Distinguishing Neck, Mid- and Low-Back Pain vs. Other Causes

As much as I pride myself on being a high-tech chiropractor with my computerized instrument adjusting and diagnostic techniques, it is important not to lose sight of basic palpation skills. Palpation means feeling the neck or back with my hands to identify the exact area that is hurting.

This last bit is an important part of my initial exam with any new patient. When someone comes in complaining of neck pain or low back pain and particularly mid back pain, I have to distinguish between a musculoskeletal cause versus an organic cause. That is to say, I want to make sure it is a joint or muscle issue as opposed to a deeper organ issue. For example, kidney pain, literally the kidneys are hurting, can manifest on the sides of the lower mid back area. The body is not very good at feeling pain in internal organs. Organ pain tends to radiate to a different area in a dull diffuse manner rather than hurting right at the site such as, say, a painful knee would

Fortunately, the vast majority of patients I see do have musculoskeletal issues. For these patients, my palpation skills are important to determine what I call the “pain generator”. By that I mean, what exactly is causing the patient’s pain? As I feel the patient’s neck, mid back and low back areas, I’m feeling for the area or areas in which the patient says, “That’s it! That’s right where it hurts!” This, in turn, allows me to focus my treatment whatever is causing the pain. Is it the muscle? A joint issue? Perhaps the disc is generating the pain?

Is important to note that more should be done than simply focusing myopically on the pain generator. Though that area certainly needs to be addressed so the patient can get back to their desired activities, I need to determine what went wrong biomechanically across the entire spine and body that caused that area to fail. To do otherwise would be to do a half job and to predispose the patient to have that area continue to flare up again and again.