DIAGNOSTICS OF BACKPAIN:
The medical specialist has to work out the optimum conclusive diagnostics-combination to be able to establish a valid bio-psycho-social diagnosis. Just this allows the therapist to create the best effective therapy combination!
The most important basis for finding this individual bio-psycho-social diagnosis is the synthesis of the clinics (=medical history + thorough investigation)! The X-Rays, CTs, MRIs,... should be just used as an additional information, to exclude or confirm the differential diagnosis the therapist has found before in the clinical setting!


This state-of-the-art investigation to work out this very complex diagnosis combination in chronic pain patients definitely takes time!
The IASP (= international association for the study of pain), the main scientific board for diagnosing and treating chronic pain disorders hat defined that such a first investigation contact has to last 60min at least!

Diagnostics - for the movement apparatus we know: functional before structural diagnostic procedures!

In  muscularskeletal diagnosis 80-90% of the complaints are more or less complex functional disturbances – there one won’t find any structural destructions like in rheumatic knee joints, osteoporotic fractures or nerve root swelling in disc prolapse. But in our medical education system up to 90% of our learning material just contains facts about these spectacular diagnoses including carcinoma, inflammation, fractur or marked neurological deficit.
Therefore, it is not surprising that the common diagnostic procedures were developed to reveal structural changes in the tissue. So, it is state of the art to diagnose fractures with X-ray, bone metastases with the CT respectively bone-scintigraphy or disc changes with the MRI - and in these diagnoses it should stay like this! But in the movement apparatus the dangerous "red flags" luckily occur just in <5-7% of all people suffering from strong pain.
 
The lion's share of pain is caused by overload of muscles, ligaments, tendons, capsules, joint blockades or crampy muscles.
The pain receptors are not mainly located in the bones, discs respectively in the nerve itself. These receptors have the largest concentration in structures out of the soft tissue - ligaments, capsules, tendons, fasciae, etc. But up to now there is no single diagnostic method to make the pain receptors visible - except of animal dissection studies performed by specialized labs.

The intensity of pain correlates very rarely with the severity of the cause"

Prof. Bigos, one of the most famous scientists in the field of spinal disorders, stated that degenerative changes in the X-Ray can be rated as grey hair or wrinkles in the face - just normal body expressions of getting older, which have mostly no clinical relevance. Much more important for the progress of back pain are relieving postures and movements as well as fear avoidance beliefs and behaviour. These pain-behaviours lead to decreasing muscle strength in the large, superficial and the small, deep stabilizers of the spine.

The decrease of strength in the small and deep segmental stabilizers is responsible for a significant loss of coordination, which increases the risk to hurt the back again during unexpected fast movements, like stumbling. The scientific knowledge  about these facts motivated scientists to construct strength-measurement-machines to be able to quantify individual strength deficits! About 20 years ago western specialists developed high-tech-machines to measure maximum strength and strength endurance. Further more they began to collect these strength data of healthy subjects of the same age, gender, height and weight in a data bank – this makes it possible, to compare the test results of a certain patient with HIS very personal reference values. With the same devices the training therapy can be performed afterwards, where one therapist just cares for a maximum of 2-3 patients at once. With this intense-care-model not only the result is impressive (about 90% reach their healthy strength levels again!). The 12-week strengthening process is also very safe – in meanwhile more than 4.000 chronic back pain patients we did not experience one single severe complication!