Understanding back pain and investigating it appropriately

We begin by discussing how your symptoms have developed: where is the pain, when did it start, and where does it radiate? We ask about movements, periods of rest and activities that change it. Previous treatments, other conditions and medicines are equally important. During the physical examination, we assess movement and function, among other things. If your symptoms suggest it is relevant, we test strength, sensation and reflexes. This helps us judge whether nerve function may be affected. Your account and the examination findings are considered together; no single test answers every question. Please also tell us what worries you. Fear of causing damage can lead to avoiding almost all movement. In that case, you need a clear explanation of which activities are possible and which changes require another examination.

Imaging is useful when its result can influence the next decision. If there are signs of a fracture, nerve compression or another specific condition, it can provide important information. For many new episodes of uncomplicated low back pain, imaging is not initially necessary. This is because the link between an image and pain is limited. Changes in discs or joints also occur in people without corresponding symptoms. Assuming too quickly that a finding is the cause can therefore lead in the wrong direction. We explain which question a scan is intended to answer. We can arrange further MRI or CT examinations and incorporate their findings into treatment. Please bring any existing X-rays, MRI or CT scans, ideally with both the written report and the images, for example through a QR code providing image access or on a CD. An up-to-date list of diagnoses and medicines helps us account for other conditions and treatments. You do not need to arrange new imaging yourself for the initial assessment.

With uncomplicated back pain, staying active within your capabilities is usually helpful. Initially, this may mean breaking up long periods of sitting and taking short walks. You do not need to follow a demanding training programme. What matters is finding a level of activity that fits into your daily life and can be increased gradually. Targeted exercise can support recovery when symptoms persist. Which exercises are suitable depends on your starting point. If you avoid many activities because you fear pain, we can plan your return together. However, worsening symptoms or new neurological symptoms should be reassessed; they should not simply be ‘exercised away’.

Treatment depends on the cause, duration and impact of your symptoms. Advice on movement and activity is an important foundation for many back problems. Depending on the findings, other measures may be added, such as manual medicine or medication for pain. Medicines should provide a discernible benefit and be suitable alongside your existing conditions and other medication. In selected cases with a clearly assessed problem, injections or periradicular therapy (PRT) may be considered. They are not the standard response to every case of back pain. Our ‘Back pain treatment’ section explains these options and their role in more detail. If non-surgical measures reach their limits or certain neurological deficits are present, further specialist or surgical assessment may be useful. A recommendation for this should clearly explain which problem it is intended to address. If muscle tension or painful areas of tight muscle contribute to your symptoms, a session on the Evocell treatment couch may be considered as an additional measure after medical assessment. It is intended to support treatment and does not replace investigation of the cause or appropriate active measures. The dedicated treatment page explains the procedure, possible aims and limitations.