serious underlying problems to your back pain, the study results showed that not getting an imaging test right off the bat did nothing to hinder the healthcare providers from identifying such health conditions in those who were not at risk for them.

As a result of their findings, the study authors concluded that clinical healthcare providers should "refrain from routine, immediate lumbar imaging in primary care patients with nonspecific, acute or subacute LBP and no indications of underlying serious conditions."

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By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.