Differential Diagnosis for Back Pain on Extension
Single Most Likely Diagnosis
- Mechanical Low Back Pain: This is the most common cause of back pain on extension, often related to strain or overuse of the muscles and ligaments in the lower back. It is typically exacerbated by activities that involve lifting, bending, or twisting.
Other Likely Diagnoses
- Herniated Disc: A herniated disc can cause back pain that worsens with extension, especially if the disc is compressing a nerve root. This condition often results from degenerative changes, trauma, or lifting heavy objects.
- Spondylolisthesis: This condition, where one vertebra slips forward over the one below it, can cause back pain that is exacerbated by extension. It may be due to degenerative changes, congenital defects, or trauma.
- Spinal Stenosis: Narrowing of the spinal canal can cause back pain, especially when extending the spine, as it increases pressure on the nerves. This condition is more common in older adults and can be due to degenerative changes.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: A serious condition where the nerves in the spinal canal are compressed, leading to severe back pain, sciatica, and potentially bladder and bowel dysfunction. It requires immediate medical attention.
- Spinal Infection (e.g., Osteomyelitis, Discitis): Infections of the spine can cause severe back pain, which may worsen with movement, including extension. These conditions are medical emergencies and require prompt diagnosis and treatment.
- Spinal Fracture: Especially in individuals with osteoporosis or those who have experienced trauma, a spinal fracture can cause back pain that worsens with extension. It is crucial to identify and treat promptly to avoid further complications.
Rare Diagnoses
- Ankylosing Spondylitis: A chronic inflammatory disease that can cause the vertebrae to fuse, leading to back pain and stiffness, which may worsen with extension. It is less common and typically presents with morning stiffness and gradual onset.
- Spinal Tumors: Both benign and malignant tumors can cause back pain, which may be exacerbated by extension. While rare, they are important to consider, especially in the presence of other systemic symptoms like weight loss or fever.