After the common cold, back pain is the problem that most frequently brings people to a doctor’s office. It is often difficult to pinpoint the exact cause of back pain because so many different body structures can be involved.
Fortunately, most episodes of back pain—about 90 percent—will clear up with little or no treatment in approximately six weeks, reducing the need for medical intervention. As long as you are not experiencing severe back pain or other symptoms (such as severe nighttime pain or pain that worsens when lying down, weight loss, bowel or bladder dysfunction, or fever) that might indicate a serious health condition, you can safely try self-treatment measures. Severe symptoms may indicate cancer, infection, cauda equina syndrome or an abdominal aortic aneurysm.
Back pain due to muscle injury typically subsides completely in about six to eight weeks. Back pain that lasts longer than this is usually due to spinal column changes and merits a visit to a physician.
Back Pain Symptoms
Few back pain episodes require immediate medical treatment. However, to rule out the possibility of a dangerous condition, doctors still need to ask certain routine questions—for example, whether you can relieve the pain by changing your position and whether you feel pain when you’re not moving.
Some of the best clues to the cause of your back pain will come from your description of the pain. Obtaining an accurate account is a doctor’s primary method of tracking down the cause and determining whether and what type of treatment is necessary. Questions your doctor will ask include:
• Where is the pain located? Is it confined to the lower back or does it radiate to the buttocks or legs? (These questions check for sciatica.)
• How severe is the pain? For example, is the pain so excruciating that any movement is difficult or impossible? Can you go about your normal daily activities, even though the pain prevents vigorous exercise or activities associated with a lot of bending and twisting, such as gardening or golf? (A good description of pain intensity can help the doctor determine its cause.)
• When did the pain begin? Was it related to an activity or an injury? (If the pain follows an injury, it is less likely to be due to a slowly progressing condition, such as spinal stenosis.)
• What makes your back feel better or worse? For example, does lying down make it feel better? Does bending forward to tie a shoe increase the pain? (The pattern of pain may indicate whether a nerve is involved, possibly because of a disk herniation.)
• Have you had a prior episode of back pain? If so, how was it treated and how effective was the treatment? (The condition may have recurred.)
• Do you have any other health problems? (Weight loss and poor appetite, for example, raise the concern that cancer has spread to the vertebrae. In addition, some disorders, such as hyperthyroidism, can cause osteoporosis.)
• What medications do you take? (Certain drugs, such as corticosteroids and anticonvulsants, can affect spinal bone mass.)
• What do you do for a living, and what kinds of exercise or other activities do you do? In what ways is the pain disabling? (Muscle injury is frequently related to a particular activity.)
Back Pain Physical Examination
During a physical exam, your doctor will typically focus on your back, legs and feet. The doctor will look at your posture and curvature of the spine; a hands-on examination of areas that are sore may provide clues to the origin of the pain. To observe muscles and joints during movement, the doctor may ask you to sit, stand, walk (including on your toes or heels), twist, or bend forward or sideways.
A neurological exam, including tests of sensation, strength and reflexes, will be conducted as well. These tests are important to detect disorders such as disk herniation and spinal stenosis, as the nerves emerging from each level of the spine are responsible for sensation and muscle strength in specific parts of the body. For example, the nerve issuing from under the fifth lumbar vertebra (L5) is responsible for sensation in a narrow band that runs down the upper leg and wraps around to the front of the lower leg and the top of the foot.
By detecting loss of sensation in a particular area or diminished strength in certain muscles, the doctor may be able to determine which level of the spine is causing the pain. Reduced reflexes at specific areas also can provide vital clues to the source of back pain.
Another important component of the physical examination is the straight-leg raise test, which can help the doctor determine whether disk herniation is responsible for the pain. During this exam, you lie on your back while the physician lifts each leg separately without bending the knee. The test is positive if raising the leg produces the typical symptoms—pain or tingling below the knee. The straight-leg raise test is also helpful in monitoring the progress of treatment once a diagnosis has been made. Last, a rectal examination may be done to assess the nerve function of the anus, because the anal nerves arise from the lower lumbar spine.