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Back pain - when you see the doctor

When you first see your health care provider for back pain, you will be asked about your back pain, including how often and when it occurs and how severe it is.

Your provider will try to determine the cause of your pain and whether it is likely to quickly get better with simple measures, such as ice, mild painkillers, physical therapy, and exercise.

Information

Questions your provider may ask include:

  • Is your back pain on one side only or both sides?
  • What does the pain feel like? Is it dull, sharp, throbbing, or burning?
  • Is this the first time you have had back pain?
  • When did the pain begin? Did it start suddenly?
  • Did you have an injury or accident?
  • What were you doing just before the pain began? For example, were you lifting or bending? Sitting at your computer? Driving a long distance?
  • If you have had back pain before, is this pain similar or different? In what way is it different?
  • Do you know what caused your back pain in the past?
  • How long does each episode of back pain usually last?
  • Do you feel the pain anywhere else, such as in your hip, thigh, leg or feet?
  • Do you have any numbness or tingling? Any weakness or loss of function in your leg or elsewhere?
  • What makes the pain worse? Lifting, twisting, standing, or sitting for long periods?
  • What makes you feel better?

You will also be asked if you have other symptoms, which may point to a more serious cause. Tell your provider if you have had weight loss, fever, a change in urination or bowel habits, or a history of cancer.

Your provider will perform a physical exam to try to find the exact location of your pain, and determine how it affects your movement. Your back will be pressed on at different spots to find where it hurts. You will also be asked to:

  • Sit, stand, and walk
  • Walk on your toes and then your heels
  • Bend forward, backward, and sideways
  • Lift your legs straight up while lying down
  • Move your back in certain positions

If the pain is worse and goes down your leg when you lift your legs straight up while lying down, you may have sciatica, especially if you also feel numbness or tingling going down the same leg.

Your provider will also move your legs into different positions, including bending and straightening your knees.

A small rubber hammer is used to check your reflexes and to see if your nerves are working properly. Your provider will touch your skin in many places, using a pin, cotton swab, or feather. This reveals how well you can feel or sense things.

References

Dixit R. Low back pain. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelly and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017:chap 47.

Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. PMID: 28192789 www.ncbi.nlm.nih.gov/pubmed/28192789.

  • Sciatica

    Sciatica

    Animation

  •  

    Sciatica - Animation

    Sciatica. It's not a new trendy restaurant in New York or LA, or a new SciFi program on your favorite cable channel. Sciatica is something much less sexy. Sciatica might actually be the cause of that the sharp pain you occasionally feel in your backside, or traveling down your hip or leg. What is sciatica? What does this pain mean? Sciatica occurs when there is pressure or damage to the Sciatic nerve. This large nerve starts in your lower spine and runs down the back of each leg. It controls the muscles of the back of your knee and lower leg. It also provides sensation to the back of your thigh, part of your lower leg, and the sole of your foot. Sciatica is usually caused by another problem, such as a slipped disk, spinal stenosis or narrowing of the spinal column, piriformis syndrome, the narrowing of muscle in your buttocks, a pelvic injury or fracture, and perhaps even tumors. Your pain may feel like a mild tingling, a dull ache, or a burning sensation. Sometimes the pain can be so bad you might not be able to move. The pain will usually occur on one side, perhaps as a sharp pain in one part of your hip or leg, or maybe you will notice the numbness. The pain may get worse after you stand or sit, at night, when you sneeze, cough, or laugh, or when you bend backwards or walk forward. For treatment, your doctor will perform a careful physical exam. Your doctor might find you have weakness when you bend your knee or move your foot, trouble bending your foot inward or downward, weak reflexes, or pain when you lift your leg straight up off the examination table while lying down. Your doctor may also do other tests to find what's causing your sciatica, including blood tests, x-rays, and other imaging tests. Treatment will focus on what causes your sciatica. Sometimes you may not need treatment because your pain will go away on its own. Your doctor will likely first recommend that you take steps to calm your symptoms and reduce inflammation, such as applying heat or ice to the painful area. You might try ice for the first 48 to 72 hours after you feel pain, then use heat afterwards. Your doctor might also tell you to take over-the-counter pain relievers. If conservative measures don't help your problem, your doctor may recommend you have injections to reduce inflammation around your sciatic nerve and other medicines to reduce the stabbing pain. Physical therapy may be a viable option, so talk to your healthcare provider about this option. Whatever you do, don't stay in bed all day. You need to reduce your normal activity for the first few days after you start having pain, but getting no activity will only make your pain worse. After a few days, try gradually returning to your normal routine. But, avoid heavy lifting or twisting your back for at least 6 weeks. Make sure you start exercising again though after 2 to 3 weeks. Remember, include exercises to strengthen your abdomen or belly and improve the flexibility of your spine.

  • Sciatica

    Sciatica

    Animation

  •  

    Sciatica - Animation

    Sciatica. It's not a new trendy restaurant in New York or LA, or a new SciFi program on your favorite cable channel. Sciatica is something much less sexy. Sciatica might actually be the cause of that the sharp pain you occasionally feel in your backside, or traveling down your hip or leg. What is sciatica? What does this pain mean? Sciatica occurs when there is pressure or damage to the Sciatic nerve. This large nerve starts in your lower spine and runs down the back of each leg. It controls the muscles of the back of your knee and lower leg. It also provides sensation to the back of your thigh, part of your lower leg, and the sole of your foot. Sciatica is usually caused by another problem, such as a slipped disk, spinal stenosis or narrowing of the spinal column, piriformis syndrome, the narrowing of muscle in your buttocks, a pelvic injury or fracture, and perhaps even tumors. Your pain may feel like a mild tingling, a dull ache, or a burning sensation. Sometimes the pain can be so bad you might not be able to move. The pain will usually occur on one side, perhaps as a sharp pain in one part of your hip or leg, or maybe you will notice the numbness. The pain may get worse after you stand or sit, at night, when you sneeze, cough, or laugh, or when you bend backwards or walk forward. For treatment, your doctor will perform a careful physical exam. Your doctor might find you have weakness when you bend your knee or move your foot, trouble bending your foot inward or downward, weak reflexes, or pain when you lift your leg straight up off the examination table while lying down. Your doctor may also do other tests to find what's causing your sciatica, including blood tests, x-rays, and other imaging tests. Treatment will focus on what causes your sciatica. Sometimes you may not need treatment because your pain will go away on its own. Your doctor will likely first recommend that you take steps to calm your symptoms and reduce inflammation, such as applying heat or ice to the painful area. You might try ice for the first 48 to 72 hours after you feel pain, then use heat afterwards. Your doctor might also tell you to take over-the-counter pain relievers. If conservative measures don't help your problem, your doctor may recommend you have injections to reduce inflammation around your sciatic nerve and other medicines to reduce the stabbing pain. Physical therapy may be a viable option, so talk to your healthcare provider about this option. Whatever you do, don't stay in bed all day. You need to reduce your normal activity for the first few days after you start having pain, but getting no activity will only make your pain worse. After a few days, try gradually returning to your normal routine. But, avoid heavy lifting or twisting your back for at least 6 weeks. Make sure you start exercising again though after 2 to 3 weeks. Remember, include exercises to strengthen your abdomen or belly and improve the flexibility of your spine.

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    Review Date: 7/7/2019

    Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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