When you see your doctor
Description
Your health care provider will ask you questions about your back pain, including how often it occurs and how severe it is. You will have a thorough physical exam.
Your provider will try to determine the cause of your back pain and whether it is likely to get better with simple measures. These might include ice, mild painkillers, physical therapy, and proper exercises.
History
Your provider will want to know about the type of pain you have and when it occurs. You will be asked:
What does the pain feel like?
- Is it dull, sharp, throbbing, or burning?
- Is your pain on one side only or on both sides?
- Do you feel the pain anywhere other than your back, like your hip, thigh, leg, or feet?
- What makes your pain worse? Does lifting, twisting, standing, or sitting for long periods of time cause pain?
- What makes you feel better?
- Do you have any numbness or tingling? Does the pain cause weakness or loss of function in your leg or anywhere else?
- Do you have trouble with your balance?
- Do you have trouble with your bowels and bladder?
When did the pain begin?
- Did it start suddenly?
- What were you doing just before the pain began? Were you lifting or bending? Sitting at your computer? Driving a long distance?
- Did you have an injury or accident before your pain started?
- Is this the first time you have had back pain?
If you have had back pain before?
- Is this pain similar or different? If it is different, how is it different?
- How long does each episode of back pain usually last?
- Are you missing work because of your back pain?
Your provider will ask you about red flag findings. These are things that suggest a more serious issue is causing your back pain.
Physical exam
During your physical exam, your provider will try to pinpoint the location of the pain and figure out how it affects your movement. You will be asked to:
- Sit, stand, and walk. While you walk, your provider may ask you to try walking on your toes, then on your heels.
- Bend forward, backward, and sideways.
- Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs. Sciatica is pain that involves the sciatic nerve, a large nerve that goes from your lower back and down each leg.
- Straighten your legs in front of you from a sitting position on the exam table. Leg pain that occurs when you do this suggests a slipped disk in your lower back. Disks are the "cushions" between the bones of your spine.
Your provider will also move your legs in different positions, including bending and straightening your knees.
All of the things your provider asks you to do will help assess your strength and your ability to move.
To test your nerve function, your provider will use a rubber hammer to check your reflexes. To check for loss of feeling or numbness, your provider will touch many places on your legs with a pin, cotton swab, or feather. Your provider will ask you to speak up if there are areas where the sensation from the pin, cotton, or feather is duller. Your provider may also test your reflexes at the bottom of your foot. It can be a bit uncomfortable but the sensation is short.
Your provider will also check:
- Your muscle strength, which may be weaker
- Your posture or the way your spine curves
It is uncommon but your doctor may need to do a rectal examination if you have a serious back problem.
What comes next?
After talking with you about your medical history and doing an exam, your provider will decide on next steps. Depending on the findings, your provider may:
- Give you some tips on how to handle your pain and start becoming more active.
- Refer you for x-rays, MRI or other tests.
- Prescribe medicines to help relieve your pain.
- Refer you to a doctor who is trained to help people with low back pain, or to a physical therapist who will teach you exercises that will help.
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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