To carry out a correct diagnosis of low back pain, it is necessary to have a detailed clinical history with a complete physical examination:
In the clinical history, we investigate the personal history and ongoing pathologies. Likewise, we identify the causes of pain (mechanical or inflammatory), we discriminate between low back pain and lumbosciatica, and we contrast different variables such as the evolution of pain.
During the physical examination, we examine the patient from the moment he enters the office door. The type of gait, the postural attitude and the functional limitations in the examination positions are determining factors in the diagnosis. We must assess active mobility in all planes (Toe-Ground Distance, Schöber test, lateralizations, and rotations), evaluate possible root affectations in the hip and sacroiliac joints, and perform root elongation tests (Lasègue, Bragard, toe, and heel walking) and explore strength alterations, atrophies or alterations in reflexes.
We support this diagnosis with the following complementary tests:
The radiological study is an essential test that, in addition, must be the first to be performed on the patient.
Magnetic resonance imaging (MRI) is the best test to identify soft tissue injuries. It is essential in the diagnosis of sciatica, suspicion of malignancy, infection, or neurological deficits.
The CT scan is a very useful test in the structural bone assessment of the vertebra and the result can help us identify spinal stenosis or vertebral malformations.
To diagnose tumors, inflammations or infections, the complementary GGO test is used.
Lastly, neurophysiology studies (electromyograms/electroneurograms) are useful for evaluating neuromyopathic alterations that contribute to lumbocytalgia.