THE OFFICIAL NEWS SOURCE OF ACR CONVERGENCE 2022 • NOVEMBER 10-14



Getting back to basics is key to addressing spine pain, renowned expert says

David Borenstein, MD
David Borenstein, MD

When dealing with back and neck pain, physicians must consider anatomy, physical exam maneuvers, and imaging studies to make an appropriate diagnosis and treatment plan. One of Tuesday’s Clinical Practice sessions will review these critical areas for this common problem.

Anatomy: Correlate Physical Exam, Anatomy & Imaging in Neck & Back Pain will take place from 11:00 AM – 12:00 pm in the Thomas Murphy Ballroom 3-4, Building B in the Georgia World Congress Center.

ACR Past President David Borenstein, MD, Clinical Professor of Medicine in the Division of Rheumatology at George Washington University Medical Center, Washington, DC, said this session is about getting back to basics.

“Even when clinicians deal with these issues on a regular basis, how often do we really think about them?” asked Dr. Borenstein, author of Heal Your Back: Your Complete Prescription For Preventing, Treating, and Eliminating Back Pain. “This is a refresher on things we think we know but may not actually remember correctly. Every once in awhile, looking back at our basic anatomy can strengthen our understanding and correct misconceptions we may have. Reviewing the basics can get us back on
track.”

He will begin with a review of the common causes of back pain and the role the anatomy of the spine plays in these conditions.

“We rarely think about why we have the shape we do,” he said. “Why do we develop our curves once we start walking? What are the areas associated with motion? Where do we get the rotation? Flexion? Extension? Why does the neck move one way and the low back another?”

He said the components that he will discuss — the anatomy, the physician exam, and the imaging — follow one another if clinicians keep in mind how the body is put together.

“Too many times, our brains fill in what we think we see,” he said. “I’ve seen physicians see changes on x-ray that weren’t there. Or find something on an exam that wasn’t actually there. If you look at anatomy in its normal state and then you look at the physical exam, then we see that the radiographs do, in fact, follow what we see in the physical exam.”

Dr. Borenstein said this illustrates the importance of regularly looking at normal anatomy, including normal variants.

“I think what sometimes happens is health providers forget what normal looks like,” he said. “I appreciate seeing a normal radiograph. Not only because it suggests the patient likely doesn’t have a severe problem, but also because it reminds me what normal looks like. Without knowing what normal is, it becomes difficult to say what is abnormal. And there’s a whole huge text book of normal variants we must remember, too — variants that are not associated with illness or dysfunction, but are part of the normal pattern of what can be seen in humans.”

With just 60 minutes, Dr. Borenstein said this talk won’t cover everything, but will provide clinicians with a review of what they should be looking for and testing for when evaluating a patient with back or neck pain.

“With the physical exam, so much depends on the patient,” he said. “You can do a complete exam on every individual and still miss something because what an exam reveals depends on what the patient complains about. And that correlates with what physicians do to bring things out.”

Dr. Borenstein said he expects attendees to have a lot of questions about specific physical exam maneuvers and tests, so he will address as many as possible. The session will also include a lot of images to illustrate the discussion.

For those looking for more on back pain, Dr. Borenstein also will present a Meet the Professor session on Tuesday. Pain: Evaluation & Treatment of Low Back Pain will take place from 7:45 – 9:15 am in Room A404, Building A of the Georgia World Congress Center.