Physical Evaluation - When To See A Doctor: Back Pain

Content provided by the Faculty of the Harvard Medical School

Physical evaluation

Despite impressive diagnostic methods developed over the past two decades, the key to successful diagnosis of back problems is seeing a competent physician who will take a detailed medical history and conduct a thorough examination.

The medical history includes a precise account of your back pain — its duration and intensity, whether it radiates down the legs, whether it is accompanied by numbness or tingling, whether bed rest offers relief, and whether it has occurred in the past. Other questions are aimed at determining if there is any underlying cancer or infection that might be causing your pain. Telltale clues include weight loss, fever, anemia, a history of cancer or immunodeficiency, or diabetes. Since genes play a role in some types of back pain, your physician will want to know about any family history of back pain.

As part of the physical examination, your doctor will check the contour and range of motion of your back. He or she will also examine your reflexes (especially the knee and ankle jerks), test for weakness in certain muscles (particularly those in the legs), and check the sensation in your legs and feet. The physician will also search for signs of irritation of your nerve roots, often by using a straight-leg-raising test. This test, by pulling on the sciatic nerve, can produce pain in your leg if the nerve root is irritated or if a disk presses on it. If individual reflexes and muscles are affected and the physician can establish the precise location of any numbness or tingling, it is often possible to identify which nerve root or roots are affected.

Last updated:	January 23, 2007