Exam Overview

A thorough history to evaluate
low back pain includes an assessment of:

  • Your description of how the pain started. This includes whether it was sudden or gradual.
  • Pattern, intensity, and
    duration of the current episode of low back pain. You may be asked to complete
    a pain drawing to identify the sites and symptoms of pain.
  • What
    brings on or increases your pain and what makes you feel better. This includes
    whether you feel better with activity or with rest.
  • Related
    symptoms, such as leg pain, weakness, or numbness; or problems with your bowels
    or bladder.
  • Spine problems you have had since birth (congenital
    spine problems).
  • Any type of arthritis in your
    spine.
  • Previous episodes of low back pain and
    treatment.
  • Previous accidents or injuries involving the
    back.
  • Family history of low back pain.
  • Work history. This includes any link between your work and your current back
    pain.
  • Sports and other leisure activities.
  • Any legal
    action related to your back pain.
  • History of cancer and other
    illnesses, such as abdominal disease,
    pelvic disease, or
    osteoporosis.
  • Recent fever or unexplained
    weight loss.
  • Corticosteroid use.
  • Your
    smoking history.

Your doctor or nurse may also give you a written
questionnaire to screen for
depression or to assess how low back pain is affecting
your life, to rate your job satisfaction, and to describe your support system
at home and at work.

During the physical exam, your doctor will
ask you to do a series of movements while you stand, sit, and lie down. This
makes it possible to assess muscular and sensory problems contributing to your
low back pain. The physical exam will also include:

The results of these tests will help your doctor see
whether your back pain and other symptoms are related to pressure on a nerve
and which nerve or nerves may be compressed. Your doctor will use this
information to help determine what type of treatment is most likely to be
effective.

Why It Is Done

The history and physical exam
are the first part of the work-up for low back problems. Your doctor may change
or skip some of the tests to avoid further injuring your back.

Results

The history and physical exam for low
back pain may provide these results:

Normal

History does not reveal an obvious cause of the low back
pain.

A physical exam does not cause the same type of pain, muscle
weakness, or nerve-related symptoms that you have been having.

Your doctor may recommend:

  • Nonsurgical treatment (rest, pain relievers,
    heat or ice, exercise).
  • More tests and exams to find out whether
    some other medical problem is causing your low back pain.

Abnormal

The medical history and physical exam are likely to
distinguish between a low back problem related to a muscle strain or overuse
and one that is caused by pressure on a nerve or another more unusual
problem.

  • If your back pain seems to be related to
    muscle strain or overuse, or if your nerve-related symptoms are not severe,
    your doctor will likely recommend conservative treatment (rest, pain relievers,
    heat or ice, exercise) for a period of time to see whether your symptoms
    improve.
  • If your nerve-related symptoms are more serious or if your
    doctor suspects that there is a more serious problem, he or she may recommend
    more tests, such as
    X-ray,
    magnetic resonance imaging (MRI),
    computed tomography (CT), or blood tests.

What To Think About

Pain can be related to both
physical and emotional causes. When you’re stressed, for example, muscle
tightness or spasm can set into your back, causing pain or making it worse.
Similarly, troubling emotions can make pain worse. If you or your doctor have a
sense that your pain is being caused or made worse by stress, anger, or other
difficult emotions, be sure to plan for specialized treatment.
Cognitive-behavioral therapy and
biofeedback are two types of treatment that can give
you tools for managing your pain.

Complete the medical test information form (PDF) (What is a PDF document?) to help you prepare for this test.

Related Information

Credits

ByHealthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP – Emergency Medicine
Specialist Medical Reviewer Adam Husney, MD – Family Medicine

Current as ofMarch 21, 2017