Back Clinic Screening Tests. Screening tests are typically the first assessment completed and are used to determine if further diagnostic testing might be needed. Because screening tests are the first step towards diagnosis, they are designed to be more likely to overestimate the true incidence of a disease. Designed to be different from diagnostic tests in that they might demonstrate more positive results than a diagnostic test.
This can lead to both true positives as well as false positives. Once a screening test is found to be positive, a diagnostic test is then completed to confirm the diagnosis. Next, we will discuss the assessment of diagnostic tests. Many screening tests are available for physicians and advanced chiropractic practitioners to utilize in their practice. For some tests, there is quite a bit of research demonstrating the benefit of such tests on early diagnosis and treatment. Dr. Alex Jimenez presents appropriate assessment and diagnostic tools used in the office to further clarify and appropriated diagnostic assessments.
Should individuals experiencing nerve pain or various sensations get a nerve conduction velocity study to examine nerve health and function?
Nerve Conduction Velocity
A nerve conduction velocity (NCV) is a noninvasive test that measures the speed and strength of nerve stimulation using electrical probes placed on the skin. It’s used to diagnose nerve damage or disease, often alongside an EMG (electromyogram) to differentiate between nerve and muscle problems. It can also evaluate sensory issues, pain, and weakness of the extremities.
This test involves safe electrical shocks that can be slightly uncomfortable but not painful.
Nerve conduction velocity (NCV) measures the speed at which electrical impulses travel along a nerve fiber, which measures how quickly electrical signals travel through a nerve.
This information indicates nerve health and function.
Electromyography (EMG) is a nerve test that involves placing tiny needles into the muscles.
A slower NCV can indicate nerve injury or dysfunction.
Test Uses
Generally, the test is ordered to assess peripheral nerve diseases, those that connect from the muscles, organs, and skin to the spinal cord or brain. It can help identify the type and location of nerve damage.
Peripheral nerve conditions typically cause pain, sensory loss, tingling, or burning.
Mild weakness and diminished reflexes can be detected during a neurological examination.
Conditions
Nerve conduction studies are performed to help diagnose conditions.
Nerve damage (neuropathy), such as from diabetes, chemotherapy, or autoimmune disorders
Charcot-Marie-Tooth disease
Nerve compression
Many different conditions, including trauma, inflammation, and tumors, can compress one or more nerves.
Radiculopathy
Often described as a pinched nerve, radiculopathy can affect an arm or a leg, causing pain and weakness.
Peripheral Neuropathy
This nerve damage begins in the most distal nerves, those farthest from the center of the body, such as the toes and fingers. It is often due to chronic alcohol misuse, uncontrolled diabetes, nutritional deficits, and inflammatory diseases. (Ferdousi M. et al., 2020)
Carpal Tunnel Syndrome
Commonly caused by inflammatory diseases or overuse of the wrists, such as from assembly line work, carpal tunnel syndrome causes numbness, pain, and weakness of the fingers and hands. (Tada K. et al., 2022)
Ulnar neuropathy
This common condition causes arm pain and sensory changes, usually due to repetitive movements or a prolonged position that causes pressure on the ulnar nerve.
Guillain-Barré syndrome (GBS)
This inflammatory condition causes demyelination, or loss of the insulating covering around nerves, which results in leg weakness.
It begins in the motor nerves, which send signals to muscles in the legs. (Shibuya K. et al., 2022)
The inflammation travels to nerves of the upper body, often affecting the muscles that control breathing.
Respiratory support is necessary until the condition improves.
Chronic Demyelinating Polyneuropathy (CIDP)
This condition is a chronic, recurrent form of GBS that usually affects the legs and causes episodes of weakness.
ICU neuropathy
Metabolic changes, severe illness, and not moving enough can cause nerves to develop a pattern of weakness and sensory loss.
Myasthenia gravis (MG)
This autoimmune condition affects the junction between the nerves and the muscles.
Myasthenia gravis causes drooping eyelids and weakness of the arms and shoulders.
Amyotrophic lateral sclerosis (ALS)
ALS is a serious, degenerative disease affecting the spinal cord’s motor neurons.
Amyotrophic lateral sclerosis progresses rapidly, resulting in substantial weakness of muscles throughout the body.
How it’s Done
Surface electrodes are placed on the skin over nerves, and a small electrical current is applied to stimulate the nerve.
The time it takes for the electrical signal to travel between the electrodes is measured, and this time is used to calculate the NCV.
Values
Normal NCV values are generally between 50 and 70 meters per second. However, these values can vary depending on the nerve and the individual.
NCV Factors
Various factors can influence NCV.
Age
Sex
Medical conditions like diabetes
Interpretation
A slower NCV can indicate nerve damage or demyelination (loss of the myelin sheath, which insulates nerve fibers), while an EMG can help determine if the problem is with the nerve or the muscle.
Results
The results of NCV testing can be used to determine the type, severity, and location of nerve damage. The results will be ready in report form about a week after the test.
The test measures velocity (how fast a nerve transmits signals) and amplitude (how many nerve fibers were activated). (Tavee J. 2019)
The measurements are transmitted to a computer and shown as waves and numerical values.
The values are compared to a standard measurement based on the tested nerve.
The distance between the electrodes.
The person’s age.
Compared to the standard, the NCV results can identify certain patterns of nerve damage. (Tada K. et al., 2022) Outcomes include: (Tavee J. 2019)
If one or more nerves are affected.
If motor nerves (control movement), sensory nerves (transmit sensory signals), or both are affected.
Whether a nerve is blocked or damaged.
The severity of the damage.
The type of nerve damage
Axonal (damage to the nerve itself)
Demyelination (damage to the protective fatty layer around the nerve)
The results can help point to certain diagnoses.
Preparation Before the Test
Individuals will not need to change their diet before having an NCV. However, patients will be asked to avoid lotions or creams on their skin before the test. Individuals who are also having an EMG at the time of their NCV might be asked to stop taking medications or supplements that increase the risk of bleeding and bruising. If a healthcare provider says not to stop taking the medicines for health reasons, the patient might be warned that they could have some bruising after the EMG test.
NCV may advise against getting the test for those with electrical device implants.
Make sure your healthcare providers are aware of your whole medical history.
Injury Medical Chiropractic & Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Peripheral Neuropathy and Chiropractic Care
References
Ferdousi, M., Kalteniece, A., Azmi, S., Petropoulos, I. N., Worthington, A., D’Onofrio, L., Dhage, S., Ponirakis, G., Alam, U., Marshall, A., Faber, C. G., Lauria, G., Soran, H., & Malik, R. A. (2020). Corneal confocal microscopy compared with quantitative sensory testing and nerve conduction for diagnosing and stratifying the severity of diabetic peripheral neuropathy. BMJ open diabetes research & care, 8(2), e001801. doi.org/10.1136/bmjdrc-2020-001801
Tada, K., Murai, A., Nakamura, Y., Nakade, Y., & Tsuchiya, H. (2022). In Carpal Tunnel Syndrome, Sensory Nerve Conduction Velocities Are Worst in the Middle Finger Than in the Index Finger. Frontiers in Neurology, 13, 851108. doi.org/10.3389/fneur.2022.851108
Shibuya, K., Tsuneyama, A., Misawa, S., Suzuki, Y. I., Suichi, T., Kojima, Y., Nakamura, K., Kano, H., Ohtani, R., Aotsuka, Y., Morooka, M., Prado, M., & Kuwabara, S. (2022). Different patterns of sensory nerve involvement in chronic inflammatory demyelinating polyneuropathy subtypes. Muscle & Nerve, 66(2), 131–135. doi.org/10.1002/mus.27530
What is a bone density test, how is it performed, and what do the results mean?
Bone Density Test
A bone density test examines bone mass, which indicates overall bone strength. Assessing bone density or mass is necessary for diagnosing osteopenia or osteoporosis, conditions that increase the risk of broken bones. The scan is performed through dual-energy X-ray absorptiometry (DEXA), which examines the thickness of the bones. Results from DEXA scans are compared to standardized values to determine whether bone density is lower than normal and whether osteopenia or osteoporosis is present.
Examination
The procedure examines bone density, or bone mass. The bones’ density, or mass, is an overall indicator of bone strength. The greater the bone density, the thicker and stronger the bones are. The test is used to diagnose osteoporosis, a condition characterized by brittle bones at risk of breaking due to significantly low bone density. A bone density test can also diagnose osteopenia, a condition characterized by lower than normal bone mass that can lead to osteoporosis. (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2025) It is recommended that all women aged 65 and older and all men aged 70 and older have a bone density scan to screen for bone loss to help prevent fractures. (Kling J. M., Clarke B. L., & Sandhu N. P. 2014)
Bone density scans can establish a baseline level of bone density and track changes over time.
For individuals with osteoporosis or osteopenia, a bone density scan can help track how well their bones respond to treatment.
During a DEXA scan, the patient will lie on their back on a table with their legs elevated on a padded platform.
An X-ray scanner will pass over the spine and hips while another scans beneath.
While the scan takes place, the patient will be asked to hold very still to obtain an accurate image.
The scan will obtain bone density readings from the spine and hip, the two most commonly fractured bones, and generally takes less than 30 minutes.
Results
A DEXA scan measures bone density in grams per centimeter squared (g/cm²). This number indicates how densely bone cells are packed together in a specific area of bone. This bone density reading is then compared to a standardized value to determine if bone density is within a normal range or lower than average.
Between minus 1.0 and minus 2.5: Low bone density (osteopenia)
Equal to minus 2.5 or below: Osteoporosis
Bone density values are reported as a Z score for women who have not undergone menopause and men under 50 years old.
Z scores are compared to bone density levels of individuals of the same age and sex.
A Z score of minus 2.0 or lower indicates low bone density, which can be caused by factors other than aging, such as medication side effects, nutritional deficiencies, or thyroid problems.
Arthritis Diagnosis
Because a DEXA scan only measures the thickness of bones, it doesn’t work to diagnose arthritis. An X-ray of the affected joint is currently the most accurate way to diagnose arthritis. The Kellgren-Lawrence classification system categorizes the extent of arthritis based on the severity of joint damage seen on an X-ray. According to this system, arthritis can be classified as: (Kohn M. D., Sassoon A. A., & Fernando N. D. 2016)
Grade 1 (minor)
Minimal or no joint space narrowing, with possible bone spur formation.
Grade 2 (mild)
Possible joint space narrowing, with definite bone spur formation.
Grade 3 (moderate)
Definite joint space narrowing, moderate bone spur formation, mild sclerosis (abnormal thickening of bone), and possible deformation of bone ends.
Grade 4 (severe)
Severe joint space narrowing, large bone spur formation, marked sclerosis, and definite deformation of bone ends.
Injury Medical Chiropractic & Functional Medicine Clinic
Exercise can be incredibly beneficial for improving bone density, joint mobility, and the strength of surrounding muscles, which support and protect joints and bones. Talk to a healthcare provider to learn what interventions and available treatment options would be the most effective. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Kling, J. M., Clarke, B. L., & Sandhu, N. P. (2014). Osteoporosis prevention, screening, and treatment: a review. Journal of women’s health (2002), 23(7), 563–572. doi.org/10.1089/jwh.2013.4611
Kohn, M. D., Sassoon, A. A., & Fernando, N. D. (2016). Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clinical orthopaedics and related research, 474(8), 1886–1893. doi.org/10.1007/s11999-016-4732-4
Can the Oswestry Low Back Pain Disability Questionnaire help assess how low back pain impacts individuals’ ability to perform everyday tasks and activities and help physical therapists incorporate the outcome measure into an effective treatment plan?
Oswestry Disability Questionnaire
The Oswestry Disability Questionnaire, also known as the Oswestry Disability Index, provides objective data about an individual’s lower back pain. It determines the severity of the pain and how much it limits their daily activities. The questionnaire is a validated measure backed by research that can be used to justify the need for medical treatment. It includes questions regarding the symptoms and severity of low back pain and how these symptoms interfere with regular activities. Lower back pain can result from various causes (National Institute of Neurological Disorders and Stroke, 2020)
Arthritis, including inflammatory types of arthritis like psoriatic arthritis and ankylosing spondylitis.
Lumbar vertebrae compression fractures – usually from trauma or osteoporosis.
Low back surgery – including spinal fusions, discectomies, and laminectomies.
Spinal stenosis
Spondylolisthesis
Scoliosis
How The Questionnaire Works
The Oswestry Disability Questionnaire consists of 10 questions about the impact of lower back pain on daily life. The questions are divided into the following categories: (American Academy of Orthopedic Surgeons, N.D.)
Pain Intensity
How intense is the pain?
If painkillers are used, how much symptom relief do they provide?
Personal Care
Can the patient perform self-care activities like bathing and dressing when experiencing significant pain or limitations?
Whether physical assistance from another person is needed?
Lifting
Can the patient lift objects like weights with or without pain?
Can lifting be performed from the floor or a higher surface like a table if the objects are light, moderate, or heavy?
Walking
If and to what extent does the pain limit the patient’s walking distance and independence?
If an assistive device like a cane or crutches are needed?
Sitting
If so, how much pain limits the patient’s sitting tolerance?
Standing
If so, how much pain limits the patient’s standing tolerance?
Sleeping
If so, how much pain limits a patient’s sleeping duration?
Whether pain medication is needed to help the patient sleep comfortably?
Social Life
If and to what extent a patient’s social activities are limited because of pain symptoms?
Traveling
If so, to what extent does pain limit a patient’s ability to travel?
Employment and/or Homemaking Duties
Does pain limit a patient’s ability to perform job-related and/or household activities, including physically demanding and light duties?
Patients self-report the information and complete it on their own based on their understanding of the extent of their lower back pain and disability.
Each question can be scored between 0 and 5, with 0 indicating no limitations and 5 indicating complete disability.
The scores from all the questions are added together for a cumulative total score of 50 points.
Scores
The Oswestry Disability Questionnaire assesses how much a patient’s lower back pain limits daily activities. This information is used in clinical documentation for medical services. A higher score indicates a greater level of disability, according to the following scoring criteria:
0–4: No disability
5–14: Mild disability
15–24: Moderate disability
25–34: Severe disability
35–50: Completely disabled
Physical therapists must create individualized goals for each patient to develop a treatment plan and receive authorization from insurance companies. One of the most important aspects of a physical therapy goal is that it must be measurable. The Oswestry Disability Questionnaire provides a numerical score to track functional limitations and monitor the range of motion and strength testing. A baseline measurement is taken at the beginning of treatment, and progress is tracked in follow-up visits. A new score is used as a treatment goal. According to a study, the minimal clinically important difference (MCID) for the Oswestry Disability Questionnaire is 12.88. The MCID is the minimum score healthcare providers need to confirm a patient’s progress in function due to treatment. (Johnsen, L. G. et al., 2013)
By tracking changes in the total score before, during, and after treatment, healthcare providers can better assess whether treatment improves symptoms. A decrease in total score by 13 points or more would indicate that treatment is helping to improve a patient’s lower back pain and level of disability. Along with physical examination results, the patient’s score and the severity of symptoms can help healthcare providers determine an appropriate treatment plan.
No Disability
Treatment is unnecessary other than providing advice for lifting mechanics and general physical activity to maintain health.
Mild Disability
Conservative measures, such as physical therapy, exercise, hot or cold therapy, pain medication, and rest, are needed to help alleviate symptoms.
Moderate Disability
More aggressive intervention is needed, which can include extensive physical therapy services and pain management.
Severe Disability
Significant medical intervention is needed, including surgery, pain management, equipment like wheelchairs, and help from a caretaker.
Completely Disabled
Patients are either bedbound or have worsening symptoms, and a caretaker is needed to complete daily activities and self-care tasks.
Injury Medical Chiropractic and Functional Medicine Clinic
Improvements in range of motion, strength, and quality of movement and a decrease in total score can help show the treatment’s positive impact in managing lower back pain. A thorough medical exam and diagnostic tests, such as X-ray, MRI, or EMG, can help determine the underlying causes, discover the cause of the problem, and develop an effective treatment plan. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers.
Johnsen, L. G., Hellum, C., Nygaard, O. P., Storheim, K., Brox, J. I., Rossvoll, I., Leivseth, G., & Grotle, M. (2013). Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease. BMC musculoskeletal disorders, 14, 148. doi.org/10.1186/1471-2474-14-148
The hip joint is a ball-and-socket joint composed of the femur head and a socket, which is part of the pelvis. The labrum is a cartilage ring on the socket part of the hip joint that helps keep joint fluid inside to ensure frictionless hip motion and alignment during movement. A labral tear of the hip is an injury to the labrum. The extent of the damage can vary. Sometimes, the hip labrum can have mini tears or fray at the edges, usually caused by gradual wear and tear. In other cases, a section of the labrum can separate or get torn away from the socket bone. These types of injuries are usually due to trauma. There are conservative hip labral tear tests to determine the type of injury. The Injury Medical Chiropractic and Functional Medicine Clinic team can help.
Symptoms
Symptoms are similar regardless of the type of tear, but where they are felt depends on whether the tear is in the front or the back. Common symptoms include:
Hip stiffness
Limited range of motion
A clicking or locking sensation in the hip joint when moving.
Pain in the hip, groin, or buttocks, especially when walking or running.
Night discomfort and pain symptoms when sleeping.
Some tears can cause no symptoms and can go unnoticed for years.
Hip Labral Tear Tests
A hip labral tear can occur anywhere along the labrum. They can be described as anterior or posterior, depending on which part of the joint is affected:
Anterior hip labral tears: The most common type of hip labral tear. These tears occur on the front of the hip joint.
Posterior hip labral tears: This type appears on the back of the hip joint.
Tests
The most common hip labral tear tests include:
The Hip Impingement Test
The Straight Leg Raise Test
The FABER Test – stands for Flexion, Abduction, and External Rotation.
The THIRD Test – stands for the Hip Internal Rotation with Distraction.
Hip Impingement Tests
There are two types of hip impingement tests.
Anterior Hip Impingement
This test involves the patient lying on their back with their knee bent at 90 degrees and then rotated inward towards the body.
If there is pain, the test is considered positive.
Posterior Hip Impingement
This test involves the patient lying on their back with their hip extended and their knee flexed and bent at 90 degrees.
The leg is then rotated outward away from the body.
If it results in pain or apprehension, it is considered positive.
Straight Leg Raise Test
This test is used on various medical conditions that involve back pain.
The test begins with the patient sitting or lying down.
On the unaffected side, the range of motion is examined.
Then the hip is flexed while the knee is straight on both legs.
The patient may be asked to flex the neck or extend the foot to stretch nerves.
The FABER Test
It stands for Flexion, Abduction, and External Rotation.
The test begins with the patient lying on their back with their legs straight.
The affected leg is placed in a figure four position.
The physician will then apply incremental downward pressure to the bent knee.
If there is hip or groin pain, the test is positive.
The THIRD Test
This stands for – the Hip Internal Rotation with Distraction
The test begins with the patient lying on their back.
The patient then flexes their knee to 90 degrees and turns it inward around 10 degrees.
The hip is then rotated inward with downward pressure on the hip joint.
The maneuver is repeated with the joint slightly distracted/pulled apart.
It is considered positive if the pain is present when the hip is rotated and diminished pain when distracted and rotated.
Chiropractic Treatment
Chiropractic treatment involves hip adjustments to realign the bones around the hip and up through the spine, soft tissue massage therapy to relax the muscles around the pelvis and thigh, targeted flexibility exercises to restore range of motion, motor control exercises, and strengthening exercises to correct muscular imbalances.
Treatment and Therapy
References
Chamberlain, Rachel. “Hip Pain in Adults: Evaluation and Differential Diagnosis.” American family physician vol. 103,2 (2021): 81-89.
Groh, M.M., Herrera, J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med 2, 105–117 (2009). doi.org/10.1007/s12178-009-9052-9
Diagnosing ankylosing spondylitis usually involves multiple tests. When doctors order blood tests to diagnose ankylosing spondylitis, an individual is experiencing worsening symptoms in their back and joints. Often, a blood test diagnosis means the doctor is looking for evidence of anything else that could be causing the symptoms. However, blood tests by themselves cannot definitively diagnose ankylosing spondylitis, but when combined with imaging and assessment, they can provide important clues that point to the answers.
Ankylosing Spondylitis Blood Test Diagnosis
Ankylosing spondylitis is arthritis that primarily affects the spine and hips. It can be difficult to diagnose as no single test can provide thorough information for a definitive diagnosis. A combination of diagnostic tests are utilized, including a physical exam, imaging, and blood tests. Doctors are not only looking for results that will point to ankylosing spondylitis, but they are looking for any results that might point away from the spondylitis results that might provide a different explanation for symptoms.
Physical Exam
The diagnostic process will begin with the individual’s medical history, family history, and physical exam. During the exam, the doctor will ask questions to help rule out other conditions:
How long have symptoms been presenting?
Do symptoms get better with rest or exercise?
Are the symptoms getting worse or staying the same?
Are the symptoms worse at a particular time of day?
The doctor will check for limitations in mobility and palpate tender areas. Many conditions can cause similar symptoms, so the doctor will check to see if the pain or lack of mobility is consistent with ankylosing spondylitis. The feature sign of ankylosing spondylitis is pain and stiffness in the sacroiliac joints. The sacroiliac joints are located in the lower back, where the base of the spine and pelvis meet. The doctor will look at other spinal conditions and symptoms:
Back pain symptoms caused by – injuries, posture patterns, and/or sleeping positions.
The HLA-B27 gene corresponds with ankylosing spondylitis; if an individual has it, one of their parents has it.
Imaging
X-rays often serve as the first step to a diagnosis.
As the disease progresses, new small bones form between the vertebrae, eventually fusing them.
X-rays work best at mapping the disease progression than the initial diagnosis.
An MRI provides clearer images in the early stages as smaller details are visible.
Blood Tests
Blood tests can help rule out other conditions and check for signs of inflammation, providing supportive evidence along with the results of imaging tests. It typically only takes about a day or two to get the results. The doctor may order one of the following blood tests:
Antinuclear antibodies, or ANA, go after the proteins in the cell’s nucleus, telling the body its cells are the enemy.
This activates an immune response that the body fights to eliminate.
A study determined that ANA is found in 19% of individuals suffering from ankylosing spondylitis and is higher in women than men.
Combined with other tests, the presence of ANA provides another clue to a diagnosis.
Gut Health
The gut microbiome plays an important role in triggering the development of ankylosing spondylitis and its treatment.
Tests to determine the gut’s health can give a doctor a complete picture of what is happening inside the body.
Blood test diagnoses for ankylosing spondylitis and other inflammatory conditions rely heavily on piecing together different tests alongside clinical exams and imaging.
Causes, Symptoms, Diagnosis, and Treatment
References
Cardoneanu, Anca, et al. “Characteristics of the intestinal microbiome in ankylosing spondylitis.” Experimental and therapeutic medicine vol. 22,1 (2021): 676. doi:10.3892/etm.2021.10108
Prohaska, E et al. “Antinukleäre Antikörper bei Spondylitis ankylosans (Morbus Bechterew)” [Antinuclear antibodies in ankylosing spondylitis (author’s transl)]. Wiener klinische Wochenschrift vol. 92,24 (1980): 876-9.
Sheehan, Nicholas J. “The ramifications of HLA-B27.” Journal of the Royal Society of Medicine vol. 97,1 (2004): 10-4. doi:10.1177/014107680409700102
Wenker KJ, Quint JM. Ankylosing Spondylitis. [Updated 2022 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK470173/
Xu, Yong-Yue, et al. “Role of the gut microbiome in ankylosing spondylitis: an analysis of studies in the literature.” Discovery medicine vol. 22,123 (2016): 361-370.
The Adams forward bend test is a simple screening method that can help with scoliosis diagnosis and help in developing a treatment plan. The exam is named after the English physician William Adams. As part of an examination, a doctor or chiropractor will look for an abnormal side-to-side bend in the spine.
Scoliosis Diagnosis
The Adams forward-bend test can help determine if there are indicators for scoliosis.
It is not an official diagnosis, but the results can be used as a starting point.
The Adams test will reveal signs of scoliosis and/or other potential deformities like:
Uneven shoulders
Uneven hips
Lack of symmetry between the vertebrae or the shoulder blades.
The head does not line up with a rib hump or the pelvis.
Detection of Other Spinal Issues
The test can also be used to find spinal curvature issues and conditions like:
Kyphosis or hunchback, where the upper back is bent forward.
Scheuermann’s disease is a form of kyphosis where the thoracic vertebrae can grow unevenly during a growth spurt and cause the vertebrae to develop into a wedge-like shape.
The Adams test by itself is not enough to confirm scoliosis.
A standing X-ray with Cobb angle measurements above 10 degrees is required for diagnosing scoliosis.
The Cobb angle determines which vertebrae are tilted the most.
The higher the angle, the more severe the condition and the more probable it will produce symptoms.
Computed tomography or CT and magnetic resonance imaging or MRI scans can also be used.
Forward Bend Test
References
Glavaš, Josipa et al. “The role of school medicine in the early detection and management of adolescent idiopathic scoliosis.” Wiener klinische Wochenschrift, 1–9. 4 Oct. 2022, doi:10.1007/s00508-022-02092-1
Grossman, T W et al. “An evaluation of the Adams forward bend test and the scoliometer in a scoliosis school screening setting.” Journal of pediatric orthopedics vol. 15,4 (1995): 535-8. doi:10.1097/01241398-199507000-00025
Letts, M et al. “Computerized ultrasonic digitization in the measurement of spinal curvature.” Spine vol. 13,10 (1988): 1106-10. doi:10.1097/00007632-198810000-00009
Senkoylu, Alpaslan, et al. “A simple method for assessing rotational flexibility in adolescent idiopathic scoliosis: modified Adam’s forward bending test.” Spine deformity vol. 9,2 (2021): 333-339. doi:10.1007/s43390-020-00221-2
Low back pain is one of the most common ailments for people visiting a doctor or an urgent care clinic. When the back pain becomes intense, it can get you thinking something is seriously wrong with your back. The doctor might offer an x-ray or MRI scan to put your concerns at ease.
Fortunately, most cases of low back pain, even acute pain, improve within days or a few weeks. Most cases are remedied with chiropractic, physical therapy, heat/ice therapy, and rest. And a lot of these cases do not require any form of spinal imaging. However, those are why X-ray, MRI, and CT scans are necessary to figure out what’s happening.
Strained muscle
Sprained ligament
Poor posture
These typical causes of low back pain can be painful and limit activities.
Back Pain Lasting Longer Than 2/3 Weeks
Subacute pain lasts between 4 and 12 weeks, while chronic back pain lasts three months or longer. These are not indications of a severe lower back spinal condition.
Less than 1% of people with low back pain are diagnosed with the condition that may require spine surgery:
Doctors may recommend an x-ray or MRI if the low back pain is from a traumatic injury, like a:
Slip
Fall
Automobile accident
Other potential causes of low back pain may warrant medical imaging immediately or later.
The diagnostic process starts with the evaluation of the low back symptoms and how they relate to what was found during the:
Physical exam
Neurological exam
Medical history
A doctor utilizes these results to determine whether spinal imaging is necessary, along with the type of imaging test, x-ray, or MRI and the timing to confirm a diagnosis.
A Low Back X-Ray/MRI
X-ray spinal imaging best detects bony structural problems but is not so great with soft tissue injuries. X-ray series may be performed to diagnose vertebral compression fractures.
Anterior
Posterior
Lateral views
MRI is a radiation-free test. MRIs create 3-D anatomical views of the spinal bones and soft tissues. A contrast dye like gadolinium is used to enhance and improve the quality of the images. The contrast is injected through an intravenous line in your hand or arm before or during the test. An MRI can evaluate neurological symptoms, like radiating pain or pain that develops after a cancer diagnosis.
Symptoms, Co-existing Medical Diagnoses, and Conditions that may Require Spine Imaging
Neurological symptoms
Low back pain that radiates, fans out, or downward into the buttocks, legs, and feet
Abnormal reflexes in the lower body can indicate nerve disruption
Radiation to your entire body is measured through the millisievert (mSv), also known as the effective dose. The radiation dose is the same amount every time you experience an x-ray. When undergoing an x-ray, the radiation not absorbed by the body creates the image.
The effective dose helps a doctor measure the risk for possible side effects of radiographic imaging:
CT scans use radiation as well
Specific body tissues and organs in the lower back are sensitive to radiation exposure, like the reproductive organs.
MRI Radiation-Free Why Not Just Use This Test All The Time
MRI cannot be used on all patients because of its powerful magnet technology. Pregnant women or individuals with metal inside their body, like a spinal cord stimulator, heart pacemaker, etc., cannot be scanned with an MRI.
MRI testing is also expensive; doctors do not want to prescribe unnecessary tests that increase costs. Or because of the fine detail that MRIs provide, sometimes a spinal issue can look severe but is not.
Example: An MRI of the lower back reveals a herniated disc in a patient with no back/leg pain or other symptoms.
This is why doctors bring all their findings like the symptoms, physical exam, and medical history to confirm a diagnosis and create a custom treatment plan.
Imaging Test Takeaways
If low back pain takes its toll, listen to what the doctor recommends. They might not order a lumbar x-ray or MRI immediately but remember the issues mentioned above, like neurological symptoms and co-existing medical conditions. But these tests help discover the cause or causes of the pain. Remember this is to help get patients to their optimal health and pain-free.
How to eliminate Back Pain naturally | (2020) Foot Levelers |El Paso, Tx
NCBI Resources
Imaging diagnostics is an essential element in the evaluation of spine trauma. The rapid evolution of imaging technology has tremendously changed the assessment and treatment of spine injuries. Imaging diagnostics utilizing CT and MRI, among others, are helpful in acute and chronic settings. Spinal cord and soft-tissue injuries are best evaluated by magnetic resonance imaging, or MRI, whereas computed tomography scanning or CT scans best evaluate spinal trauma or spine fracture.
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