Diagnosis

Diagnosis

Because nearly all cases of low back pain clear up in a short time and are not due to serious problems, a medical history and a brief physical examination are almost always sufficient.

Still, with very severe or chronic back pain, it is important that any serious medical causes as well as cauda equina syndrome and progressive nerve damage be ruled out first. If the doctor suspects a serious underlying cause, the approach to determining the origin of back pain involves answering three questions:

• Is some general medical disorder present that could be causing the pain?
• Are there social or emotional factors that might be intensifying the pain?
• Are the nerves in the spine involved in the pain (such as in sciatica)?

Such questions can usually be answered with a medical history and physical examination.

Medical History

A patient should report any serious health problems and concerns during a medical and family history, especially those listed below.

• Previous episodes of back pain
• Any injuries or accidents involving the neck, back, or hips
• History of cancer
• Unexplained weight loss or chronic infection
• The frequency, duration, and nature of the back pain
• When the back pain occurs
• What triggered the pain (such as lifting a heavy object)
• Conditions that make the pain worse such as coughing
• Any situation that relieves the pain
• Urination of bowel movement problems
• Other relevant symptoms such as morning stiffness, weakness, or numbness in the legs.

Physical Examination

The main goal of a physician exam is to try and determine the source of the pain and to determine limits of movement.

• Patients are asked to sit, stand, and walk in different ways (flat-footed, on the toes, and on their heels).
• In some cases they are asked to walk on a treadmill to test for weakness in toe or heel walking (which may indicate stenosis).
• Patients will be requested to bend forward, backward, and sideways and to twist.
• Patients will be asked to lift their leg straight up while lying down. The doctor will also move the patient's legs in different positions and bend and straighten the knees. (Pain caused by sciatica can be intensified by lifting the affected leg straight in the air. It is usually sharp, localized, and accompanied by numbness or tingling. Pain caused by inflammation is duller and more generalized and not affected by lifting a straight leg.)
• The doctor may measure the circumference of the calves and thighs to look for muscle deterioration.
• To test nerve function and reflexes, doctors will tap the knees and ankles with a rubber hammer. The doctor may also touch parts of the body lightly with a pin, cotton swab, or feather to test for numbness and nerve sensitivity.