A thorough review of your medical history, including immediate family members who have back problems. Some back problems (eg, scoliosis, osteoporosis) have a familial tendencies.
- Discussion about the particulars of your pain. When it started, what you were doing when pain began or the problem occurred, current pain level and type (e.g, stabbing, burning, tingling, extension to arms/legs, etc), how pain may have changed since it began, and other questions. We want to learn as much about your pain and symptoms before we examine you. A good thorough history provides us with valuable information supporting an accurate diagnosis.
- Physical examination evaluates your vital signs (eg, blood pressure, pulse, etc). We then examine you, feeling for abnormalities and tenderness, before performing controlled motion and movement assessments, looking for imbalance, flexibility and functional weakness while you walk, bend, move and so forth. Then a careful orthopedic assessment is performed to selectively stress various components of your spine and joint structures to narrow down and eliminate all potential causes of your problem.
- The physical examination also includes a neurological exam, which involves an assessment of your nerve sensation and strength functions. We make sure feeling is the same on both sides and test your reflexes, along with any other nerve function tests as necessary.
- Diagnosis and Medical Decision Making. After a thorough review, we will arrive at to one or two conclusions as to the root cause of your pain and other symptoms. We sit down and discuss the anatomy and function of the spine or area of complaint with you, explaining how and why your problem may have developed. If necessary, we may recommend further diagnostic testing (such as x-ray, MRI CT scan or EMG/NCV nerve tests) in order to obtain more information. If necessary, lab tests are ordered. We pride ourselves on our education and clinical skills and an accurate diagnosis is essential to a well-developed treatment plan.
- Treatment Plan: We will then discuss the variety of treatment options available for you that are best suited to your particular problem. This may include (or even just be limited to) referring you out to the most appropriate health professional if we feel we aren’t appropriately suited to helping you by ourselves. We always treat towards a goal of treatment independence, and will not attempt to ever sign you up for extended treatment courses or packages costing thousands of dollars.
- Treatment: Once you feel comfortable with our explanation and recommendations, we will then start treatment according to a well designed and evidence-based trial of care. Our philosophy is to ‘test – treat – re-test” with frequent re-assessments or ‘benchmarks’ to assure appropriate progression and improvement, avoiding unnecessary treatment.