Identifying the anatomy of pain generators in the diagnosis of back pain should always be at the forefront of any workup.
Even though research has not helped us much in assisting physicians with reliable and valid orthopedic tests, that does not mean they do not exist. Dynamic Disc Designs(ddd) believes better initial physical exam workups can help with the identification of pain specific tissues. Dr. Jerome Fryer BSc DC, the founder of ddd, suggests dividing the the spine into anterior and posterior pain producers can simplify and aid the physician in the initial exam. Understanding the anatomical structures that are challenged with dynamic flexion and/or extension and how the patient responds when the pain presents can be a real clue in identifying the sensitive tissue.
He explains: If someone with back pain is guarded during the movement of active lumbar flexion and is only able to achieve 15 degrees, then quickly stops and utilizes the upper extremities by placing their hands on their thighs, Dr. Jerome Fryer would suggest that the unloading of the intervertebral disc is occurring with this avoidance behaviour. A painful intradiscal lesion should be in the differential. On the other hand, if a patient is able to move through the lumbar flexion but there is a “sore spot” in the middle of the range, one has to think about a painful facet as these facets glide on each other and translate anteriorly while approximating.”
These models were developed for patient education primarily but have also been developed to help in the differential diagnosis of painful anatomical spine structures. Spine doctors are finding them an invaluable resource for education.