Musculoskeletal conditions drive millions of patients to doctor’s offices each year. Back and hip pain are among the most common reason. The hip and low back are next to one another in the body. Often, these conditions overlap with only one of the two usually being diagnosed. This can lead to inadequate treatment, unnecessary costs, and unsatisfying outcomes for the patient with prolonged pain, disability, and mental health distress.
In some cases, a problem elsewhere in the body can refer pain to in another region. For example, dysfunction in the upper neck could result in symptoms in the wrist and hand. It could appear to be carpal tunnel syndrome. An issue in one area can change a patient’s gait and lead to a problem with the knee. It’s possible that the patient may only seek care for knee pain. Their foot may not have obvious symptoms for concern. With the hip and low back, both scenarios can occur. This is why it’s important to focus on the whole patient and not just the area of chief complaint.
Chiropractors consider the whole patient when they present for conditions like hip pain or back pain. Starting with a thorough patient history includes asking the right questions. We frequently use the acronym LMNOPQRST. This stands for Location, Medical History (or Mechanism of injury), New, Other Symptoms (or, Onset), Provoking/Palliative, Quality, Radiation, Severity, and Timing. These questions MUST be asked for each complaint.
History of Conditions
The remaining history of Past, Family, and Social histories and, a Review of Systems allows the chiropractor to consider other potentially important aspects of the patient’s past such as prior injuries, accidents, surgeries, current medications, genetics, social aspects (smoking, drinking, exercise habits, sleep quality) and more, which can give clues to the current presenting complaints. The use of pain diagrams and questionnaires helps quantify the amount of suffering and serve as good outcome tools to determine treatment success.
The examination includes observing the patient walk and moves (with or without distress), their posture, and their affect (is their condition all-consuming); palpating or feeling for painful structures and performing movements that both increase and relieve their pain; measuring patient’s range of motion; determining what position is favored or “best” vs. “worst”; and nerve function tests to look for impairments with regards to sensation, strength, and reflexes.
Each part of the examination is considered in order to arrive at the correct diagnosis. This is so that treatment can accurately focus on healing and improving the function of the ailing parts.
